New approaches to correction of cognitive impairment in cerebrovascular diseases

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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.

About the authors

Мarine М. Tanashyan

Research Center of Neurology

Author for correspondence.
ORCID iD: 0000-0002-5883-8119

D. Sci. (Med.), Prof., Corresponding member of RAS, Deputy Director for science, Head, 1st Neurological department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Rodion N. Konovalov

Research Center of Neurology

ORCID iD: 0000-0001-5539-245X

Cand. Sci. (Med.), senior researcher, Neuroradiology department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Olga V. Lagoda

Research Center of Neurology

Russian Federation, Moscow


  1. Suslina Z.A., Varakin Yu.Ya. Klinicheskoye rukovodstvo po ranney diagnostike, lecheniyu i profilaktike sosudistykh zabolevaniy golovnogo mozga [Clinical guidelines for early diagnosis, treatment and prevention of cerebrovascular diseases]. Мoscow; 2015. 440 p. (In Russ.).
  2. Zakharov V.V. [Cognitive disorders without dementia: classification, underlying causes and treatment]. Effektivnaya farmakoterapiya 2016; (1): 22–31. (In Russ.).
  3. O'Brien J., Ames D., Gustafson L. et al. (eds.) Cerebrovascular disease, cognitive impairment and dementia. Second edition of Cerebrovascular disease and dementia. L.; 2004.
  4. Preobrazhenskaya I.S., Yakhno N.N. [Age-related cognitive dysfunction: diagnosis and treatment]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakov 2006; 11(106): 33–38. (In Russ.).
  5. Shprakh V.V., Sayutina S.B., Romazina Т.А. Lecheniye kognitivnykh narusheniy pri serdechno-sosudistykh zabolevaniyakh [Treatment of cognitive disorders in cardiovascular diseases]. Irkutsk; 2009. 24 p. (In Russ.).
  6. Bullmore E. The future of functional MRI in clinical medicine. Neuroimage 2012; 62: 1267–1271. doi: 10.1016/j.neuroimage.2012.01.026. PMID: 22261374.
  7. Nathan P.J., Phan K.L., Harmer C.J. et al. Increasing pharmacological knowledge about human neurological and psychiatric disorders through functional neuroimaging and its application in drug discovery. Curr Opin Pharmacol 2014; 14: 54–61. doi: 10.1016/j.coph.2013.11.009. PMID: 24565013.
  8. Shmidt E.V. [Classification of vascular lesions of the brain and spinal cord]. Zhurnal nevropatologii i psikhiatrii im. S.S. Korsakova 1985; 85(9): 1281–1288. (In Russ.).
  9. Stakhovskaya L.V. (ed.) Klinicheskiye rekomendatsii po vedeniyu bol'nykh s ishemicheskim insul'tom i tranzitornymi ishemicheskimi atakami [Clinical recommendations for management of patients with ischemic stroke and transient ischemic attacks]. Мoscow; 2017. 208 p. (In Russ.).
  10. Tanashyan M.M., Lagoda O.V., Fedin P.A. et al. [The use of vinpocetine for the treatment of cognitive impairment in patients with chronic cerebrovascular diseases]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova 2007; 107(10): 41–43. (In Russ.).
  11. Strokov I.A., Fedorova O.S., Fokina A.S., Golovacheva V.A. [Actovegin: mechanisms of action and effectiveness in neurological complications of diabetes mellitus]. Atmosfera. Nervnyye bolezni 2012; 3: 21–26. (In Russ.).
  12. Piradov M.A., Tanashyan M.M., Domashenko M.A., Maksimova M.Yu. [Neuroprotection in cerebrovascular diseases: a search for life on Mars or a promising direction of treatment? Part 2. Chronic forms of disorders of cerebral circulation]. Annals of clinical and experimental neurology 2015; 9(3): 10–19. (In Russ.).
  13. Mehta M.A., O’Daly O.G. Pharmacological application of fMRI. Methods Mol Biol 2011; 711: 551–565. doi: 10.1007/978-1-61737-992-5_28. PMID: 21279622.
  14. Borsook D., Becerra L., Hargreaves R. A role for fMRI in optimizing CNS drug development. Nat Rev Drug Discov 2006; 5: 411–424. doi: 10.1038/nrd2027. PMID: 16604100.
  15. Zhivolupov S.A., Samartsev I.N., Yakovlev E.V. et al. [Evaluation of the efficacy of vinpocetine (Cavinton Comforte) in the treatment of vertigo in patients with dyscirculatory encephalopathy according to the level of the neurotrophic brain factor (BDNF) in blood plasma]. Klinicheskaya farmakologiya i terapiya 2016; 25(1): 49–54. (In Russ.).
  16. Tanashyan M.M., Lagoda O.V., Fedin P.A. [Modern approaches to the treatment of patients with chronic vascular diseases of the brain]. Atmosfera. Nervnyye bolezni 2010; (4): 19–22. (In Russ.).
  17. Shavlovskaya O.A. [New aspects of the use of Actovegin: from the mechanisms of action to clinical effects]. Effektivnaya farmakoterapiya. Nevrologiya 2016; (2): 2–6. (In Russ.).
  18. Tanashyan M.M., Barkhatov D.Yu. [Metabolic therapy in neurology: new approaches]. Russkiy meditsinskiy zhurnal 2012; 20(8): 406–408. (In Russ.).
  19. Logothetis N.K. What we can do and what we cannot do with fMRI. Nature 2008; 453: 869–78. doi: 10.1038/nature06976. PMID: 18548064.

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Copyright (c) 2018 Tanashyan M.М., Konovalov R.N., Lagoda O.V.

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