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The influence of the nature of the atherosclerotic stenizing lesion on the clinical picture of cognitive impairment (KN) has not been sufficiently studied.

The purpose of the study is to assess the effect of the degree and localization of the atherosclerotic stenosis process on cerebral perfusion and the state of cognitive functions.

Patients and methods. 123 patients were examined (65 men and 58 women) aged 50 to 75 years old, having stenoses of brachiocephalous arteries at least 40%, without arterial hypertension, diabetes mellitus or other systemic vascular pathology. The structural state of the substance of the brain and the state of cerebral blood flow were evaluated using magnetic resonance imaging and magnetic resonance angiography. To determine the changes in the white matter, the P. Scheltens scale et al. The localization and degree of the stenosis process was evaluated by extracronal and transcranial duplex scanning by the method of extracranial and transcranial. Prince was determined using a set of neuropsychological scales. The Hamilton depression was also used.

Ascension and discussion. Most of the brachiocephalous arteries examined against the background of atherosclerosis revealed varying severity of the Prince. The most severe KNs were associated with the defeat of the parietal and frontal lobes. A reliable deterioration of cognitive functions was observed as the percentage of stenosis increases: with stenosis in the carotid system, more severe KNs were observed than with stenosis in the vertebral basin. In addition, in patients with combined stenosis and tandem stenosis, more pronounced KN were noted compared to patients with stenosis of the same artery. It is shown that cerebral atherosclerosis is one of the main risk factors for the development of Prince. The influence of not only degrees is noted, but also to a greater extent localization of stenosis on the occurrence of KN, accompanied by the development of perfusion deficiency in specific vascular pools. Determining the nature of the stenosis process will allow to predict the development of KN in patients with atherosclerosis and choose the appropriate treatment tactics.

Key words: atherosclerosis; stenosis of brachiocephalous arteries; Cognitive disorders.

The purpose of the study is to study the state of cerebrovascular reactivity (CVR) and structural changes in the substance of the brain in patients with moderate cognitive disorders.

Patients and methods. 385 patients aged 57 to 79 years with moderate vascular cognitive disorders (SKN) were examined. The relationship of clinical variants of SKN and depression with the volume and localization of ischemic damage to the brain substance, as well as with the state of CVR in various vascular pools at the stage of inclusion in the study and after 20 months, has been studied.

Results. The connection of the neuropsychological profile and the severity of the SKN with the features of structural damage to the substance of the brain was revealed, but to a greater extent with a decrease in the CVR in the carbon arteries (SA) system and a combined decrease in the CVR in the CA and the verteba -basial basin (VBB). The association of the frequency of development of depression with the localization of ischemic damage in the frontal lobes and a decrease in the CVR in CA on the left, as well as a combined decrease in the CVR and VBB, has been established.

Conclusion. The state of the CVR, determined in various vascular pools, can serve as an early prognostic sign of developing SKN or depression.

Key words: vascular cognitive impairment; cognitive and emotional disorders; Cerebrovascular reactivity.

Changes in the cognitive sphere during aging in the Russian population are not understood enough.

The purpose of the study is to evaluate the dynamics of indicators of cognitive functions (KF) in two serial dimensions over 9 years in the city population of medium, elderly and senile age and their relationship with the level of education.

Patients and methods. The random population sample of men and women is 45–69 years old, residents of Novosibirsk (n = 9360; the Hapiee project) was examined. CF testing is performed by standard methods. A repeated examination was carried out in a random subsidiary (n = 1663) included in this analysis. The average observation period was 8.8 years (SD = 1.1).

Results and discussion. In the test on semantic fluency of speech, a dynamic decrease was revealed in all age groups, more pronounced in women than in men (p <0.001). Persons 70 years and older have a negative dynamics of memory indicators, semantic speech activity and concentration of attention (p <0.001). In persons with primary (8th and less classes of high school; 6%) and professional (26%) levels of education, a high speed of reducing indicators in the test of delayed reproduction (p = 0.011; 0.038) was revealed than in persons with higher education (35%). Conclusion. It was established that the dynamic reduction of the KF begins at the age of 55–59 years, it is more pronounced in a group of people 70 years and older. The age regression of the memory function was accelerated by participants with a low level of education.

Keywords: cognitive functions; age dynamics; cognitive decrease; The level of education.

Vascular depression is a very frequent and serious complication of cerebrovascular diseases. Vascular factors play an important role in the formation of affective disorders. Depression, in turn, also has a negative impact on the course of cardiovascular pathology, contributing to its progression, worsens the quality of life of patients, reduces functional activity, increases mortality, increases the risk of stroke. The diagnosis of vascular depression is confirmed by the detection of leulyoaaresis on an MRI, while the hyperinatheism of the deep parts of the white matter is important. Very important features of vascular depression are the presence of cognitive impairment and increasing the risk of dementia.

The main forms of cognitive disorders (KN) are characterized by significant variability of the connection of morphological changes and clinical manifestations. One of the promising concepts explaining these features is the modern model of the cognitive reserve. The concept of a cognitive reserve, most widely used in the context of dementia, is often used to explain the mechanisms of the stability of the functional systems of the brain to the development of neuropathological changes. The mechanisms that ensure the functioning of the cognitive reserve are normal and during the pathology of the brain are the activation of neuronal relationships of the brain. Therefore, persons with a higher efficiency of neuronal connections and the ability to form alternative neuronal networks and, accordingly, the formation of cognitive strategies in response to an increase in cognitive load are characterized by a higher level of cognitive reserve. The modern concept of a cognitive reserve opens the prospects for explaining the causes and mechanisms of the development of KN, and also justifies the possibilities of using alternative strategies for their correction.

Key words: cognitive reserve; brain reserve; Alzheimer's disease; Dementia.

The clinical expression of chronic brain ischemia (Khim) is the occurrence of not isolated syndrome (rarely found), but a complex of neurological and neuropsychological disorders. Some of them are subclinically and are detected only when using special tests and samples. To clarify the nature of the headache, it is necessary to find out whether it is provoked by overwork after physical and emotional load and whether after a short -term rest decreases. The vascular type of headache is associated with different options for craniocerebral arteriovenous dystonia, which very often do not correlate with the main indicators of systemic hemodynamics.

Currently, there is no approved list of biomarkers for the diagnosis of vascular cognitive dysfunction. The main problem for a practitioner doctor when identifying cognitive disorders in patients is differential diagnosis of Alzheimer's disease, vascular cognitive dysfunction and other types of cognitive impairment, which are much less common. Vascular cognitive dysfunction includes post-industry dementia, cognitive dysfunction for cardiovascular and cerebrovascular diseases. Without determining the etiology of the disease, it is impossible to prescribe adequate treatment. Another problem is the identification of cognitive disorders before the development of dementia. A review of literature is devoted to the search and critical analysis of candidates for biomarkers of vascular cognitive dysfunction and the establishment of markers of moderate cognitive dysfunction. The search for articles was carried out in the databases of Web of Science and Pubmed. A list of liquor, plasma, serum and genetic biomarkers was compiled, which allowing differential diagnosis between vascular dysfunction and Alzheimer's disease, and markers of moderate cognitive dysfunction, which make it possible to identify cognitive impairment at the subordinate stage. Keywords: vascular dementia, moderate cognitive dysfunction, homocysteine, cerebral nodtriuretic peptide, ghrelin, protein S100β.

The article of a review nature outlines the issues of pathogenesis, clinic, diagnosis and treatment of chronic brain ischemia. The aspects of the development of "disease of small vessels", endothelial dysfunction, processes of peroxidation of lipids, apoptosis and neuroplasticity are highlighted. It was noted that the joint management of patients with chronic brain ischemia neurologists and doctors of other specialties, the appointment of individualized pathogenetic therapy. Key words: chronic brain ischemia, small vessels disease, endothelial dysfunction, apoptosis, neuroplasticity.

Key words: chronic brain ischemia, small vessels disease, endothelial dysfunction, apoptosis, neuroplasticity.

The purpose of the study is to study the emotional status (including Alexitimia, anxiety and depression) in patients with a brain infarction in the basin of the middle cerebral artery on the left in the late recovery period and the development of the method of correcting identified disorders.

Material and methods. The study was attended by 30 patients with a brain infarction in the basin of the middle cerebral artery on the left, the comparison group was 10 patients with chronic brain ischemia.

Results and conclusion. The data obtained demonstrate the dependence of the level of Alexitimia on the neurological deficit, gender, level of anxiety and depression. It was established that the development of brain infarction affects the level of Alexitimia. The presence of Alexitimia in patients with a brain infarction leads to a violation of adequate self -esteem of the physical and mental state, which can complicate the rehabilitation of such patients and requires correction - a combination of pharmacotherapy and psychotherapeutic effects.

Keywords: Alexitimia, brain heart attack, anxiety, depression.

The article based on the results of multicenter clinical research and the experience of leading domestic and foreign experts sets out actual theoretical and practical aspects of therapy and prevention of acute cerebrovascular accident. The pharmacotherapy of patients with strokes is examined in detail. The importance of the use of neuroprotective drugs has been demonstrated, among which Mexidol - Antihyxant with a multimodal action mechanism occupies a special place.

Keywords: stroke, therapy, prevention, neuroprotection, antihypoxants, Mexidol.

Chronic cerebrovascular failure (KHNMK) is the result of cerebral micriangiopathy, most often due to uncontrolled arterial hypertension. At the same time, the brain suffers due to repeated “dumb” heart attacks and/or micro -power without clinical manifestations of stroke and chronic brain ischemia. The main manifestation of a chronic progressive non -navigable vascular brain damage is progressive cognitive disorders with a predominance of insufficient concentration of attention, a decrease in the cognitive activity, a violation of planning and control with the relative preservation of memory.
As a rule, these disorders are combined with changes in the emotional sphere in the form of affective lability and depression. A description of the characteristic clinical case of KHNMK is given, the mechanisms of the formation of neurological symptoms are understood, modern approaches to the management of such patients are stated.

Key words: chronic brain ischemia, discirculatory encephalopathy, vascular cognitive impairment.

The purpose of the study.

To clarify the mechanisms of the anti -stress effect of the antioxidant drug (Mexidol) in patients with chronic brain ischemia (Khim). Material and methods. 67 patients with chemicals, 48 ​​women and 19 men, the average age 48.2 years observed. To assess the state of a multi -level stress system, they studied: the level of anxiety and depression, the degree of vegetative imbalance, adaptive blood reactions and the functional properties of red blood cell membranes, the level of medium mass molecules in the blood plasma. Therapeutic complexes included standard therapy and Mexidol of 500 mg (10 ml) intravenously by a drop of 200 ml of physiological solution 1 time per day for 10 days with the subsequent transition to the oral intake of 1 tablet (125 mg) 3 times a day for 3 months. Results and conclusion. In the group of patients receiving Mexidol, a more pronounced and prolonged positive effect on the clinical symptoms of chemicals was noted. These patients had a persistent decrease in anxiety, a decrease in vegetative imbalance. The dynamics of adaptive blood reactions indicated the activation of the function of the adrenal cortex. There was a decrease in the content of the level of medium mass molecules and the restoration of the sorption capacity of ER Itrocytes. The results indicate a multicomponent multi -level stressful effect of Mexidol in patients with chronic brain ischemia.

Key words: Mexidol, chronic brain ischemia, treatment, stress.

The purpose of the study.

Studying the structure of an alarming symptom complex in patients of late age with amnestic, disregional and polymodal types of moderate cognitive disorder (UKR) and determining the clinical efficiency of ethylmethylhydroxypyridine (Mexol).

Material and methods.

The selective study included 32 patients with both sexes over 55 years old from UKR (F06.7 according to ICD-10), who applied for medical help for anxiety. The inclusion criteria were compensation for concomitant somatic pathology, the lack of
significant stress events during the year, the lack of depression. They used clinical-psychopathological and psychometric methods: Hamilton's scale for evaluating anxiety (HAM-A), a geriatric depression questionnaire (GDS), a brief scale for evaluating mental status (MMSE), a scale of a general clinical impression (CGI-S, CGI-I), a scale for evaluating stress events. The main criterion for the effectiveness of 4-week therapy with Mexidol (375 mg per day) was the reduction of a common score on the scale of us-a. Results and conclusion. At the time of inclusion in the study,
the average points on the HAM-A and MMSE scales amounted to 39.9 ± 3.18 and 25.7 ± 0.6, respectively. When studying the structure of an alarming state in people with amnestic, dysregulatory and polymodal types of UKR, it was found that the phenomenology of an alarming symptom complex with these types of UKR is different. A re-assessment of anxiety on the HAM-A scale was carried out after 1, 2 and 4 weeks of therapy with Mexidol. Improving the mental state was noted with all types of UKR, but the proportion of people with a significant improvement was higher with amnestic and dysregulatory types compared
to polymodal. The development rate of the anti -aircraft effect was noted more with the dysregulatory type of UKR. In all patients, the use of Mexidol contributed to an increase in the stability of the function of attention and correction of autonomic dysfunction.

Key words: anxiety, moderate cognitive disorder (UKR), neuropsychological types of UKR, Mexidol.

The purpose of the study is to determine using the cerebral oximetry of the effectiveness of the antihypoxic effect of Mexidol with carotid endarctomy (CE) in patients with stenosis cerebral atherosclerosis.

Material and methods. In 109 patients with stenosis cerebral atherosclerosis with a degree of stenosis of the internal carotid artery 69 ± 7% and a clinical picture of chronic brain ischemia, clinical and psychineological monitoring was carried out in the pre- and postoperative periods of KE. Cerebral cerebral oximetry was perimetically. In 54 patients, the operation was carried out after the course of Mexidol at a dose of 1000 mg/day for 14-15 days. The other 55 people made a comparison group that did not receive Mexidol. Results and conclusion. The difference in the initial
oxygenation of the brain (RSO2) was revealed: 60.8 ± 5.0 and 47.29 ± 5.5%, respectively, in these groups. During the operation in the same groups of patients, the degree of blood saturation with oxygen decreased to 57 and 41%, respectively. On the 7th day after the KE with patients in both groups of both groups, a reliable improvement was obtained when performing the Shulti test to the group that received Mexidol, when evaluating the effectiveness of work and mental stability before and after surgery, which was not observed in patients who did not conduct antioxidant therapy. The use of Mexidol as
antihyplack of KE in patients with stenosis atherosclerosis of extracerebral arteries significantly reduces the degree of brain hypoxia, reduces the time of surgery, improves the neurological status of patients and the implementation of neuropsychological tests in the postoperative period.

Keywords: cerebral stenosis atherosclerosis, carotid endarterctomy, cerebral oximetry, Mexidol.

The results of a series of domestic clinical trials are given to study the effectiveness and safety of the drug Mexidol in patients with cerebrovascular disorders, in particular with ischemic stroke (AI). It is emphasized that the use of Mexidol is associated with a more complete and rapid regression of focal neurological deficiency. Good tolerance of treatment with Mexidol and the absence of significant undesirable side effects are noted. It is recommended to use the drug in forms for enteric and parenteral use in patients with AI.
Key words: ischemic stroke, treatment, Mexidol.