Сiticoline in the treatment of cognitive impairments in cerebral microangiopathy

Cerebral microangiopathy (CMА), also known as cerebral small vessel disease (CSVD), is characterized by impairment of multiple cognitive functions, including executive functions, processing speed, memory and behavior condition. These impairments are primarily associated with disruption of frontal-subcortical networks resulting from white matter damage. An additional contribution to cognitive deficit is made by vascular lesions of subcortical structures, such as the thalamus and basal ganglia. Citicoline is one of the promising and pharmacologically substantiated drugs for the treatment of cognitive impairment (CI) in СМА. Efficacy of сiticoline is due to impact on key mechanisms of brain damage. Citicoline stabilizes cell membranes by inhibiting the activity of phospholipases – enzymes that trigger apoptosis (programmed cell death) under conditions of ischemia and hypoxia. This effect is particularly important in СМА, as chronic impairment of cerebral blood flow causes the death of oligodendrocytes, which are responsible for myelin formation, and neurons. The results of clinical studies confirm the ability of Citicoline to improve cognitive functions, primarily information processing speed and executive functions. Furthermore, longterm use of Citicoline stimulates endogenous mechanisms of neurogenesis and regeneration of nervous tissue. This article presents a clinical case of CMA with CI. The patient’s main complaints were poor concentration, fatigue and memory impairment. In addition to standard therapy, including antihypertensive, lipid-lowering and antiplatelet drugs, the patient was prescribed сiticoline: initially intravenously at 1000 mg/day for 10 days, then orally at 1000 mg/day for 6 months. After 6 months of taking сiticoline, the patient reported an increase in the ability to work and improvement in memory recall. A follow-up examination also revealed positive dynamics: an improvement in cognitive status measured by the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination (ACE) scales. The obtained data indicate the high efficacy of сiticoline in the correction of CI and allow to recommend its inclusion in the complex therapy of patients with CMA.

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