Introduction. The problem of cognitive impairment of vascular genesis takes an important place in modern angioneurology. Verification of changes occurring in the brain is carried out with the help of neuroimaging methods; and functional magnetic resonance imaging (fMRI) may reveal the main points of pharmacological activity of drugs with the declared neurometabolic effect with a greater probability.
Objective. Objectivization of the effect of basic angioneurological drugs on the cognitive sphere in patients with chronic cerebrovascular diseases.
Materials and methods. A detailed analysis of the neuropsychological sphere (cognitive tests) and neuroimaging results by studying a pharmacological fMRI of the brain with a cognitive paradigm was carried out for 154 patients with discirculatory encephalopathy.
Results. Despite similar clinical indications for the use of vinpocetine (cavinton), cortexin, cerebrolysin, and actovegin, the mechanism of their action at the cellular level, identified with fMRI, was different. The vasoactive and antiplatelet clinical effect of vinpocetine is supplemented with new data on the improvement of cerebral neuroplasticity due to the expansion of the activation zones and intensification of the signal intensity from them, as well as the emergence of new activation zones in the projection of associative fibers. Cerebrolysin and cortexin with a neurotrophic effect lead to a narrowing of the activation zones, both of the main cognitive zones and of the associative regions, which may indicate a decrease in brain energy expenditure during the cognitive loads. Given protective function of drugs appears in a positive cerebroprotective effect. During treatment with actovegin, fMRI revealed a primary increase in activation of the hippocampal brain zones responsible for improving cognitive functions, which reveals the polymodal effect of the drug, with neuroprotective action among the others.
Conclusions. The use of pharmacological fMRI together with a complex clinical and laboratory studies allows us to discover new aspects of the effect of drugs and to justify the need for a personalized approach in the treatment of cognitive impairment.
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