medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-208medsovet-7640Research ArticleКОГНИТИВНЫЕ РАССТРОЙСТВАCOGNITIVE DISRODERSВедение пациентов с умеренными когнитивными нарушениями: возможности применения оксида азотаManagement of patients with mild cognitive impairment: the possibility of using nitric oxidehttps://orcid.org/0000-0002-1992-7960ПарфеновВ. А.ParfenovV. A.

Парфенов Владимир Анатольевич, д.м.н., профессор, врач-невролог, заведующий кафедрой нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119021, Москва, ул. Россолимо, д. 11, стр. 1

Vladimir A. Parfenov, Dr. Sci. (Med.), Professor, Neurologist, Head of Department of Nervous Diseases and Neurosurgery, Sklifosovskiy Institute of Clinical Medicine

11, Bldg. 1, Rossolimo St., Moscow, 119021

vladimirparfenov@mail.ruhttps://orcid.org/0000-0001-6624-5500СтарчинаЮ. А.StarchinaYu. A.

Старчина Юлия Александровна, к.м.н., врач-невролог, ассистент кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119021, Москва, ул. Россолимо, д. 11, стр. 1

Yulia A. Starchina, Cand. Sci. (Med.), Neurologist, Teaching Assistant of Department of Nervous Diseases and Neurosurgery, Sklifosovskiy Institute of Clinical Medicine

11, Bldg. 1, Rossolimo St., Moscow, 119021

yul-starchina@yandex.ruhttps://orcid.org/0000-0003-3524-3494ГринюкВ. В.GrinyukV. V.

Гринюк Владислав Владимирович, к.м.н., врач-невролог, ассистент кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119021, Москва, ул. Россолимо, д. 11, стр. 1

Vladislav V. Grinyuk, Cand. Sci. (Med.), Neurologist, Teaching Assistant of Department of Nervous Diseases and Neurosurgery, Sklifosovskiy Institute of Clinical Medicine

11, Bldg. 1, Rossolimo St., Moscow, 119021

grinukvladislav@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation20232107202301050–54Copyright © Парфенов В.А., Старчина Ю.А., Гринюк В.В., 20232023Парфенов В.А., Старчина Ю.А., Гринюк В.В.Parfenov V.A., Starchina Y.A., Grinyuk V.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7640

Когнитивные нарушения (КН) представляют одну из ведущих причин инвалидизации пожилых людей, наиболее часто они вызваны нейродегенеративным (НДЗ) и/или цереброваскулярным заболеванием (ЦВЗ). Умеренные КН (УКН) представляют промежуточное состояние между нормальными когнитивными функциями (КФ) и деменцией, они отмечаются у значительной части людей пожилого возраста. Пациенты с УКН имеют более высокий риск развития деменции, чем в популяции, поэтому профилактика прогрессирования УКН представляет актуальное направление современной неврологии. В настоящее время не найдено лекарственных средств, способных замедлить прогрессирование КН, вызванных ЦВЗ или НДЗ; эффективные при деменции лекарственные средства не дают существенного эффекта на стадии УКН. В профилактике деменции на стадии УКН отмечается важная роль нелекарственных методов (регулярная физическая активность, рациональное питание, умственная активность, отказ от курения и злоупотребления алкоголем) и лекарственных воздействий (антигипертензивная терапия, антитромботическая терапия, статины). В последние годы обсуждается применение оксида азота при ЦВЗ и НДЗ с целью ослабления процессов оксидативного стресса, апоптоза и высвобождения цитокинов. В нашей стране имеется положительный опыт ингаляционного применения оксида азота с помощью аппарата, синтезирующего его из воздуха, при легочных, сердечно- сосудистых заболеваниях и ЦВЗ. В настоящее время изучается эффективность ингаляционного применения оксида азота с помощью аппарата, синтезирующего его из воздуха, у пациентов с УКН вследствие ЦВЗ и НДЗ. Представлено клиническое наблюдение пациентки с УКН, у которой через месяц после ингаляционного применения оксида азота отмечено улучшение КФ по данным нейропсихологического обследования.

Cognitive impairment (CI) is one of the leading causes of disability in the elderly, most often caused by neurodegenerative disease (NDD) and/or cerebrovascular disease (CVD). Mild CI (MCI) represents an intermediate state between normal cognitive functions (CF) and dementia and occurs in a significant proportion of the elderly. Patients with MCI have a higher risk of developing dementia than in the general population; therefore, prevention of the progression of MCI is an important area of modern neurology. Currently, no drugs have been found that can slow the progression of CI caused by CVD or NDD; drugs effective for dementia do not have a significant effect at the stage of MCI. In the prevention of dementia at the stage of MCI, an important role is noted for non-drug methods (regular physical activity, rational nutrition, mental activity, smoking cessation and alcohol abuse) and drug interventions (antihypertensive therapy, antithrombotic therapy, statins). In recent years, the use of nitric oxide in CVD and NDD has been discussed in order to attenuate the processes of oxidative stress, the release of cytokines, and the processes of apoptosis. In our country, there is a positive experience of inhaled use of nitric oxide with the help of an apparatus synthesized from the air for pulmonary, cardiovascular diseases and CVD. The effectiveness of inhaled nitric oxide using an apparatus synthesized from air is currently being studied in patients with MCI due to CVD and NDD. A clinical observation of a patient with MCI is presented, in which a month after the inhalation use of nitric oxide, an improvement in CF was noted according to neuropsychological examination.

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