geriatrРоссийский журнал гериатрической медициныRussian Journal of Geriatric Medicine2686-86362686-8709Сайт издателя10.37586/2686-8636-3-2020-236-242geriatr-61Research ArticleОБЗОРЫREVIEWSСмешанная деменция у пациента, перенесшего инсультMixed dementia in stroke patienthttps://orcid.org/0000-0002-9054-0881ЧердакМ. А.CherdakM. A.

Чердак Мария Алексеевна - кандидат медицинских наук, ассистент кафедры болезней старения ФДПО ФГАОУ ВО РНИМУ имени Н.И. Пирогова Минздрава России.

Москва.

Телефон: +7(926)5604289

MD, PhD, Assistant Professor of Department of aging diseases, Faculty of additional professional education, Pirogov Russian National Research Medical University.

Moscow.

+7(926)5604289

maria.cherdak@yandex.ruРНИМУ им. Н.И. Пирогова Минздрава России, кафедра болезней старения ФДПОРоссияPirogov Russian National Research Medical University, Faculty of Additional Professional Education, Department of Aging DiseasesRussian Federation20200209202003236242Copyright © Чердак М.А., 20202020Чердак М.А.Cherdak M.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.geriatr-news.com/jour/article/view/61

Развитие инсульта сопряжено с высоким риском последующих когнитивных расстройств. Длительное наблюдение за больными, перенесшими инсульт, свидетельствует о том, что в значительной части случаев в развитии постинсультных когнитивных нарушений играют роль нейродегенеративные изменения, характерные для болезни Альцгеймера. Взаимосвязь между сосудистым и нейродегенеративным компонентами сложна, а прижизненная диагностика болезни Альцгеймера у лиц, перенесших инсульт, сопряжена с выраженными сложностями. Учитывая аддитивные и синергические эффекты сосудистого и нейродегенеративного компонентов, способствующие более злокачественному течению заболевания, различную эффективность и переносимость базисных противодементных средств, дифференциальная диагностика «чистой» сосудистой и смешанной деменции может иметь принципиальное значение. Приведен клинический случай, наглядно демонстрирующий проблемы, связанные с дифференциальной диагностикой и ведением пациента с КР после перенесенного инсульта. Описаны современные возможности лабораторной и инструментальной диагностики, повышающей точность прижизненного выявления сопутствующего нейродегенеративного процесса альцгеймеровского типа. Показана корреляция параклинических данных с особенностями нейропсихологического статуса, позволяющими заподозрить сопутствующую болезнь Альцгеймера. Продемонстрирована тесная взаимосвязь когнитивных и других нервно-психических расстройств у пациента, перенесшего инсульт.

The stroke is linked to the high risk of the subsequent cognitive impairment. At the same time results of longitudinal studies suggest that in many patients main factor of post-stroke cognitive impairment is neurodegenerative changes, typical for Alzheimer's disease. Relationship of vascular and neurodegenerative components of post-stroke dementia is very complex and diagnostic of co-occurring Alzheimer's disease in stroke survivors is associated with severe difficulties. Differentiation of pure vascular and mixed dementia after stroke may be critical due to the additive and synergistic effects of vascular and neurodegenerative components associated with poorer prognosis and possible differences in effectiveness and tolerability of basic anti-dementia drugs. Presented clinical case illustrates modern methods of laboratory and instrumental diagnostics that facilitates the identification of concomitant Alzheimer's disease. Correlation of non-clinic data with specific neuropsychological pattern of possible concomitant Alzheimer's disease is shown. A close relationship of cognitive and other neuropsychiatric disorders in a patient who had a stroke is noted.

инсульткогнитивные нарушениянервно-психические расстройстваболезнь Альцгеймерамаркеры нейродегенерациисмешанная деменцияstrokeneuropsychiatric disorderscognitive impairmentAlzheimer's diseaseneurodegeneration biomarkersmixed dementiaReferencesMok V., Leung E., Chu W. et al. Pittsburgh compound B binding in poststroke dementia. J Neurol Sci. 2010; 290(1-2): 135-137. DOI: 10.1016/j.jns.2009.12.014.Mok V., Leung E., Chu W. et al. Pittsburgh compound B binding in poststroke dementia. J Neurol Sci. 2010; 290(1-2): 135-137. DOI: 10.1016/j.jns.2009.12.014.Cai Z., Wang C., He W., et al. Cerebral small vessel disease and Alzheimer's disease. Clinical Interventions in Aging. 2015; 10: 1695-1704. DOI: 10.2147/CIA.S90871.Cai Z., Wang C., He W., et al. Cerebral small vessel disease and Alzheimer's disease. Clinical Interventions in Aging. 2015; 10: 1695-1704. DOI: 10.2147/CIA.S90871.Attems J., Jellinger K.A. The overlap between vascular disease and Alzheimer's disease — lessons from pathology. BMC Med. 2014; 12: 206. DOI: 10.1186/s12916-014-0206-2.Attems J., Jellinger K.A. The overlap between vascular disease and Alzheimer's disease — lessons from pathology. BMC Med. 2014; 12: 206. DOI: 10.1186/s12916-014-0206-2.Azarpazhooh M.R., Avan A., Cipriano L.E., et al. A third of community-dwelling elderly with intermediate and high level of Alzheimer's neuropathologic changes are not demented: A meta-analysis. Ageing Res Rev. 2020; 58: 101002. DOI: 10.1016/j.arr.2019.101002.Azarpazhooh M.R., Avan A., Cipriano L.E., et al. A third of community-dwelling elderly with intermediate and high level of Alzheimer's neuropathologic changes are not demented: A meta-analysis. Ageing Res Rev. 2020; 58: 101002. DOI: 10.1016/j.arr.2019.101002.Benjamin E.J., Blaha M.J., Chiuve S.E., et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10): e146-e603. DOI: 10.1161/CIR.0000000000000485.Benjamin E.J., Blaha M.J., Chiuve S.E., et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10): e146-e603. DOI: 10.1161/CIR.0000000000000485.Sun J.H., Tan L., Yu J.T. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med. 2014; 2(8): 80. DOI: 10.3978/j.issn.2305-5839.2014.08.05.Sun J.H., Tan L., Yu J.T. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med. 2014; 2(8): 80. DOI: 10.3978/j.issn.2305-5839.2014.08.05.Pendlebury S.T., Rothwell P.M.; Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019; 18: 248-258. DOI: 10.1016/S1474-4422(18)30442-3.Pendlebury S.T., Rothwell P.M.; Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019; 18: 248-258. DOI: 10.1016/S1474-4422(18)30442-3.Barba R., Castro M.D., del Mar Morin M., et al. Prestroke dementia. Cerebrovasc Dis. 20020 11(3): 21224. DOI: 10.1159/000047642.Barba R., Castro M.D., del Mar Morin M., et al. Prestroke dementia. Cerebrovasc Dis. 20020 11(3): 21224. DOI: 10.1159/000047642.Kavirajan H., Schneider L.S. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomised controlled trials. Lancet Neurol. 2007; 6(9): 782-792. DOI: 10.1016/S1474-4422(07)70195-3.Kavirajan H., Schneider L.S. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomised controlled trials. Lancet Neurol. 2007; 6(9): 782-792. DOI: 10.1016/S1474-4422(07)70195-3.McAleese K.E., Alafuzoff I., Charidimou A., et al. Post-mortem assessment in vascular dementia: advances and aspirations. BMC Med. 2016; 14(1): 129. DOI: 10.1186/s12916-016-0676-5.McAleese K.E., Alafuzoff I., Charidimou A., et al. Post-mortem assessment in vascular dementia: advances and aspirations. BMC Med. 2016; 14(1): 129. DOI: 10.1186/s12916-016-0676-5.Reitz C. Toward precision medicine in Alzheimer's disease. Annals of Translational Medicine. 2016; 4(6): 107. DOI: 10.21037/atm.2016.03.05.Reitz C. Toward precision medicine in Alzheimer's disease. Annals of Translational Medicine. 2016; 4(6): 107. DOI: 10.21037/atm.2016.03.05.Brainin M., Tuomilehto J., Heiss W.D., et al. Post-stroke cognitive decline: an update and perspectives for clinical research. Eur J Neurol. 2015; 22(2): 229-e16. DOI: 10.1111/ene.12626.Brainin M., Tuomilehto J., Heiss W.D., et al. Post-stroke cognitive decline: an update and perspectives for clinical research. Eur J Neurol. 2015; 22(2): 229-e16. DOI: 10.1111/ene.12626.Savva G.M., Stephan B.C.; Alzheimer's Society Vascular Dementia Systematic Review Group. Epidemiological studies of the effect of stroke on incident dementia: a systematic review. Stroke. 2010; 41(1): e41-e46. DOI: 10.1161/STROKEAHA.109.559880.Savva G.M., Stephan B.C.; Alzheimer's Society Vascular Dementia Systematic Review Group. Epidemiological studies of the effect of stroke on incident dementia: a systematic review. Stroke. 2010; 41(1): e41-e46. DOI: 10.1161/STROKEAHA.109.559880.Fanning J.P., Wong A.A., Fraser J.F. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Medicine. 2014; 12: 119. DOI: 10.1186/s12916-014-0119-0.Fanning J.P., Wong A.A., Fraser J.F. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Medicine. 2014; 12: 119. DOI: 10.1186/s12916-014-0119-0.Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010; 9(7): 689-701. DOI: 10.1016/S1474-4422(10)70104-6.Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010; 9(7): 689-701. DOI: 10.1016/S1474-4422(10)70104-6.Дамулина А.И., Коновалов Р.Н., Кадыков А.С. Постинсультные когнитивные нарушения. Неврологический журнал. 2015; 20(1): 12-19. DOI: 10.18821/1560-9545-2015-20-1-12-19.Damulina A.I., Konovalov R.N., Kadykov A.S. Poststroke cognitive impairments. Nevrologicheskiy zhurnal. 2015; 20(1): 12-19. (In Russ.) DOI: 10.18821/1560-9545-2015-20-1-12-19.Jack C.R. Jr, Albert M.S., Knopman D.S., et al. Introduction to the recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7(3): 257-262. DOI: 10.1016/j.jalz.2011.03.004.Jack C.R. Jr, Albert M.S., Knopman D.S., et al. Introduction to the recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7(3): 257-262. DOI: 10.1016/j.jalz.2011.03.004.Csukly G., Siraly E., Fodor Z., et al. The Differentiation of Amnestic Type MCI from the Non-Amnestic Types by Structural MRI. Front Aging Neurosci. 2016; 8: 52. DOI: 10.3389/fnagi.2016.00052.Csukly G., Siraly E., Fodor Z., et al. The Differentiation of Amnestic Type MCI from the Non-Amnestic Types by Structural MRI. Front Aging Neurosci. 2016; 8: 52. DOI: 10.3389/fnagi.2016.00052.Matsui T., Nemoto M., Maruyama M., et al. Plasma homocysteine and risk of coexisting silent brain infarction in Alzheimer's disease. Neurodegener Dis. 2005; 2(6): 299-304. DOI: 10.1159/000092316.Matsui T., Nemoto M., Maruyama M., et al. Plasma homocysteine and risk of coexisting silent brain infarction in Alzheimer's disease. Neurodegener Dis. 2005; 2(6): 299-304. DOI: 10.1159/000092316.Мхитарян Э.А., Преображенская И.С. Болезнь Альцгеймера и цереброваскулярные расстройства. Неврологический журнал. 2006; 11(1): 31-36.Mkhitaryan E.A., Preobrazhenskaya I.S. Alzheimer's disease and cerebrovascular disorders. Nevrologicheskii zhurnal. 2006; 11(1): 31-36. (In Russ.).Kimberly W.T., Gilson A., Rost N.S., et al. Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology. 2009; 72(14): 1230-1235. DOI: 10.1212/01.wnl.0000345666.83318.03.Kimberly W.T., Gilson A., Rost N.S., et al. Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology. 2009; 72(14): 1230-1235. DOI: 10.1212/01.wnl.0000345666.83318.03.Концевой В.А., Скворцова В.И., Петрова У.А., Савина М.А. Депрессия и парадепрессивные расстройства при церебральном инсульте: эпидемиология, патогенез и факторы риска. Журнал неврологии и психиатрии имени С.С. Корсакова. 2009; 109(8): 4-10.Kontsevoi V.A., Skvortsova V.I., Petrova E.A., Savina M.A. Depression and Paradepressive Disorders in Cerebral Stroke: Epidemiology, Pathogenesis and Risk Factors. Zh Nevrol Psikhiatr Im S.S. Korsakova. 2009; 109(8): 4-10. (In Russ.).Скворцова В.И., Концевой В.А., Савина М.А., Петрова Е.А., Серпуховитина И.А., Шанина Т.В. Постинсультное генерализованное тревожное расстройство: эпидемиология, диагностика, клиническая типология. Журнал неврологии и психиатрии имени С.С. Корсакова. 2010;110(9): 4-7.Skvortsova V.I., Kontsevoi V.A., Savina M.A., Petrova E.A., Serpukhovitina I.A., Shanina T.V. Zh Nevrol Psikhiatr Im S.S. Korsakova. 2010; 110(9): 4-7. (In Russ.).Jorge R.E., Starkstein S.E., Robinson R.G. Apathy following stroke. Can J Psychiatry. 2010; 55(6): 350-354. DOI: 10.1177/070674371005500603.Jorge R.E., Starkstein S.E., Robinson R.G. Apathy following stroke. Can J Psychiatry. 2010; 55(6): 350-354. DOI: 10.1177/070674371005500603.Kalashnikova L.A., Gulevskaya T.S., Kashina E.M. Disorders of higher mental function due to single infarctions in the thalamus and in the area of the thalamofrontal tracts. Neurosci Behav Physiol. 1999; 29(4): 397-403. DOI: 10.1007/BF02461075.Kalashnikova L.A., Gulevskaya T.S., Kashina E.M. Disorders of higher mental function due to single infarctions in the thalamus and in the area of the thalamofrontal tracts. Neurosci Behav Physiol. 1999; 29(4): 397-403. DOI: 10.1007/BF02461075.Kumral E., Evyapan D., Balkir K. Acute caudate vascular lesions. Stroke. 1999; 30(1): 100-108. DOI: 10.1161/01.str.30.1.100.Kumral E., Evyapan D., Balkir K. Acute caudate vascular lesions. Stroke. 1999; 30(1): 100-108. DOI: 10.1161/01.str.30.1.100.Rahme R., Moussa R., Awada A., et al. Acute Korsakoff-like amnestic syndrome resulting from left thalamic infarction following a right hippocampal hemorrhage. AJNR Am J Neuroradiol. 2007; 28(4): 759-760.Rahme R., Moussa R., Awada A., et al. Acute Korsakoff-like amnestic syndrome resulting from left thalamic infarction following a right hippocampal hemorrhage. AJNR Am J Neuroradiol. 2007; 28(4): 759-760.Кутлубаев М.А., Менделевич В.Д., Ахмадеева Л.Р. Проблема агрессивного поведения после инсульта. Неврологический журнал. 2017; 22(3): 142147.Kutlubaev M.A., Mendelevich V.D., Akhmadeeva L.R. The problem of aggressive behavior after stroke. Nevrologicheskiy Zhurnal. 2017; 22(3): 142-147. (In Russ.).Burns A. Neuropsychiatric phenomena in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2001; 71(6): 715. DOI: 10.1136/jnnp.71.6.715.Burns A. Neuropsychiatric phenomena in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2001; 71(6): 715. DOI: 10.1136/jnnp.71.6.715.Douiri A., McKevitt C., Emmett E.S., Rudd A.G., Wolfe C.D. Long-term effects of secondary prevention on cognitive function in stroke patients. Circulation. 2013; 128(12): 341-1348. DOI: 10.1161/CIRCULATIONAHA.113.002236.Douiri A., McKevitt C., Emmett E.S., Rudd A.G., Wolfe C.D. Long-term effects of secondary prevention on cognitive function in stroke patients. Circulation. 2013; 128(12): 341-1348. DOI: 10.1161/CIRCULATIONAHA.113.002236.

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