medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-225medsovet-7651Research ArticleПРАКТИКАPRACTICEМолодой пациент на приеме у невролога: особенности диагностики и терапииA young patient at a neurologist’s appointment: features of diagnostics and therapyhttps://orcid.org/0000-0002-8655-8501ПутилинаМ. В.PutilinaM. V.

Путилина Марина Викторовна, д.м.н., профессор, профессор кафедры клинической фармакологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1 

Marina V. Putilina, Dr. Sci. (Med.), Professor, Department of Clinical Pharmacology, Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997

profput@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202324072023010146–152Copyright © Путилина М.В., 20232023Путилина М.В.Putilina M.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/7651

Амбулаторный неврологический прием в большинстве случаев состоит из пациентов старше 45 лет. Пандемия новой коронавирусной инфекции изменила эту статистику. В поликлиники стали чаще обращаться молодые пациенты с жалобами на головную боль, чувство слабости, снижение физической активности, забывчивость, изменения концентрации внимания. COVID- 19 спровоцировал развитие коагулопатий у пациентов с генетическими мутациями и признаками дисплазии. Увеличилась доля пациентов с приобретенной или врожденной тромбофилией. Большинство из них имеют те или иные проявления недифференцированной дисплазии с признаками нарушения венозного оттока и характерным цефалгическим синдромом, особенностью которого является полиморфность, непостоянство, отсутствие в большинстве случаев связи с конкретными сосудистыми и гемодинамическими факторами (исключая головную боль при венозных тромбозах), уменьшение частоты встречаемости по мере прогрессирования болезни. Наличие определенных жалоб (головная боль, астения, когнитивные нарушения) требует назначения специфической терапии. Монотерапия одним препаратом даже при наличии у него плейотропного эффекта не всегда достигает лечебных целей, так как превалирует тот или иной механизм фармакологического действия, а остальные являются вторичными, требующими усиления или другими препаратами, или немедикаментозными методами. Учитывая низкую приверженность молодых пациентов к лечению, выходом из создавшейся ситуации является использование комбинированных препаратов. Комбинированные ноотропные препараты могут использоваться как многофункциональные лекарства, потенцируя или суммируя свои эффекты, при этом снижая риск полипрагмазии и нежелательных реакций. Одна из наиболее перспективных комбинаций – препарат Пикамилон Гинкго (экстракт листьев гинкго двулопастного + никотиноил гамма- аминомасляная кислота), который зарекомендовал себя как эффективный корректор астении и когнитивных нарушений у пациентов любого возраста.

Outpatient neurological appointments in most cases consist of patients older than 45 years. The novel coronavirus pandemic has changed this statistic. Young patients began to turn to polyclinics more often with complaints of headache, feeling of weakness, decreased physical activity, forgetfulness, and changes in concentration. COVID-1 9 provoked the development of coagulopathy in patients with genetic mutations and signs of dysplasia. The percentage of patients with acquired or congenital thrombophilia has increased. Most of them had certain manifestations of undifferentiated dysplasia, with signs of impaired venous outflow with a characteristic cephalgic syndrome. The peculiarity of which is polymorphism, inconstancy, the absence, in most cases, of connection with specific vascular and hemodynamic factors (excluding headache in venous thrombosis), a decrease in the frequency of occurrence as the disease progresses. The presence of certain complaints (headache, asthenia, cognitive impairment) requires the appointment of specific therapy. Monotherapy with one drug, even if it has a pleiotropic effect, does not always achieve therapeutic goals, since one or another mechanism of pharmacological action prevails, and the rest are secondary, requiring enhancement or other drugs, or non-drug methods. Given the poor adherence of young patients to treatment, the way out of this situation is the use of combined drugs. Combination drugs can be used as multifunctional drugs, potentiating or summarizing their effects, while reducing the risk of polypharmacy and unwanted side reactions. One of the most promising combinations is Picamilon Ginkgo (Ginkgo biloba leaf extract + Nicotinoyl gamma-a minobutyric acid), which has established itself as an effective corrector of asthenia and cognitive impairment in patients of any age.

астенические расстройствакогнитивные нарушениянарушения венозного оттокацефалгический синдромкомбинированные ноотропные препаратыгинкго билобаникотиноил гамма-аминомасляная кислотаasthenic disorderscognitive impairmentvenous outflow disorderscephalgic syndromecombined nootropic drugsginkgo bilobanicotinoyl gamma-aminobutyric acidReferencesQuickStats: Percentage of Adults Aged ≥18 Years Who Had Lower Back Pain in the Past 3 Months, by Sex and Age Group – National Health Interview Survey, United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;68(5152):1196. https://doi.org/10.15585/mmwr.mm685152a5.QuickStats: Percentage of Adults Aged ≥18 Years Who Had Lower Back Pain in the Past 3 Months, by Sex and Age Group – National Health Interview Survey, United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;68(5152):1196. https://doi.org/10.15585/mmwr.mm685152a5.Путилина М.В., Мутовина З.Ю., Курушина О.В., Халилова Д.М., Саверская Е.Н., Степанова С.Б. и др. Определение распространенности постковидного синдрома и оценка эффективности препарата Кортексин в терапии неврологических нарушений у пациентов с постковидным синдромом. Результаты многоцентровой наблюдательной программы КОРТЕКС. Журнал неврологии и психиатрии им. С.С. Корсакова. 2022;122(1):84–90. https://doi.org/10.17116/jnevro202212201184.Putilina M.V., Mutovina Z.Yu., Kurushina O.V., Khalilova D.M., Saverskaya E.N., Stepanova S.B. et al. Determination of the prevalence of post-C OVID syndrome and assessment of the effectiveness of the drug Cortexin in the treatment of neurological disorders in patients with post-C OVID syndrome. Results of the multicenter clinical and epidemiological observational program CORTEX. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2022;122(1):84–90. (In Russ.) https://doi.org/10.17116/jnevro202212201184.Devita M., Bordignon A., Sergi G., Coin A. The psychological and cognitive impact of COVID- 19 on individuals with neurocognitive impairments: research topics and remote intervention proposals. Aging Clin Exp Res. 2021;33(3):733–736. https://doi.org/10.1007/s40520-020-01637-6.Devita M., Bordignon A., Sergi G., Coin A. The psychological and cognitive impact of COVID- 19 on individuals with neurocognitive impairments: research topics and remote intervention proposals. Aging Clin Exp Res. 2021;33(3):733–736. https://doi.org/10.1007/s40520-020-01637-6.LaPrade M.D., Melugin H.P., Hale R.F., Leland D.P., Bernard C.D., Sierra R.J. et al. Incidence of Hip Dysplasia Diagnosis in Young Patients With Hip Pain: A Geographic Population Cohort Analysis. Orthop J Sports Med. 2021;9(3):2325967121989087. https://doi.org/10.1177/2325967121989087.LaPrade M.D., Melugin H.P., Hale R.F., Leland D.P., Bernard C.D., Sierra R.J. et al. Incidence of Hip Dysplasia Diagnosis in Young Patients With Hip Pain: A Geographic Population Cohort Analysis. Orthop J Sports Med. 2021;9(3):2325967121989087. https://doi.org/10.1177/2325967121989087.Bai C., Wang Z., Stone C., Zhou D., Ding J., Ding Y. et al. Pathogenesis and Management in Cerebrovenous Outflow Disorders. Aging Dis. 2021;12(1):203–222. https://doi.org/10.14336/AD.2020.0404.Bai C., Wang Z., Stone C., Zhou D., Ding J., Ding Y. et al. Pathogenesis and Management in Cerebrovenous Outflow Disorders. Aging Dis. 2021;12(1):203–222. https://doi.org/10.14336/AD.2020.0404.Mu S., Li J., Lin K., Fang Y., Lin F., Li Z. et al. Predictive Factors for Early- Onset Seizures in Patients With Cerebral Venous Sinus Thrombosis. Front Neurol. 2022;13:842807. https://doi.org/10.3389/fneur.2022.842807.Mu S., Li J., Lin K., Fang Y., Lin F., Li Z. et al. Predictive Factors for Early- Onset Seizures in Patients With Cerebral Venous Sinus Thrombosis. Front Neurol. 2022;13:842807. https://doi.org/10.3389/fneur.2022.842807.Tinelli C., Di Pino A., Ficulle E., Marcelli S., Feligioni M. Hyperhomocysteinemia as a Risk Factor and Potential Nutraceutical Target for Certain Pathologies. Front Nutr. 2019;6:49. https://doi.org/10.3389/fnut.2019.00049.Tinelli C., Di Pino A., Ficulle E., Marcelli S., Feligioni M. Hyperhomocysteinemia as a Risk Factor and Potential Nutraceutical Target for Certain Pathologies. Front Nutr. 2019;6:49. https://doi.org/10.3389/fnut.2019.00049.Calderón- Ospina C.A., Nava-M esa M.O. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. 2020;26(1):5–13. https://doi.org/10.1111/cns.13207.Calderón- Ospina C.A., Nava-M esa M.O. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. 2020;26(1):5–13. https://doi.org/10.1111/cns.13207.Plantone D., Pardini M., Rinaldi G. Riboflavin in Neurological Diseases: A Narrative Review. Clin Drug Investig. 2021;41(6):513–527. https://doi.org/10.1007/s40261-021-01038-1.Plantone D., Pardini M., Rinaldi G. Riboflavin in Neurological Diseases: A Narrative Review. Clin Drug Investig. 2021;41(6):513–527. https://doi.org/10.1007/s40261-021-01038-1.Xu J., Patassini S., Begley P., Church S., Waldvogel H.J., Faull R.L.M. et al. Cerebral deficiency of vitamin B5 (d-pantothenic acid; pantothenate) as a potentially- reversible cause of neurodegeneration and dementia in sporadic Alzheimer’s disease. Biochem Biophys Res Commun. 2020;527(3):676–681. https://doi.org/10.1016/j.bbrc.2020.05.015.Xu J., Patassini S., Begley P., Church S., Waldvogel H.J., Faull R.L.M. et al. Cerebral deficiency of vitamin B5 (d-pantothenic acid; pantothenate) as a potentially- reversible cause of neurodegeneration and dementia in sporadic Alzheimer’s disease. Biochem Biophys Res Commun. 2020;527(3):676–681. https://doi.org/10.1016/j.bbrc.2020.05.015.Путилина М.В., Ермошкина Н.Ю., Сидельникова Л.В. Венозный инфаркт головного мозга у пациентки с тромбофилией на фоне приема гормональных препаратов. Медицинский алфавит. 2020;(11):10–16. https://doi.org/10.33667/2078-5631-2020-11-10-16.Putilina M.V., Ermoshkina N.Yu., Sidelnikova L.V. Venous cerebral infarction in patient with thrombophilia while taking hormonal drugs. Medical Alphabet. 2020;(11):10–16. (In Russ.) https://doi.org/10.33667/2078-56312020-11-10-16.Chaturvedi S., Braunstein E.M., Brodsky R.A. Antiphospholipid syndrome: Comp lement activation, complement gene mutations, and therapeutic implications. J Thromb Haemost. 2021;19(3):607–616. https://doi.org/10.1111/jth.15082.Madison J.A., Duarte- García A., Zuo Y., Knight J.S. Treatment of thrombotic antiphospholipid syndrome in adults and children. Curr Opin Rheumatol. 2020;32(3):215–227. https://doi.org/10.1097/BOR.0000000000000702.Путилина М.В., Баранова О.А. Результаты многоцентровой клинико-эпидемиологической наблюдательной программы «ГЛОБУС» (определение распространенности головокружения и оценка схем терапии на амбулаторном уровне). Журнал неврологии и психиатрии им. С.С. Корсакова. 2014;114(5):33–38. Режим доступа: https://www.mediasphera.ru/issues/zhurnal-nevrologii-ipsikhiatrii-im-s-skorsakova/2014/5/031997-7298201456.Chaturvedi S., Braunstein E.M., Brodsky R.A. Antiphospholipid syndrome: Comp lement activation, complement gene mutations, and therapeutic implications. J Thromb Haemost. 2021;19(3):607–616. https://doi.org/10.1111/jth.15082.Григорьев К.И., Поважная Е.Л. Проблема повышенной метеочувствительности у детей и подростков. Российский вестник перинатологии и педиатрии. 2018;63(3):84–90. https://doi.org/10.21508/1027-4065-2018-63-3-84-90.Putilina M.V., Baranova O.A. The results of the multicenter observational program “GLOBUS” on the study of the prevalence of vertigo and treatment schemes in outpatient clinics. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2014;114(5):33–38. (In Russ.) Available at: https://www.mediasphera.ru/issues/zhurnal-nevrologii-ipsikhiatrii-im-s-skorsakova/2014/5/031997-7298201456.Федин А.И., Ермошкина Н.Ю., Путилина М.В., Васильев Ю.Д., Козлов М.Б., Сидельникова Л.В., Снигерева Т.Ю. Особенности клиники и диагностики церебральных венозных тромбозов. Клиническая физиология кровообращения. 2014;(1):33–43. Режим доступа: https://cfc-journal.com/catalog/detail.php?SECTION_ID=938&ID=18300.Grigoryev K.I., Povazhnaya E.L. The problem of increased meteosensitivity in children and adolescents. Russian Bulletin of Perinatology and Pediatrics. 2018;63(3):84–90. (In Russ.) https://doi.org/10.21508/1027-4065-2018-633-84-90.Grahame R., Bird H.A., Child A. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000;27(7): 1777–1779. Available at: https://pubmed.ncbi.nlm.nih.gov/10914867/.Fedin A.I., Ermoshkina N.Yu., Putilina M.V., Vasiliev Yu.D., Kozlov M.B., Sidelnikova L.V., Snigereva T.Yu. Clinical and diagnostic features of cerebral venous thrombosis. Klinicheskaya Fiziologiya Krovoobrashcheniya. 2014;(1):33–43. (In Russ.) Available at: https://cfc-journal.com/catalog/detail.php?SECTION_ID=938&ID=18300.Сатыбалдыев А.М. Синдром гипермобильности суставов в ревматологии. Современная ревматология. 2017;11(2):68–74. https://doi.org/10.14412/1996-7012-2017-2-68-74.Grahame R., Bird H.A., Child A. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000;27(7): 1777–1779. Available at: https://pubmed.ncbi.nlm.nih.gov/10914867/.Шостак Н.А., Правдюк Н.Г., Магомедова Д.Н. Гипермобильный синдром: клиника, диагностика, подходы к терапии. РМЖ. 2009;(4):288–290. Режим доступа: https://www.rmj.ru/articles/revmatologiya/Gipermobilynyy_sindrom__klinika_diagnostika_podhody_k_terapii/.Satybaldyev A.M. Joint hypermobility syndrome in rheumatology. Modern Rheumatology Journal. 2017;11(2):68–74. (In Russ.) https://doi.org/10.14412/1996-7012-2017-2-68-74.Pantoja Zarza L., Díez Morrondo C., Alexis D. Hyperlax Ehlers-D anlos syndrome: benign hypermobility? Reumatol Clin. 2014;10(3):189–190. https://doi.org/10.1016/j.reuma.2013.06.001.Shostak N.A., Pravdyuk N.G., Magomedova D.N. Hypermobility syndrome: clinic, diagnosis, approaches to therapy. RMJ. 2009;(4):288–290. (In Russ.) Available at: https://www.rmj.ru/articles/revmatologiya/Gipermobilynyy_sindrom__klinika_diagnostika_podhody_k_terapii/.Tofts L.J., Elliott E.J., Munns C., Pacey V., Sillence D.O. The differential diagnosis of children with joint hypermobility: a review of the literature. Pediatr Rheumatol Online J. 2009;7:1. https://doi.org/10.1186/1546-0096-7-1.Pantoja Zarza L., Díez Morrondo C., Alexis D. Hyperlax Ehlers-D anlos syndrome: benign hypermobility? Reumatol Clin. 2014;10(3):189–190. https://doi.org/10.1016/j.reuma.2013.06.001.Li M., Su C., Fan C., Chan C.C., Bai C., Meng R. Internal jugular vein stenosis induced by tortuous internal carotid artery compression: two case reports and literature review. J Int Med Res. 2019;47(8):3926–3933. https://doi.org/10.1177/0300060519860678.Tofts L.J., Elliott E.J., Munns C., Pacey V., Sillence D.O. The differential diagnosis of children with joint hypermobility: a review of the literature. Pediatr Rheumatol Online J. 2009;7:1. https://doi.org/10.1186/1546-0096-7-1.Путилина М.В., Теплова Н.В. Алгоритмы рациональной терапии при хронической ишемии головного мозга. Нервные болезни. 2019;(1):10–16. https://doi.org/10.24411/2226-0757-2019-12074.Li M., Su C., Fan C., Chan C.C., Bai C., Meng R. Internal jugular vein stenosis induced by tortuous internal carotid artery compression: two case reports and literature review. J Int Med Res. 2019;47(8):3926–3933. https://doi.org/10.1177/0300060519860678.Napoletano F., Schifano F., Corkery J.M., Guirguis A., Arillotta D., Zangani C., Vento A. The Psychonauts’ World of Cognitive Enhancers. Front Psychiatry. 2020;11:546796. https://doi.org/10.3389/fpsyt.2020.546796.Putilina M.V., Teplova N.V. Rational therapeutic algorithms in chronic cerebral ischemia. Nervous Diseases. 2019;(1):10–16. (In Russ.) https://doi.org/10.24411/2226-0757-2019-12074.Jarvis S., Livingston J., Childs A.M., Fraser L. Outpatient appointment non-attendance and unplanned health care for children and young people with neurological conditions: a retrospective cohort study. Dev Med Child Neurol. 2019;61(7):840–846. https://doi.org/10.1111/dmcn.14070.Napoletano F., Schifano F., Corkery J.M., Guirguis A., Arillotta D., Zangani C., Vento A. The Psychonauts’ World of Cognitive Enhancers. Front Psychiatry. 2020;11:546796. https://doi.org/10.3389/fpsyt.2020.546796.Sodavarapu S., Ali S.W., Goyal M. Cerebral Venous Sinus Thrombosis with Bilateral Abducens Palsy in a Patient with Heterozygous Prothrombin G20210A Mutation. Cureus. 2019;11(11):e6124. https://doi.org/10.7759/cureus.6124.Jarvis S., Livingston J., Childs A.M., Fraser L. Outpatient appointment non-attendance and unplanned health care for children and young people with neurological conditions: a retrospective cohort study. Dev Med Child Neurol. 2019;61(7):840–846. https://doi.org/10.1111/dmcn.14070.Путилина М.В. Эндотелий – мишень для новых терапевтических стратегий при сосудистых заболеваниях головного мозга. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(10):122–130. https://doi.org/10.17116/jnevro2017117101122-130.Sodavarapu S., Ali S.W., Goyal M. Cerebral Venous Sinus Thrombosis with Bilateral Abducens Palsy in a Patient with Heterozygous Prothrombin G20210A Mutation. Cureus. 2019;11(11):e6124. https://doi.org/10.7759/cureus.6124.Tinelli C., Di Pino A., Ficulle E., Marcelli S., Feligioni M. Hyperhomocysteinemia as a Risk Factor and Potential Nutraceutical Target for Certain Pathologies. Front Nutr. 2019;6:49. https://doi.org/10.3389/fnut.2019.00049.Putilina M.V. Endothelium as a target for new therapeutic strategies in cerebral vascular diseases. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2017;117(10):122–130. (In Russ.) https://doi.org/10.17116/jnevro2017117101122-130.Garcia- Horton A., Kovacs M.J., Abdulrehman J., Taylor J.E., Sharma S., Lazo- Langner A. Impact of thrombophilia screening on venous thromboembolism management practices. Thromb Res. 2017;149:76–80. https://doi.org/10.1016/j.thromres.2016.11.023.Tinelli C., Di Pino A., Ficulle E., Marcelli S., Feligioni M. Hyperhomocysteinemia as a Risk Factor and Potential Nutraceutical Target for Certain Pathologies. Front Nutr. 2019;6:49. https://doi.org/10.3389/fnut.2019.00049.Chaturvedi S., Braunstein E.M., Brodsky R.A. Antiphospholipid syndrome: Complement activation, complement gene mutations, and therapeutic implications. J Thromb Haemost. 2021;19(3):607–616. https://doi.org/10.1111/jth.15082.Garcia-Horton A., Kovacs M.J., Abdulrehman J., Taylor J.E., Sharma S., Lazo-  Langner A. Impact of thrombophilia screening on venous thromboembolism management practices. Thromb Res. 2017;149:76–80. https://doi.org/10.1016/j.thromres.2016.11.023.Wardlaw J.M., Smith E.E., Biessels G.J., Cordonnier C., Fazekas F., Frayne R. et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822–838. https://doi.org/10.1016/S1474-4422(13)70124-8.Chaturvedi S., Braunstein E.M., Brodsky R.A. Antiphospholipid syndrome: Complement activation, complement gene mutations, and therapeutic implications. J Thromb Haemost. 2021;19(3):607–616. https://doi.org/10.1111/jth.15082.Mahammedi A., Wang L.L., Williamson B.J., Khatri P., Kissela B., Sawyer R.P. et al. Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know. AJNR Am J Neuroradiol. 2022;43(5):650–660. https://doi.org/10.3174/ajnr.A7302.Wardlaw J.M., Smith E.E., Biessels G.J., Cordonnier C., Fazekas F., Frayne R. et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822–838. https://doi.org/10.1016/S1474-4422(13)70124-8.Путилина М.В. Современные представления о болезни мелких сосудов головного мозга. Журнал неврологии и психиатрии им. С.С. Корсакова. 2019;119(11):65–73. https://doi.org/10.17116/jnevro201911911165.Mahammedi A., Wang L.L., Williamson B.J., Khatri P., Kissela B., Sawyer R.P. et al. Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know. AJNR Am J Neuroradiol. 2022;43(5):650–660. https://doi.org/10.3174/ajnr.A7302.Tordoff J.M., Brenkley C., Krska J., Smith A. Exploring Medicines Burden Among Adults in New Zealand: A Cross- Sectional Survey. Patient Prefer Adherence. 2019;13:2171–2184. https://doi.org/10.2147/PPA.S231202.Putilina M.V. Current concepts about small vessel disease. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2019;119(11):65–73. (In Russ.) https://doi.org/10.17116/jnevro201911911165.Dalton A.R., Soljak M., Samarasundera E., Millett C., Majeed A. Prevalence of cardiovascular disease risk amongst the population eligible for the NHS Health Check Programme. Eur J Prev Cardiol. 2013;20(1):142–150. https://doi.org/10.1177/1741826711428797.Tordoff J.M., Brenkley C., Krska J., Smith A. Exploring Medicines Burden Among Adults in New Zealand: A Cross- Sectional Survey. Patient Prefer Adherence. 2019;13:2171–2184. https://doi.org/10.2147/PPA.S231202.Гогниева Д.Г., Щекочихин Д.Ю., Гаврилова Е.В., Сыркина Е.А., Богданова Р.С., Сыркин А.Л., Копылов Ф.Ю. Проблема приверженности к лечению в общей медицинской практике. Кардиология и сердечно-сосудистая хирургия. 2019;12(6):510–515. https://doi.org/10.17116/kardio201912061510.Dalton A.R., Soljak M., Samarasundera E., Millett C., Majeed A. Prevalence of cardiovascular disease risk amongst the population eligible for the NHS Health Check Programme. Eur J Prev Cardiol. 2013;20(1):142–150. https://doi.org/10.1177/1741826711428797.Crupi R., Impellizzeri D., Cuzzocrea S. Role of Metabotropic Glutamate Receptors in Neurological Disorders. Front Mol Neurosci. 2019;12:20. https://doi.org/10.3389/fnmol.2019.00020.Gognieva D.G., Shchekochikhin D.Yu., Gavrilova E.V., Syrkina E.A., Bogdanova R.S., Syrkin A.L., Kopylov F.Yu. The problem of adherence to treatment in general medical practice. Kardiologiya i Serdechno- Sosudistaya Khirurgiya. 2019;12(6):510–515. (In Russ.) https://doi.org/10.17116/kardio201912061510.Путилина М.В. Особенности комбинированной нейропротекторной терапии острых нарушений мозгового кровообращения. РМЖ. 2009;(4):261–266. Режим доступа: https://www.rmj.ru/articles/nevrologiya/Osobennosti_kombinirovannoy__neyroprotektornoy_terapii_ostryh__narusheniy_mozgovogo_krovoobrascheniya/.Crupi R., Impellizzeri D., Cuzzocrea S. Role of Metabotropic Glutamate Receptors in Neurological Disorders. Front Mol Neurosci. 2019;12:20. https://doi.org/10.3389/fnmol.2019.00020.Medrano M., Molina- Hidalgo C., Alcantara J.M.A., Ruiz J.R., Jurado- Fasoli L. Acute Effect of a Dietary Multi- Ingredient Nootropic as a Cognitive Enhancer in Young Healthy Adults: A Randomized, Triple- Blinded, Placebo- Controlled, Crossover Trial. Front Nutr. 2022;9:858910. https://doi.org/10.3389/fnut.2022.858910.Putilina M.V. Features of combined neuroprotective therapy for acute cerebrovascular accidents. RMJ. 2009;(4):261–266. (In Russ.) Available at: https://www.rmj.ru/articles/nevrologiya/Osobennosti_kombinirovannoy__neyroprotektornoy_terapii_ostryh__narusheniy_mozgovogo_krovoobrascheniya/.Malík M., Tlustoš P. Nootropics as Cognitive Enhancers: Types, Dosage and Side Effects of Smart Drugs. Nutrients. 2022;14(16):3367. https://doi.org/10.3390/nu14163367.Medrano M., Molina- Hidalgo C., Alcantara J.M.A., Ruiz J.R., Jurado- Fasoli L. Acute Effect of a Dietary Multi- Ingredient Nootropic as a Cognitive Enhancer in Young Healthy Adults: A Randomized, Triple- Blinded, Placebo- Controlled, Crossover Trial. Front Nutr. 2022;9:858910. https://doi.org/10.3389/fnut.2022.858910.Бурчинский С.Г. Препараты гинкго билоба: по пути открытий в клинической нейрофармакологии. Міжнародний неврологічний журнал. 2017;(4). Режим доступа: http://www.mif-ua.com/archive/article/44865.Malík M., Tlustoš P. Nootropics as Cognitive Enhancers: Types, Dosage and Side Effects of Smart Drugs. Nutrients. 2022;14(16):3367. https://doi.org/10.3390/nu14163367.Byun J.I., Shin Y.Y., Chung S.E., Shin W.C. Safety and Efficacy of Gamma- Aminobutyric Acid from Fermented Rice Germ in Patients with Insomnia Symptoms: A Randomized, Double- Blind Trial. J Clin Neurol. 2018;14(3):291–295. https://doi.org/10.3988/jcn.2018.14.3.291.Burchinsky S.G. Ginkgo biloba preparations: toward discoveries in the clinical neuropharmacology. International Neurological Journal. 2017;(4). (In Russ.) Available at: http://www.mif-ua.com/archive/article/44865.Митрохин К.В., Баранишин А.А. Классификация и краткое описание лекарственных препаратов – аналогов производных гамма- аминомасляной кислоты и токсических веществ, влияющих на ГАМКергическую связь. Анестезиология и реаниматология. 2018;(6):22–30. https://doi.org/10.17116/anaesthesiology201806122.Byun J.I., Shin Y.Y., Chung S.E., Shin W.C. Safety and Efficacy of Gamma- Aminobutyric Acid from Fermented Rice Germ in Patients with Insomnia Symptoms: A Randomized, Double- Blind Trial. J Clin Neurol. 2018;14(3):291–295. https://doi.org/10.3988/jcn.2018.14.3.291.Смирнова А.А., Живолупов С.А. Патогенетические механизмы когнитивных нарушений при цереброваскулярной патологии и перспективы их коррекции с помощью ноотропных и нейропротекторных средств. Медицинский совет. 2023;(6):85–93. https://doi.org/10.21518/ms2023-099.Mitrokhin K.V., Baranishin A.A. Classification and brief description of drug analogues, derivatives of gamma- aminobutyric acid and toxic substancesinfluencing GABA-ergic connections. Russian Journal of Anaesthesiology and Reanimatology. 2018;(6):22–30. (In Russ.) https://doi.org/10.17116/anaesthesiology201806122.Захаров В.В., Бородулина И.В., Вахнина Н.В. Лечение больных с хронической ишемией головного мозга: опыт применения комбинированного нейропротективного препарата Пикамилон Гинкго. Журнал неврологии и психиатрии им. С.С. Корсакова. 2022;122(9):95–103. https://doi.org/10.17116/jnevro202212209195.Smirnova A.A., Zhivolupov S.A. Pathogenetic mechanisms of cognitive impairment in cerebrovascular pathology and prospects for their correction using nootropic and neuroprotective agents. Meditsinskiy Sovet. 2023;(6):85–93. (In Russ.) https://doi.org/10.21518/ms2023-099.Путилина М.В. Коморбидный пациент в реальной клинической практике. Consilium Medicum. 2017;19(2):71–79. Режим доступа: https://omnidoctor.ru/upload/iblock/321/321a55a22e6fafb6c3d1cab9526979a3.pdf.Zaharov V.V., Borodulina I.V., Vakhnina N.V. Treatment of patients with chronic cerebral ischemia: experience of using the combined neuroprotective drug Picamilon Ginkgo. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2022;122(9):95–103. (In Russ.) https://doi.org/10.17116/jnevro202212209195.Putilina M.V. Patient comorbidity in clinical practice. Consilium Medicum. 2017;19(2):71–79. (In Russ.) Available at: https://omnidoctor.ru/upload/iblock/321/321a55a22e6fafb6c3d1cab9526979a3.pdf.Putilina M.V. Patient comorbidity in clinical practice. Consilium Medicum. 2017;19(2):71–79. (In Russ.) Available at: https://omnidoctor.ru/upload/iblock/321/321a55a22e6fafb6c3d1cab9526979a3.pdf.

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