Cognitive impairment in patients with chronic cerebral ischemia (discirculatory encephalopathy)

Chronic cerebral ischemia (CCI), also known as discirculatory encephalopathy (DE), is one of the most common diagnoses in Russian neurological practice. In patients diagnosed with CCI or DE, assessing cognitive function (CF) is essential for distinguishing between individuals with and without cognitive impairment (CI). If CI is present in a patient with CCI or DE, comorbid Alzheimer's disease (AD) or other neurodegenerative disorders affecting CF should be considered. Neuropsychological assessment (identifying amnestic syndrome) and MRI of the brain (evidence of hippocampal atrophy) can raise suspicion for AD, with definitive diagnosis relying on detection of biological markers of the disease. Unfortunately, many patients with AD are long misdiagnosed with CCI or DE and thus do not receive appropriate treatment. Patients with a diagnosis of CCI or DE and preserved CF often suffer from other neurological or psychiatric disorders, most frequently anxiety-depressive disorders, primary headaches (tension-type headache, migraine, medication-overuse headache), peripheral vestibulopathy, or persistent postural-perceptual dizziness. Managing patients with CI requires controlling vascular risk factors, preventing stroke, applying psychosocial interventions, and encouraging household, social, physical, and intellectual activity. In the dementia stage, cognitive function may be improved by central acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the glutamate receptor antagonist memantine. The efficacy and safety of choline alfoscerate in patients with AD and cerebrovascular disease are also discussed.