Diagnosis and treatment of cognitive impairment in outpatient practice

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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