medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-266medsovet-9343Research ArticleНЕВРОЛОГИЯNEUROLOGYДиагноз и лечение когнитивных нарушений в амбулаторной практикеDiagnosis and treatment of cognitive impairment in outpatient practicehttps://orcid.org/0000-0002-1992-7960ПарфеновВ. А.ParfenovV. A.

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

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Vladimir A. Parfenov, Dr. Sci. (Med.), Professor, Head of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University

8, Bldg. 2, Trubetskaya St., Moscow, 119991

vladimirparfenov@mail.ruhttps://orcid.org/0000-0002-0246-5149СилинаЕ. В.SilinaE. V.

Силина Екатерина Владимировна, д.м.н., профессор кафедры патологии человека Института профессионального образования врачей

119991, Москва, ул. Трубецкая, д. 8, стр. 2

katerina V. Silina, Dr. Sci. (Med.), Professor of the Department of Human Pathology, Institute of Professional Education of Physicians

8, Bldg. 2, Trubetskaya St., Moscow, 119991

silinaekaterina@mail.ruhttps://orcid.org/0009-0000-6787-0287ДаниелянA. Р.DanielyanA. R.

Даниелян Ася Рубеновна, клинический ординатор кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Asya R. Danielyan, Clinical Resident of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

8, Bldg. 2, Trubetskaya St., Moscow, 119991

as.danielyan.msk@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation20251009202519134854Copyright © Парфенов В.А., Силина Е.В., Даниелян A.Р., 20252025Парфенов В.А., Силина Е.В., Даниелян A.Р.Parfenov V.A., Silina E.V., Danielyan A.R.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/9343

Ведение пациентов с когнитивными нарушениями (КН) представляет собой одну из актуальных проблем современной медицины и осуществляется преимущественно в амбулаторной практике. Болезнь Альцгеймера (БА), вызванные цереброваскулярным заболеванием (ЦВЗ) КН и их сочетание являются наиболее частой причиной снижения когнитивных функций в пожилом возрасте. Диагноз КН основывается на результатах нейропсихологического обследования, наличии нейровизуализационных признаков ЦВЗ и/или БА, отсутствии данных о других причинах КН. При нейропсихологическом обследовании при КН, вызванных церебральной микроангиопатией, обычно обнаруживаются нарушения управляющих функций, замедленность умственной деятельности, снижение концентрации внимания, при БА – снижение памяти на текущие события (амнестический тип КН). Многие пациенты с БА длительно наблюдаются с ошибочным диагнозом «хроническая ишемия головного мозга» или «дисциркуляторная энцефалопатия». В последние годы для точной диагностики БА в нашей стране используются биологические маркеры заболевания. Для БА характерно снижение концентрации бета-амилоида (низкий уровень Αβ42, увеличен е соотношения Aβ40/Aβ42) и повышение уровней общего и фосфорилированного тау-протеина в цереброспинальной жидкости. Ведущее значение для предупреждения развития и прогрессирования КН имеют коррекция сосудистых факторов риска, регулярная физическая и умственная активность, когнитивный тренинг, выявление и эффективное лечение сочетанных заболеваний, включая эмоциональные нарушения и расстройства сна. На стадии выраженных КН (деменции) для улучшения когнитивных функций эффективны ингибиторы центральной ацетилхолинэстеразы (донепезил, ривастигмин, галантамин) и блокатор глутаматных рецепторов мемантин. Обсуждаются вопросы эффективности и безопасности применения цитиколина при КН разной степени выраженности.

Management of patients with cognitive impairment (CI) is one of the topical problems of modern medicine and is carried out mainly in outpatient practice. Alzheimer’s disease (AD) and cerebrovascular disease (CVD)-induced CI and their combination represent the most common cause of cognitive decline in the elderly. The diagnosis of CVD is based on the results of neuropsychological examination, the presence of neuroimaging signs of CVD and/or AD, and the absence of evidence for other causes of CVD. During a neuropsychological examination of CI caused by cerebral microangiopathy, disorders of executive functions are usually detected: slow mental activity, decreased concentration; in AD, decreased memory for current events (amnestic type of CI). Many patients with AD are observed for a long time with a misdiagnosis of chronic cerebral ischemia or dyscirculatory encephalopathy. In recent years, biological markers of the disease have been used for accurate diagnosis of AD in our country. AD is characterized by a decrease in the concentration of beta-amyloid (low level of Αβ42, an increase in the ratio of Aβ40/Aβ42) and an increase in the levels of total and phosphorylated tau protein in the cerebrospinal fluid. Correction of vascular risk factors, regular physical and mental activity, cognitive training, identification and effective treatment of comorbidities, including emotional and sleep disorders, are of leading importance for prevention of development and progression of CVD. At the stage of pronounced CI (dementia), central acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and glutamate receptor blocker memantine are effective for cognitive function improvement. The issues of efficacy and safety of citicoline use in CI of different severity are discussed.

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