medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-067medsovet-7410Research ArticleКОГНИТИВНЫЕ РАССТРОЙСТВАCOGNITIVE DISRODERSОбоснованная терапия додементных когнитивных нарушений блокаторами кальциевых каналовSubstantiated therapy of pre-dementia cognitive impairment with calcium-channel blockershttps://orcid.org/0000-0002-9851-4362ЖитковаЮ. В.ZhitkovaYu. V.

Житкова Юлия Владимировна доктор медицинских наук, врач-невролог поликлинического отделения, Межрегиональный клинико-диагностический центр; ассистент кафедры неврологии, нейрохирургии и медицинской генетики. Казанский ГМУ.

420101, Республика Татарстан, Казань, ул. Карбышева, д. 12а; 420012, Республика Татарстан, Казань, ул. Бутлерова, д. 49

Yuliya V. Zhitkova Dr. Sci. (Med.), Neurologist of the Outpatient Department, Interregional Clinical Diagnostic Center; Teaching Assistant of the Department of Neurology, Neurosurgery and Medical Genetics, Kazan SMU.

12a, Karbishev St., Kazan, Republic of Tatarstan, 420101; 49, Butlerov St., Kazan, Republic of Tatarstan, 420012

zhitkova@mail.ruМежрегиональный клинико-диагностический центр; Казанский государственный медицинский университетРоссияInterregional Clinical Diagnostic Center; Kazan State Medical UniversityRussian Federation202310042023033843Copyright © Житкова Ю.В., 20232023Житкова Ю.В.Zhitkova Y.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7410

Додементные когнитивные нарушения являются важной частью спектра когнитивных нарушений как наиболее перспективные в плане предотвращения конверсии в деменцию. Вместе с тем лечение додементных когнитивных нарушений представляет определенные трудности в связи с отсутствием четких лекарственных стратегий с высоким уровнем доказательности. Согласно действующим клиническим рекомендациям первоочередное значение в лечении додементных когнитивных нарушений имеет коррекция модифицируемых факторов риска прогрессирования когнитивных нарушений и нелекарственные методы терапии. Тем не менее существует большая потребность в получении доказательств патогенетически обоснованного применения лекарств с потенциально эффективным механизмом действия. Универсальным и ранним патогенетическим событием при многих заболеваниях ЦНС, приводящих к развитию когнитивных нарушений, в т. ч. болезни Альцгеймера, является дисгомеостаз кальция. В этой связи применение лекарств, регулирующих обмен кальция в нейронах в лечении пациентов с додементными когнитивными нарушениями, особенно препаратов с высокой проникающей способностью в мозговой кровоток, является потенциально обоснованным. В статье проведен обзор данных современных исследований, изучающих эффективность и безопасность нимодипина селективного блокатора кальциевых каналов II класса. Приведены примеры использования нимодипина в лечении и профилактике додементных синдромов различного генеза: болезни Альцгеймера, хронической церебральной гипоперфузии, постлучевой и постоперационной когнитивной дисфункции и др. Приведены экспериментальные данные о применении нимодипина в профилактике послеоперационного делирия у пожилых и в терапии некогнитивных неврологических расстройств. Дано обоснование перспектив расширения области применения и направления для дальнейшего исследования нимодипина.

Pre-dementia cognitive impairments are a significant part of a cognitive impairment range, considered the most perspective in terms of conversion into dementia prevention. At the same time pre-dementia cognitive impairment treatment presents certain difficulties in connection with the absence of precise medicinal strategies with the high evidence level. According to current clinical recommendations, the priority in cognitive pre-dementia treatment lies in the correction of modifiable risk factors of cognitive impairment progression and non-drug therapy methods. Nevertheless, there is a great need in receiving the proofs of pathogenetically justified use of drugs with a potentially effective mechanism of action. Universal and early pathogenetical mechanism of many diseases of central nervous system, leading to the development of cognitive impairments, including Alzheimer’s disease, is Ca2+ dyshomeostasis. In this connection, the use of drugs, regulating Ca2+ metabolism in neurons in treatment of patients with pre-dementia cognitive impairments, especially high brain penetrance drugs, is potentially well-grounded. The article gives the data review of modern researches, studying the efficiency and safety of nimodipin a selective Ca+ channel blocker of the 2 class. The article provides examples of the use of nimodipin in treatment and prevention of pre-dementia syndroms of various genesis: Alzheimer’s disease, chronic brain hypoperfusion damage, post-radiation and postoperative cognitive dysfunction, etc. The article presents experimental data about nimodipin use in the prevention of postoperative delirium in elderly people and in the treatment of non-cognitive neurological disorders. Justification of the perspectives of the application area extension and directions for the further research of nimodipin are as well given in the article.

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The authors declare that there are no conflicts of interest present.