Амбулаторное ведение пациентов с сосудистыми когнитивными нарушениями

Возрастные когнитивные нарушения являются одной из основных проблем общественного здравоохранения нашего времени. Сосудистые когнитивные нарушения включают весь спектр когнитивных нарушений, начиная от клинически легких, которые проявляются только при когнитивном тестировании, и заканчивая умеренными и выраженными, доходящими до степени деменции. Сосудистые когнитивные нарушения определяют весь спектр неврологических расстройств, вызванных сосудистыми заболеваниями головного мозга. Неврология когнитивных нарушений в более позднем возрасте часто представляет собой смесь сосудистой патологии, болезни Альцгеймера и других нейродегенеративных заболеваний, которые накладываются друг на друга и увеличивают риск развития когнитивных нарушений. Когнитивные нарушения проявляются в прогрессирующей потере способностей к обучению, ухудшению памяти и внимания, что приводит к росту зависимости и социальной изоляции. Цереброваскулярные факторы риска распространены среди пожилых людей и являются основными факторами, способствующими развитию сосудистых когнитивных нарушений. К наиболее распространенным сосудистым факторам риска относят артериальную гипертензию, высокий уровень холестерина, сахарный диабет и курение, которые широко встречаются в популяции. Основными причинами сосудистых когнитивных нарушений считаются острые нарушения мозгового кровообращения, немые (бессимптомные) инфаркты и микрокровоизлияния в сочетании с изменением структуры и плотности белого вещества или без них. Церебральная болезнь мелких сосудов является одной из наиболее актуальных из-за ее влияния с точки зрения социально-экономического бремени. Определение вклада сосудистых заболеваний в развитие сосудистых когнитивных нарушений значительно облегчается с использованием нейровизуализации, в частности магнитно-резонансной томографии. В настоящее время не существует специфических методов лечения сосудистых когнитивных нарушений, но рекомендуются стандартные меры профилактики инсульта. Мультимодальные вмешательства, включающие модификацию сосудистых факторов риска и образа жизни, в настоящее время являются наиболее перспективной стратегией лечения и профилактики. Холинергические предшественники были одними из первых соединений, использованных для лечения когнитивных нарушений.

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