Actovegin in the treatment of patients with cognitive impairments in the chronic cerebral ischemia
https://doi.org/10.17650/2222-8721-2015-5-4-25-31
Abstract
Chronic cerebral ischemia is a common problem especially among the elderly. It gradually leads to social disability and invalidisation of those patients. One of the possible pathogenic mechanisms of this condition is the endothelial dysfunction. Thus, the attempt to repair the latter is one of the treatment goals. It is assumed that actovegin improves tissue microcirculation by expanding precapillary zone – the main marker of the metabolic activity in the microvascular endothelium. Actovegin activates anaerobic metabolism and oxygenation in endotheliocytes. Patients, treated by actovegin, showed improvement of cognitive functions and psycho-emotional state. Due to the absence of proteins, the drug has good tolerance and low toxicity.
About the Author
L. M. Boriskina
M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; Bldg. 2, 8 Trubetskaya St., Moscow, 119992, Russia
Russian Federation
Russian Federation
References
1. Федин А.И. Избранные лекции по амбулаторной неврологии. М.: ООО «АСТ 345». 2014. 128 с. [Fedin А.I. Selected lectures on the outpatient neurology. Мoscow: “AST 345”. 2014. 128 p. [In Russ.)].
2. Суслина З.А., Румянцева С.А. Нейрометаболическая терапия хронической ишемии мозга. Методическое пособие. М.: ВУНМЦМЗ РФ, 2005. 30 с. [Suslina Z.А., Rumyantseva S.А. Neurometabolic therapy of the chronic brain ischemia. Resource book. Мoscow: VUNMCMZ RF, 2005. 30 p. [In Russ.)].
3. Шмидт Е.В., Лунев Д.К., Верещагин Н.В. Сосудистые заболевания головного и спинного мозга. М.: Медицина, 1976. 284 с. [Scmidt Е.V., Lunev D.K., Vereshchagin N.V. Vascular diseases of brain and spine. Мoscow: Меditsina, 1976. 284 p. [In Russ.)].
4. Бувальцев В.И. Дисфункция эндотелия как новая концепция профилактики и лечения сердечно-сосудистых заболеваний. Международный медицинский журнал 2001;(3):202–8. [Buvaltsev V.I. Endothelium dysfunction as a new concept for the prophylactics and treatment of cardiovascular diseases. Меzhdunarodniy meditsinkiy zhurnal = International Medical Journar 2001;(3):202–8. [In Russ.)].
5. Сторожаков Г.И., Верещагина Г.С., Малышева Н.В. Эндотелиальная дисфункция при артериальной гипертонии у пациентов пожилого возраста. Клиническая геронтология 2003;(1):23–8. [Storozhakov G.I., Vereshchagina G.S., Malysheva N.V. Endothelial dysfunction at arterial hypertension of elderly patients. Clinicheskaya gerontologiya = Clinical gerontology 2003;(1):23–8. [In Russ.)].
6. Esper R.J., Nordaby R.A., Vilarino J.O. et al. Endothelial dysfunction: a comprehensive appraisal. Cardiovasc Diabetol 2006;5(4):1–18.
7. Mudau M., Genis A., Lochner A., Strijdom H. Endothelial dysfunction: the early predictor of atherosclerosis Cardiovasc J Afr 2012;23(4):222–31.
8. Chhabra N. Endothelial dysfunction – a predictor of atherosclerosis. Internet J Med Update 2009;4(1):33–41.
9. Бувальцев В.И. Вазодилатирующая функция эндотелия и возможные пути ее коррекции у больных артериальной гипертонией. Дис. … д-ра мед. наук. М., 2003. 222 с. [Buvaltsev V.I. Vasodilating function of the endothelium and possible ways of its correction at patients with arterial hypertension. Thesis … of doctor of medical sciences. Мoscow, 2003. 222 p. [In Russ.)].
10. Новикова Н.А. Дисфункция эндотелия – новая мишень медикаментозного воздействия при сердечно-сосудистых заболеваниях. Врач 2005;(8):51–3. [Novikova N.А. Endothelium dysfunction – new target of the medicamental influence at cardiovascular diseases. Vrach = Physician 2005;(8):51–3. [In Russ.)].
11. Verma S., Buchanan M.R., Anderson T.J. Endothelial function testing as a biomarker of vascular disease. Circulation 2003;108: 2054–9.
12. Landmesser U., Hornig B., Drexler H. Endothelial function. A critical determinant in atherosclerosis? Circulation 2004;109(1):27–33.
13. Чазов Е.И., Кухарчук В.В., Бойцов С.А. Руководство по атеросклерозу и ишемической болезни сердца. М.: Медиа Медика, 2007. 736 с. [Chazov Е.I., Kukharchuk V.V., Boytsov S.А. Manual on atherosclerosis and ischemic heart disease. Мoscow: Меdia Medika, 2007. 736 p. [In Russ.)].
14. Мищенко Т.С., Здесенко И.В., Мищенко В.Н. Терапевтические возможности лечения церебральных венозных нарушений. Международный неврологический журнал 2011;(1):39. [Мishtchenko Т.S., Zdesenko I.V., Мishschenko V.N. Тherapeutic capabilities of the treatment of cerebral venous diseases. Меzhdunarodniy evrologicheskiy zhurnal = International Neurologic Journal 2011;1:39. [In Russ.)].
15. Савельева Л.А., Тулупов А.А. Особенности венозного оттока от головного мозга по данным магнитно-резонансной ангиографии. Вестник Новосибирского государственного университета. Серия: Биология, клиническая медицина 2009;7(1):36–40. [Savel’eva L.А., Tulupov А.А. Peculiarities of the venous drainage from the brain according to the magnetic resonance angiogram data. Vestnik Novosibirskogo gosudarstvennogo universiteta. Seria: Biologia, klinicheskaya meditsina = Herald of the Novosibirsk State University. Series: Biology, Clinical Medicine) 2009;7(1):36–40. [In Russ.)].
16. Свистов Д.В. Патология синусов и вен твердой мозговой оболочки. Здоров’я Украiни 2004;(9):3. [Svistov D.V. Pathology of sinuses and veins of the scleromeninx. Health of Ukraine 2004;(9):3. [In Ukr.)].
17. Kearney P.M., Whelton M., Reynolds K. et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217–23.
18. Диагностика и лечение артериальной гипертонии. Рекомендации РМОАГ. Кардиологический вестник 2015;(1):5–30. [Diagnostics and treatment of the arterial hypertension. RMOAG. Cardiologicheskiy vestnik = Сardiology Herald 2015;(1):5–30. [In Russ.)].
19. Старчина Ю.А., Парфенов В.А. Память и другие когнитивные функции у больных с артериальной гипертензией. Клиническая геронтология 2004;(8):33–9. [Starchina Yu.А., Parfenov V.А. Memory and other cognitive functions at patients with arterial hypertension. Clinicheskaya gerontologiya = Clinical Gerontology 2004;(8):33–9. [In Russ.)].
20. Lima L.M., Carvalho M., Ferreira C.N. et al. Atheromatosis extent in coronary artery disease is not correlated with apolipoprotein-E polymorphism and its plasma levels, but associated with cognitive decline. Curr Alzheimer Res 2010;7(6):556–63.
21. Dregan A., Stewart R., Gulliford M.C. Cardiovascular risk factors and cognitive decline in adults aged 50 and over: a population-based cohort study. Age Ageing 2013;42(3):338–45.
22. Ancelin M.L., Ripoche E., Dupuy A.M. et al. Genderspecific associations between lipids and cognitive decline in the elderly. Eur Neuropsychopharmacol 2014;24(7):1056–66.
23. Henderson A.S. Dementia. Geneva: World Health Organization, 1994.
24. Larrieu S., Letteneur L., Orgogozo J.M. et al. Incidence and outcome of mild cognetive impairment in a populationbased prospective cohort. Neurology 2002;59(10): 1594–9.
25. Forette F., Seux M.L., Staessen J.A. et al. Prevention of dementia in randomised doubleblind placebo-controlled. Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998;352(9137): 1247–351.
26. Trenkwalder P. The study on cognition and prognosis in the elderly (SCOPE) – recent analyses. J Hypertens Suppl 2006;24(1):107–14.
27. Левин О.С. Когнитивные нарушения в практике терапевта: заболевания сердечно-сосудистой системы. Consilium Medicum 2009;11(2):55–61. [Levin О.S. Cognitive disorders in the general physician’s practice: cardiovascular diseases. Consilium Medicum 2009;11(2):55–61. [In Russ.)].
28. Levy B.I., Ambrosio G., Pries A.R., Struijker-Boudier H.A. Microcirculacion in hypertension. A new target for treatment? Circulation 2001;104(6):735–40.
29. Путилина М.В. Алгоритм диагностики и терапии хронических форм нарушений венозного кровообращения. Лечащий врач 2015;(6):66–72. [Putilina М.V. Аlgorithm of the diagnostics and therapy of chronic forms of the venous circulation diseases. Lechashchiy vrach = Assistant physician 2015;(6):66–72. [In Russ.)].
30. Machicao F., Muresanu D.F., Hundsberger H. et al. Pleiotropic neuroprotective and metabolic effects of Actovegin’s mode of action. J Neurol Sci 2012;322(1):222–7.
31. Elmlinger M.W., Kriebel M., Ziegler D. Neuroprotective and anti-oxidative effects of the hemodialysate actovegin on primary rat neurons in vitro. Neuromolecular Med 2011;13(4):266–74.
32. Юринская М.М., Винокуров М.Г, Грачев С.В., Асташкин Е.И. Актовегин снижает апоптоз клеток нейробластомы SK-N-SH, индуцированный пероксидом водорода, в результате ингибирования p38MAPKиPI-3K. Доклады Академии наук 2014;456(5):618–21. [Yurinskaya М.М., Vinokurov М.G., Grachev S.V., Аstashkin Е.I. The Actovegin decreases the apoptosis of SK-N-SH neuroblastoma cells, induced by hydrogen peroxide as a result of inhibition of p38MAPK and PI-3K. Doklady Akademii Nauk = Reports of the Academy of Science. 2014:456(5);618–21. [In Russ.)].
33. Fedorovich A.A. Non-invasive evaluation of vasomotor and metabolic functions of microvascular endothelium in human skin. Microvasc Res 2012;84:86–93.
34. Hayward C.S., Kraidly M, Webb CM, Collins P. Assessment of endothelial function using peripheral waveform analysis. J Am Coll Cardiol 2002;40:521–8.
35. Antonios T.F., Singer D.R., Markandu N.D. et al. Rarefaction of skin capillaries in borderline essential hypertension suggests an early structural abnormality. Hypertension 1999;34(4Pt1):655–8.
36. Kanishcheva E., Fedorovich A., Loukianov M., Boytsov S. Capillary nail bed parameters in hypertensives and normotensives in age group of 60–80 years. J Hypertens 2010;28. Issue p e182. doi: 10.1097/01. hjh.0000378763.47218.0d.
37. Гурфинкель Ю.И., Макеева О.В., Острожинский В.А. Особенности микроциркуляции, эндотелиальной функции и скорости распространения пульсовой волны у пациентов с начальными стадиями артериальной гипертензии. Функциональная диагностика 2010;(2):18–25. [Gurfinkel Yu.I., Маkeeva О.V., Оstrozhinskiy V.А. Peculiarities of the microcirculation, endothelial function and the pulse wave propagation velocity at patients with initial stages of the arterial hypertension. Funktsionalnaya diagnostika = Functional Diagnosis 2010;(2):18–25. [In Russ.)].
38. Федорович А.А., Соболева Г.Н. Коррекция когнитивных нарушений Актовегином у больных артериальной гипертензией и ишемической болезнью сердца. Эффективная фармакотерапия 2015;(23):42–51. [Fedorovich А.А., Soboleva G.N. Correction of cognitive disorders with Actovegin at patients with arterial hypertension and ischemic heart disease. Effektivnaya farmakoterapiya = Effective Pharmacotherapy 2015;(23):42–51. [In Russ.)].
39. Cheng C., Dascalakis C., Falkner B. Capillary rarefaction in treated and untreated hypertensive subjects. Ther Adv Cardiovasc Dis 2008;2(2):79–88. doi: 10.1177/1753944708089696.
40. Суслина З.А., Варакин Ю.Я., Верещагин Н.В. Сосудистые заболевания головного мозга. М., 2009. [Suslina Z.А., Varakin Yu.Ya., Vereshtchagin N.V. Brain vascular diseases. Мoscow, 2009. [In Russ.)].
41. Bakker S.L. de LeeuwF.E., de Groot J.C. et al. Cerebral vasomotor reactivity and cerebral white matter lesions in the elderly. Neurology 1999;52:578–83.
42. Лупанов В.П., Максименко А.В. Протективная ишемия в кардиологии. Формы кондиционирования миокарда. Кардиоваскулярная терапия и профилактика 2011;10(1):111–9. [Lupanov V.P., Maksimenko А.V. Protective ischemia in cardiology. Forms of the myocardium conditioning. Kardiovaskulyarnaya terapiya i profilaktika = Сardiovascular Therapy and Prophylactics 2011;10(1):111–9. [In Russ.)].
43. Murry C.E., Jenning R.D., Reimer K.A. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986;74(5):1122–36.
44. Yellon D.M., Alkhulaifi A.M., Pugsley W.B. Preconditioning the human myocardium. Lancet 1993;342:276–77.
45. Heidland U.E., Haintzen M.P., Michel C.J., Strauer B.E. Effect of adjunctive intracoronary adenosine on myocardial ischemia, hemodynamic function and left ventricular performance during percutaneous transluminal coronary angioplasty: clinical access to ischemic preconditioning? Coron Artery Dis 2000;11(5):421–8.
46. Leerar M.A., Stoddard M., Ahmed M. Preconditioning of human myocardium with adenosine during angioplasty. Circulation 1997;95:2500–7.
47. Кузнецов М.Р., Каралкин А.В., Федин А.И. и др. Возможности фармакологического прекондиционирования при хирургическом лечении гемодинамически значимых стенозов сонных артерий. Фарматека 2015;(7):37–44. [Kuzentsov М.R., Karalkin А.V., Fedin А.I. et al. Possibilities of the pharmacologic pre-conditioning at the surgical treatment of the hemodynamically significant stenosis of carotid arteries. Farmateka = Pharmatec 2015;(7):37–44. [In Russ.)].
48. Saletu B., Grünberger J., Linzmayer L. et al. EEG brain mapping and psychometry in age-associated memory impairment after acute and 2-week infusions with the hemoderivativeActovegin: double-blind, placebo-controlled trials. Neuropsyhobiology 1990–1991;24(3):135–48.
49. Semlitsch H.V., Anderer P., Saletu B. et al. Topographic mapping of cognitive ventrelated potentials in a double-blind, placebocontrolled study with the hemoderivative Actovegin in age-associated memory impairment. Neurophychobiol 1990/1991;24:49–56.
50. Михайлова Н.М., Селезнева Н.Д., Калын Я.Б. и др. Эффективность лечения актовегином больных пожилого возраста с синдромом мягкого когнитивного снижения сосудистого генеза. Журнал неврологии и психиатрии им. С.С. Корсакова 2013;(7):69–76. [Мikhaylova N.М., Seleznyova N.D., Kalyn Ya.B. et al. Efficiency of the treatment with actovegin of elderly patients with the syndrome of soft cognitive decrease of the vascular genesis. Zhurnal nevrologii i psykhiatrii im. S.S. Korsakova = S.S. Korsakov Neurology and Psychiatry Journal 2013;(7):69–76. [In Russ.)].
51. Захаров В.В., Соснина В.Б. Применение антигипоксантов в лечении когнитивных нарушений у больных с сахарным диабетом. Неврологический журнал 2008;(5):39–43. [Zakharov V.V., Sosnina V.B. Application of antihypoxants in the treatment of cognitive disorders at patients with diabetes mellitus. Nevrologicheskiy zhurnal = Neurologic Journal 2008;(5):39–43. [In Russ.)].
52. Остроумова О.Д., Галеева Н.Ю., Первичко Е.И. Коррекция когнитивных нарушений Актовегином у больных гипертонической болезнью. Больница – все для ЛПУ. Медицинский алфавит 2012;(4): 3–6. [Оstroumova О.D., Galeeva N.Yu., Pervichko Е.I. Correction of cognitive disorders with Actovegin and patients with hypertension disease. Hospital – everything for medical treatment facilities. Меditsinskiy alfavit = Medical Alphabet 2012;(4):3–6. [In Russ.)].
53. Oswald W.D., Steger W., Oswald B., Kuntz G. Die Verbesserung fluider Kognitiver Leistungen als Indikator fur die klinische Wirksamkeit einer nootropen Substanz. Eine placebokontrollierte Doppelblind-Studie mit Actovegin. Z Gerontopsychol- Psychiatr 1991;4:209–20.
54. Kanowski S., Kinzler E., Lehmann E. et al. Confirmed clinical efficacy of Actovegin in elderly patients with organic brain syndrome. Pharmacopsychiatry 1995;28: 125–33.
55. Herrmann W.M., Bohn-OlszewskyW.J., Kuntz G. Actovegin infusion treatment in patients with primarily degenerative dementia of the Alzheimer type and multiinfarct dementia. Zeitschrift für Geriatrie 1992;5:46–55.
56. Строков И.А., Моргоева Ф.Э., Строков К.И. и др. Терапевтическая коррекция диабетической полиневропатии и энцефалопатии Актовегином. Русский медицинский журнал 2006;(9):698–703. [Strokov I.А., Моrgoeva F.E., Strokov K.I. et al. Тherapeutic correction of the diabetic polyneuropathy and encephalopathy with Actovegin. Russkiy meditsinskiy zhurnal = Russian Medical Journal 2006;(9): 698–703. [In Russ.)].
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For citations:
Boriskina L.M. Actovegin in the treatment of patients with cognitive impairments in the chronic cerebral ischemia. Neuromuscular Diseases. 2015;5(4):25-31. (In Russ.) https://doi.org/10.17650/2222-8721-2015-5-4-25-31
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