[The use of Mexidol in patients with mild (moderate) cognitive impairment: results of a meta-analysis]. / Primenenie Meksidola u patsientov s legkimi (umerennymi) kognitivnymi narusheniyami: rezul'taty metaanaliza.

OBJECTIVE: To conduct a meta-analysis of the effectiveness of Mexidol therapy in patients with chronic brain ischemia (CBI) and cognitive disorders (CD). MATERIAL AND METHODS: This meta-analysis included the results of studies on the effectiveness of Mexidol in patients with CD measured with Montreal Cognitive Assessment Scale (MoCA). The pooled effect assessment included all publications from independent clinical trials that provided efficacy data on the MoCA scale with a level of detail sufficient for further mathematical analysis. The main result of the meta-analysis was obtained for the final values of the effectiveness indicator in the Mexidol groups compared with the basic therapy groups. Data from 10 prospective randomized trials containing information on the final scores on the MoCA scale after therapy was analyzed. RESULTS: The meta-analysis of ten prospective clinical studies of the effectiveness of Mexidol against the background of basic therapy in patients with CCI and CD was carried out. The total number of patients taking Mexidol was 482; the comparison group consisted of 455 patients. According to the results of a statistical model of random effects, the effect size was 2.06; 95% confidence interval for the difference in effectiveness between the groups of the study drug and the control groups [0.98; 3.14] (p=0.0002). CONCLUSION: A statistically significant and clinically significant improvement in the cognitive functions of patients with CBI, was demonstrated after treatment with Mexidol.

[Treatment of patients with chronic cerebral ischemia: experience of using the combined neuroprotective drug Picamilon Ginkgo]. / Lechenie bol'nykh s khronicheskoi ishemiei golovnogo mozga: opyt primeneniya kombinirovannogo neiroprotektivnogo preparata Pikamilon Ginkgo.

OBJECTIVE: To compare the clinical efficacy and safety of Picamilon Ginkgo and ginkgo biloba in patients with cognitive impairment in vascular diseases of the brain (chronic cerebral ischemia). MATERIAL AND METHODS: An open multicenter randomized comparative study involved 278 patients over 45 years of age with a diagnosis of chronic cerebral ischemia and cognitive impairment. 139 of them received Picamilon Ginkgo and 139 received monotherapy with ginkgo biloba extract for 90 days. Dynamics were compared on the MoCA, MMSE, Hamilton scale for assessing depression and the quality of life of EQ-5D, and the subjective effectiveness of therapy by patients and doctors was evaluated. RESULTS: Combination therapy resulted in significantly greater regression of cognitive impairment compared to monotherapy. At the end of the study, the differences between the groups were significant both on the MMSE scale (p=0.007) and on the MoCA scale (p=00003). At the same time, significant differences between the groups in the magnitude of cognitive improvement on the MoCA scale were noted already from the 30th day of treatment. Combination therapy also contributed to a more significant improvement in the patient's quality of life: dynamics on the EQ-5D scale significantly (p<0.05) differed in the groups, also starting from the 30th day of therapy. There were no significant differences in the dynamics of the Hamilton scale for assessing depression between the compared groups. Both Picamilon Ginkgo and monotherapy with ginkgo biloba extract were safe and were not accompanied by significant adverse events. CONCLUSION: The combination of standardized ginkgo biloba extract with Picamilon has an advantage over monotherapy with ginkgo biloba extract in patients with chronic cerebral ischemia, as it contributes to a more significant regression of cognitive impairment and improvement of quality of life.

[The effect of antiplatelet therapy on the course of COVID-19]. / Vliyanie antiagregantnoi terapii na techenie COVID-19.

Numerous studies demonstrate that a new coronavirus infection is associated with an increased risk of thrombosis, which underlies many of the complications of COVID-19. At the same time, many elderly patients with COVID-19 and with concomitant cordial pathology receive antiplatelet therapy to prevent recurrent ischemic events. The aim of this systematic review was to assess the effect of antiplatelet therapy on the risk of thrombotic complications and disease course in SARS-COV-2 infected patients. We carried out the search of the articles published from 2019 to 2021 with the keywords «antiplatelet therapy¼ and «COVID-19¼ in the PubMed database. A total of 209 articles were retrieved out of which 16 which were included in the review. According to majority of retrospective studies (7 out of 10 studies, more than 30.000 patients), antiplatelet therapy is associated with a statistically significant and prominent reduction in overall mortality. Several studies showed that antiplatelet therapy positively influences the risks of severe respiratory disorders, need of invasive lung ventilation and decreases the probability of thrombotic events. However the only prospective randomized placebo-controlled study did not show a benefit of antiplatelet therapy in symptomatic patients with mild stable COPD-19. None of the studies reported a negative effect of antiplatelet therapy on the course of a new coronavirus infection. Therefore, to date there is no conclusive evidence based on prospective randomized trials, of a positive effect of antiplatelet therapy on the course of COVID-19. Further research on this issue using the double-blind method is needed. However, there are no reports of significant adverse effects of antiplatelet agents, who have previously been given antiplatelet therapy for secondary prevention.

[The criteria for effectiveness of reperfusion therapy and neuroprotective therapy in ischemic stroke]. / Kriterii effektivnosti reperfuzionnoi i neiroprotektivnoi terapii ishemicheskogo insul'ta.

The narrative review discusses the data on efficacy and safety of reperfusion therapy (RT) and neuroprotective therapy in ischemic stroke. The influence of therapy on mortality, residual neurologic deficit and disability is analyzed. It was shown that RT (thrombolysis or mechanical thromboextraction) leads to significant decrease of residual neurologic deficit or disability. The influence of RT on mortality is controversial. There is some evidence that RT can increase early mortality due to hemorrhagic complications. Neuroprotective therapy is much less studied in stroke but is recognized as safe. Neuroprotective therapy (i.e. cerebrolysin) can diminish residual neurologic deficit and disability, while it has no influence on mortality.

[Prevention of dementia in patients with mild cognitive impairment]. / Profilaktika dementsii u patsientov s umerennymi kognitivnymi narusheniyami.

Cognitive impairment is one of the most common consequences of brain dysfunction. Nowadays, there is an increasing interest in the diagnosis and treatment of cognitive impairment without dementia, as a stage of cognitive deficit spectrum that could be controlled. The article discusses the current approaches to the management of patients with mild cognitive impairment including non-pharmacological strategies as well as medical antioxidant treatment.

[Chronic cerebral circulatory insufficiency: A clinical case report]. / Khronicheskaya nedostatochnost' mozgovogo krovoobrashcheniya: opisanie klinicheskogo sluchaya.

Chronic cerebral circulatory insufficiency (CCCI) is a result of cerebral microangiopathy, most commonly due to uncontrolled hypertension. In this case, the brain is affected due to recurrent silent infarcts and/or microbleedings without clinical manifestations of stroke and chronic brain ischemia. Progressive cognitive impairments with a preponderance of inadequate attention and lower rates of cognitive performance, with impaired planning and control abilities in relative preservation of memory serve as the main manifestation of chronic progressive non-stroke vascular lesion in the brain. The above impairments are generally associated with emotional changes as affective lability and depression. The paper gives an account of a characteristic clinical case of CCCI, analyzes the mechanisms for the development of neurological symptoms, and sets forth current approaches to managing these patients.

[Use of omaron in patients with post-stroke cognitive disorders].

Efficacy of omaron (a combination of piracetam 400 mg and cinnarizin 25 mg) has been studied 3 months after stroke in 90 post-stroke patients. Forty-five patients receiving the basic therapy (antihypertensive and antithrombotic drugs, statins) have been included in the control group and 45 patients of the main group received in addition omaron (1 pill 3 times daily during 2 months). Intensity of neurologic disturbances, degree of disability, cognitive functions assessed by neuropsychological tests (the Mini-Mental State Examination, the Frontal Assessment battery, the Five words test, the Clock drawing test, the Schulte test) and emotional state (the Centre for Epidemiologic Studies Depression scale, the Spilberger scale) have been measured. During the period of the study, none of the patients had stroke or myocardial infarction. The improvement of indices of neurological status, decrease of disability degree and normalization of arterial pressure were found in both groups after 2 months of treatment. The significant improvement (p<0,05) of performance on tests for neurocognitive functions and parameters of emotional state was noted in patients treated with omaron compared to those of the control group. The good tolerability of omaron, absence of serious side-effect in combination with other drugs used for prevention of secondary stroke were reported.