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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.

¹ FGBNU "Federal Research Center for Fundamental and Transalized Medicine", Novosibirsk, Russia;
² FSBEI "Novosibirsk State Medical University" of the Ministry of Health of Russia, Novosibirsk, Russia;
³ GBUZ but "State Novosibirsk Regional Clinical Hospital", Novosibirsk, Russia

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2021, T. 121, No. 10

Summary:
Purpose of the study. Studying the effectiveness and safety of consistent therapy with Mexidol, used intravenously (500 mg 1 time per day) for 14 days, followed by the oral form of Mexidol Fort 250 at a dose of 250 mg 3 times a day for 60 days in elderly patients with Chronic ischemia of the brain (chem) against the background of arterial hypertension and atherosclerosis. Material and methods. An open avenue observation study includes 60 patients with a diagnosis of chemicals confirmed by the results of neuroimaging. All patients underwent an examination with the assessment of neuropsychological status (MOCA Test), the severity of asthenia (scale of MFI-20), emotional state (an alarm and depression scale), motor functions (formalized clinical scale for assessing the motor activity of the elderly thinetti). The effectiveness of the therapy was evaluated according to the quality questionnaire (SF-36). Results. The results of the study showed high efficiency and safety of consistent therapy with Mexidol in relation to the relief of asthenic and emotional disorders, improve the state of cognitive functions, and improve the quality of life of patients. The maximum effect took place after the end of the full course of therapy. The high commitment of patients on the therapy, the low frequency of undesirable phenomena are shown. Conclusion. The consistent use of intravenous administration of Mexidol, followed by the oral administration of the drug Mexidol Forte 250, is an effective and safe way to treat patients with chemicals. Keywords: chronic brain ischemia, arterial hypertension, atherosclerosis, ethylmethylhydroxypirinatin, Mexidol, Mexidol Forte 250, cognitive disorders.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova 2021, T. 121, No. 9

Summary:
The review is devoted to the analysis of the characteristics of pathogenesis, diagnosis and therapy of traumatic brain injury (CHMT) from the point of view of a neurologist. The mechanisms of development of damage to the central nervous system, including neuro -sparks and oxidative stress, are considered, in persons carrying the ChMT, the connection of clinical manifestations with the severity of the injury. Particular attention is paid to the description of such consequences of the TSMT as structural pharmacoresistant epilepsy and post -traumatic stress disorder. The data is given that rehabilitation measures at the victims of the Civil Code are difficult and less accessible in the conditions of the Covid-19 pandemic. The need to include antioxidant/antihypoxant Mexidol in the complex CMT therapy was noted. In the conditions of the Covid-19, the role of a neurologist increases in the provision of assistance to victims with the CCT, especially at the outpatient stage, during therapy, and medical rehabilitation. Key words: traumatic brain injury, oxidative stress, structural pharmacoresistant epilepsy, post-traumatic stress disorder, infection SARS-COV-2, Mexidol.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2021, T. 121, No. 8, Issue. 2

Summary:
atherotrombotic stroke is one of the most frequent subtypes of ischemic cerebrovascular accident, the cause of which is atherosclerosis of the large arteries of the brain or their branches. The results of the latest studies have shown that the atherosclerotic process is based on inflammatory changes in the vascular wall, leading to the initiation of atherosclerosis, endothelial dysfunction, oxidative stress, and redistributing various protein components in the composition of the hematoencephalic barrier. As a result, the progression of the described conditions leads to the manifestation of clinical symptoms and the formation of an acute vascular event. Understanding the molecular components underlying functional disorders and damage to cerebral vessels provides the key to modern therapy strategies, forming the foundation for adequate, pathogenetically substantiated drug correction. In such patients, it should be aimed at normalizing cerebral and central hemodynamics and taking into account neuroplasticity mechanisms. The drug Mexidol (ethylmethylhydroxypyridine succinate) can be considered as one of the pathogenetically reasonable drugs in complex drug therapy for brain ischemia. Keywords: ischemic stroke, atherosclerosis, vascular inflammation, oxidative stress, endothelial dysfunction, ethylmethylhydroxypirine succinate.

Place of publication:
Medical alphabet No. 22 /2021. Neurology and psychiatry (3)

Summary:
Purpose of the study. To study the features of response to stress, stress resistance and adaptation of elderly men and women with chronic brain ischemia (Khim), as well as the stressful effect of Mexidol. Materials and methods. 124 patients aged 60–74 years were examined: 72 men and 52 women (average age, respectively, 65.3 ± 0.4 and 64.7 ± 0.7 years) with the I - II stage against the background of arterial hypertension and its combination from Atherosclerosis of cerebral vessels. The level of psychosocial stress was determined on the scale of Holmes-Roya. Features of the response of patients to stress were studied using the techniques of “scale of psychological stress RSM -25” and S. Rosenzweig. Stress resistance was investigated using the self -esteem of the stress resistance of S. Cohehen and G. Willianson. The levels of anxiety were determined using the scale of Ch. D. Spielberger and Yu. L. Khanin, depression - the questionnaire of BEK. The type of adaptive reactions was studied in the leukocyte blood formula for the percentage of lymphocytes and segmented neutrophils, taking into account the representation of other uniform elements. Results. The level of stress in elderly women with chemicals was higher than in men. In men, the predominance of intropunetary orientation of the reaction to stress and the resolving type of response was revealed, in women - an extrapunitive orientation and a self -defensive type of response, which indicated a greater frustration of women. The level of stress resistance in women was lower than that of men, and correlated with higher indicators of situational anxiety. Adverse adaptive reactions were more often recorded in women. The course of treatment with Mexidol of elderly patients with chemicals led to a decrease in the severity of subjective and objective symptoms, anxiety disorders, increased the stress resistance and adaptive capabilities of the body, which was confirmed by an increase in the number of persons with favorable adaptive reactions. The high efficiency and safety of consistent therapy with Mexidol (injections, then the tablet form of Mexidol Forte 250) is shown. Key words: chronic brain ischemia, gender, stress, stress resistance, emotional disorders, anxiety, depression, Mexidol, adaptive reactions.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2021, T. 121, No. 3

Summary:
Purpose of the study. Studying the effectiveness and safety of the effect of complex therapy of ethylmethylhydroxypyridine with succinate (Mexidol Forte 250) and venotonic drugs of Lizinate and diosmine of hesperidine in patients with chronic cerebral venous insufficiency (CCVN). Material and methods. 120 patients with CCVN have clinical and ultrasonic signs of cerebral venous discirculation were examined. Patients are divided into 3 subgroups depending on the type of therapy. The first group (n = 40) was prescribed orally Mexidol Fort 250 and diosmine of hesperidine within 74 days in combination with the appointment of 2 courses of intravenous administration of lysinate escin (L-lysine of the escinate) on the 1st and 30th day from the beginning of treatment; The 2nd group (n = 40) was prescribed orally Mexidol Fort 250 and diosmine hesperidine for 74 days; The 3rd group (n = 40) orally prescribed the drug Diosmin Hesperidine for 74 days. Results and conclusion. The effectiveness and safety of the complex therapy of patients with CCVN venotonic drugs with the inclusion of the antioxidant drug Mexidol Forte 250 by 750 mg/day for 74 days is shown. The study demonstrates the reliable positive effect of Mexidol Forte 250 on the dynamics of complaints and indicators of the neurological and psychoemotional status of patients. Monotherapy with a venotonic drug with a diosmine of hesperidine showed its insufficient effectiveness. Keywords: chronic cerebral venous deficiency, antioxidants, Mexidol forte 250, venotonic drugs, lesinate escine, diosmine gesperidine.

Place of publication:
cardiology and cardiovascular surgery, 2021, T. 14, No. 1

Summary:
Purpose of the study. To study the effect of Mexidol on the functional state of the myocardium, the level of cerebral sodium peptide (NT-PROBNP), the tolerance of physical activity, the quality of life, the severity of oxidative stress, inflammatory reaction and endothelial dysfunction in patients with chronic brain ischemia and chronic heart failure ( ) II - III functional class (FC) according to the Nyha classification with the sequential intravenous and oral introduction of the drug Mexidol for 13 weeks against the background of standard basic therapy. Material and methods. The study included 44 patients with chemical and heart failure II - III FC according to Nyha. The average age was 65.5 ± 11.8 years (75% of men); 21 The patient was in the basic therapy group with the additional purpose of Mexidol, 23 patients in the basic therapy group. Initially, on the 7th day and at the 13th week, echocardiographic indicators, the level of NT-PROBNP, tolerance of physical activity (test with 6-minute walking, T6MX), assessment of the clinical state of the patient on the shock scale (modification V.Yu. Mareeva), oxidative stress parameters (level of little dyilladehyde (MDA) and the activity of superoxidsmutase (SOD)), inflammatory reaction (S-reactive protein level, tumor necrosis factor (FI-α), as well as the content of homocysthanes and level of cystatin S. initially and at the end of the study evaluated the quality of life according to the results of the Minnesotsky questionnaire of the quality of life of patients (minnesota living with Heart Failure Questionnaire, Mlhfq) and the Kansas Cardiopathy Cardiopathy CCCQ ). Results. In patients in the Mexidol+Basic therapy group, a more pronounced improvement in the quality of life, a higher increase in the results of T6Mx, a more pronounced improvement of the clinical state on the shock scale, a reliable decrease in the indicators of the finis-diastolic and endolar size of the LV, and also reliably significantly have been revealed. A more pronounced decrease in the level of NT-PROBNP on the 7th day and after 13 weeks of therapy compared to the basic therapy group. The use of Mexidol, in addition to basic therapy, led to a decrease in the concentration of MDA and an increase in the activity of SOD on the 7th day and after 13 weeks of observation. A reliable decrease in the level of CRC and FINED α was revealed both on the 7th day and 13 weeks of observation against the background of additional use of Mexidol. A slowdown in the increase in homocysteine ​​in the group of therapy with Mexidol was revealed. There were no reliable differences in the indicators of cystatin with between groups. Conclusion. Mexidol, when adding to the basic therapy of patients with chemical and heart failure II - III, FC has a beneficial effect on the quality of life, functional status, improves the clinical state, intracidian hemodynamics, has reliable antioxidant activity, reduces the severity of the inflammatory reaction, slows down the increase in homocysteine, and does not provide influences on the function of the kidneys (cystatin C). Keywords: chronic brain ischemia, heart failure, quality of life, cognitive status, ethylmethylhydroxypyridine succinate, mexidol, oxidative stress, inflammation, endothelial dysfunction.

Place of publication:
neurology, neuropsychiatry, psychosomatics. 2020; 12 (1): 56–60

Summary:
The purpose of the study is to study the effectiveness and safety of the drug Mexidol ^® Fort 250 in patients with chronic brain ischemia (chemical) against the background of arterial hypertension (hypertension) and atherosclerosis. Patients and methods. The study includes 20 patients suffering from hypertension and atherosclerosis, aged 45 to 75 years who received Mexidol ^® intravenously (500 mg 1 time per day) for 14 days, with the subsequent reception of Mexidol ^® Fort 250 orally in the dose 250 mg 3 times a day for 60 days (main group). The control group consisted of 14 patients with chemicals against the background of a combination of hypertension and atherosclerosis, who were prescribed complex therapy of chemicals without the use of these drugs. Patients were examined before and after 14 and 60 days of treatment. In dynamics, subjective complaints, neurological symptoms, indicators of the Tinetti scale for assessing the motor activity of elderly patients (Functional Mobility Assessment in Elderly Patients) were studied; Montreal scale for assessing cognitive functions (Montreal Cognitive Assessment, Mosa); Hamilton anxiety and depression (Hamilton Anxiety Rating Scale, Hars); Asthenia scales MFI-20 (MultidimenSional Fatigue Inventory); General clinical impression scales (Clinical Global Impression, CGI). Results and discussion. It was established that therapy with Mexidol ^® in patients with chemous and atherosclerosis was accompanied by positive dynamics along the MFI-20 asthenia scales, mosa cognitive functions, as well as the coordination of Tinetti movements. In patients, the control group was not noted for reliable differences in these indicators. Complex treatment of Khim, which included Mexidol ^® and Mexidol ^® Fort 250 in the form of consistent therapy, turned out to be more effective than complex therapy of chemicals without the use of these drugs as a whole by more than 2 times, and for certain values ​​of the parameters of the scales up to 10 times. Conclusion. The results of the study of the drug Mexidol ^® Forte 250 in the framework of consistent therapy used according to the above scheme indicate its clinical efficiency and safety in patients with chemicals. Keywords: chronic brain ischemia; cognitive and motor functions; asthenic and anxious-depressive disorders; Mexidol ^® Fort 250.

¹ FSBI “Scientific Center for Expertise of Medical Application” of the Ministry of Health of Russia, Moscow, Russia;
² FGAOU VO "First Moscow State Medical University named after THEM. Sechenov »Ministry of Health of Russia (Sechenov University), Moscow, Russia;
³ FGAOU in Russian National Research Medical University named after N.I. Pirogov ", Moscow, Russia;
⁴ FGBNU "Federal Scientific Center-the All-Russian Research Institute of Experimental Veterinary Medical Academy of Education named after K.I. Scriabin and Ya.R. Kovalenko of the Russian Academy of Sciences ", Moscow, Russia

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2020, T. 120, No. 12, Issue. 2

Summary:
the stroke remains one of the most urgent problems of modern medicine, which is leading the cause of mortality and disability. In the Russian Federation there is extensive experience in the use of neurocytoprotectors in ischemic stroke. In real clinical practice, it is important to observe the conditions under which neuroprotement will be as safe and effective as possible. This review presents an analysis of the results of clinical studies devoted to the effectiveness and safety of ethylmethylhydroxypyridine of succinate (Mexidol) in patients with acute ischemic stroke. Early (in the first 6 hours of stroke), the use of the drug significantly improves recovery dynamics and improves the outcome of the disease; When using the drug, the acceleration of regression of neurological disorders, improvement of the life and quality of life of patients was noted. The studies showed a high security profile of ethylmethylhydroxypyridine of succinate. Keywords: ischemic stroke, thrombolytic therapy, clinical studies, disability, antioxidant system, ethylmethydlhydroxypirinatin, Mexidol.

Summary:
Purpose of the study. To evaluate the effectiveness and safety of prolonged sequential therapy with Mexidol with a hemisphere ischemic stroke in acute and early recovery periods in patients of various age groups.

Material and methods. The study is an additional analysis of age groups among 150 patients who took part in a randomized double blind multicenter placebo-controlled in parallel groups of the epic study. The entire study of the study (62 men and 88 women) was divided into subgroups by age: under 60 years old, 60–75 years old, 76–90 years. Also, all participants in the study were divided into 2 populations: ITT (Intent to Treat Population, patients who received at least one dose of the drug/placebo drug) and PP (Per Protocol Population, patients who received the drug in accordance with the research protocol). The results were evaluated on the modified Rankin scale (MSHR) at the end of the course of therapy, the Bartel index, the Bek depression scale, and the European questionnaire for assessing the quality of life.

Results. The effectiveness of Mexidol on all the scales used did not differ depending on age. At the time of the end of the therapy, the average MSHR score was lower in patients 76–90 years (in both populations) compared to placebo (p <0.001). The dynamics of reducing the average score in MSHR (1-5th visits) was more pronounced in patients of 60–75 years (p = 0.025), including patients with diabetes. In patients 76–90 years old and patients with diabetes mellitus compared to placebo, the severity of cognitive-affective symptoms of depression (p = 0.049 and p = 0.02, respectively), the share of patients with lack of problems with everyday affairs, increased statistically significant (P = P = P = P = P = P = P = P = P = P = P. 0.007 and p = 0.02, respectively). In patients with diabetes, the level of everyday activity (p = 0.023) has also increased statistically significantly significantly increased and the quality of life has improved (p = 0.045). There were no reliable differences in the frequency of unwanted phenomena in all studied groups.

Conclusion. It is recommended that the use of Mexidol in the acute and early recovery periods of ischemic stroke in all age groups, including patients with diabetes mellitus.

Key words: ischemic stroke, Mexidol, ethylmethylhydroxypyridine succinate, effectiveness and safety, ischemic stroke, acute period, early recovery period, epic.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2020, T. 120, No. 12

Summary:
the main risk factors for blood circulation diseases and the leading causes of mortality in the world continue to be arterial hypertension, diabetes, obesity and dyslipidemia, and the combination of these diseases significantly increases the likelihood of developing cardio and cerebrovascular pathology. Improving approaches to the diagnosis and therapy of these diseases is a priority problem of modern medicine. Currently, there is no universal drug that allows you to influence all links in the pathological process both in cerebrovascular diseases and in diabetes mellitus, and the problem of rational use of drugs in patients with co -filled pathology has not been completely resolved. The difficult clinical task is not only in the timely detection of the disease and making the correct diagnosis, but also in choosing the safest and most effective drug. A number of clinical studies showed the effectiveness of Mexidol in the treatment of this category of patients, which is determined by its complex, playotropic and multimodal mechanism of action. Key words: cerebrovascular diseases, diabetes mellitus, metabolic syndrome, antioxidants, Mexidol.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2020, T. 120, No. 11

Summary:
Purpose of the study. Studying the effectiveness and safety of consistent therapy with Mexidol drugs (injections intravenously for 14 days - a saturation phase) and Mexidol Forte 250 (tablets for 60 days - the phase of maximization of the therapeutic effect) in patients with chronic brain ischemia (chemical) against the background of arterial hypertension and atherosclerosis. Material and methods. In the group of therapy with Mexidol, 27 patients were observed (24 women and 3 men) with Khim I-II century. Against the background of a combination of arterial hypertension and atherosclerosis, which is treated with Mexidol with the drug intravenously (500 mg once a day) for 14 days with the subsequent intake of Mexidol Forte 250 in a daily dose of 750 mg (1 tablet 3 times a day) for 60 days) . The comparison group consisted of 30 patients (22 women and 8 men) with KhMI I-II century, comparable by age, the nature of risk factors and the severity of neurological manifestations. Patients of both groups received basic therapy to correct their risk factors. They assessed the state of motor activity (Tinetti test), cognitive functions (MOCA Test), anxiety and depression (Hamilton's depression scale), a general clinical impression scale. Results and conclusion. The inclusion of Mexidol and Mexidol Forte 250 in the form of consistent prolonged therapy is the inclusion of chemical therapy in the standard therapy. The results indicate more clinical efficiency and sufficient safety of combined therapy. By the end of the study (on the 74th day), patients of the therapy group of Mexol with the drug, a reliable improvement in motor activity, cognitive functions of the emotional sphere, as well as a decrease in fatigue and neurological manifestations in comparison with a comparison group, was noted. Key words: chronic brain ischemia, Mexidol, Mexidol Forte 250.

ANO "Central Clinical Medicine-Sanitary Part", Magnitogorsk, Russia

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2020, T. 120, No. 10

Summary:
Purpose of the study. Evaluate the effectiveness and safety of consistent therapy with Mexidol drugs (a solution for iv and iv in the administration) and Mexidol Forte 250 (tablets covered with a shell) in patients with a hemispherral ischemic stroke in an acute and early recovery periods. Material and methods. At the time of the end of the therapy, the dynamics on the modified Rankin scale (MRS), the test results on the stroke of the National Institute of Health (NIHSS), the Bartel (BI), the Montreal Cognitive Functions Assessment (MOCA), the BEK questionnaire (BDI), the questionnaire questionnaire (BDI). Evaluation of the quality of life (EQ-5D). Results and conclusion. Consistent long -term therapy with Mexidol with a dosage of 500 mg/day for 14 days (saturation phase) and Mexol Forte 250 by 250 mg 3 times a day for 60 days (phase of maximization of the therapeutic effect) provides additional opportunities for more complete restoration in acute and acute and acute and acute The early recovery periods of the hemisphere stroke (improves the quality of life, improves the restoration of motor and cognitive functions). Keywords: Holding ischemic stroke, Mexidol Fort 250, acute and early recovery periods, quality of life.

Place of publication:
New therapeutic magazine "Non Nocera", September, 2020

Summary:
In recent decades around the world, significant changes in the age structure of the population have occurred: a group of people from 60 years has grown at a higher rate, and therefore the prevention and treatment of diseases in older people are one of the most important tasks of modern medicine. With age in the entire body, and especially in the nervous system, there are anatomical and functional changes and disorders of various biological processes, leading to a deterioration in the blood supply to the brain and subsequent change in the small cerebral vessels (micro- and macroangiopathy), which leads to a decrease in microcirculatory blood flow, a change in vascular walls.

Summary:
Purpose of the study. To evaluate the effectiveness and safety of prolonged sequential therapy with Mexidol with a hemisphere ischemic stroke in acute and early recovery periods in patients of various age groups. Material and methods. The study is an additional analysis of age groups among 150 patients who took part in a randomized double blind multicenter placebo-controlled in parallel groups of the epic study. The entire study of the study (62 men and 88 women) was divided into subgroups by age: under 60 years old, 60–75 years old, 76–90 years. Also, all participants in the study were divided into 2 populations: ITT (Intent to Treat Population, patients who received at least one dose of the drug/placebo drug) and PP (Per Protocol Population, patients who received the drug in accordance with the research protocol). The results were evaluated on the modified Rankin scale (MSHR) at the end of the course of therapy, the Bartel index, the Bek depression scale, and the European questionnaire for assessing the quality of life. Results. The effectiveness of Mexidol on all the scales used did not differ depending on age. At the time of the end of the therapy, the average MSHR score was lower in patients 76–90 years (in both populations) compared to placebo (p <0.001). The dynamics of reducing the average score in MSHR (1-5th visits) was more pronounced in patients of 60–75 years (p = 0.025), including patients with diabetes. In patients 76–90 years old and patients with diabetes mellitus compared to placebo, the severity of cognitive-affective symptoms of depression (p = 0.049 and p = 0.02, respectively), the share of patients with lack of problems with everyday affairs, increased statistically significant (P = P = P = P = P = P = P = P = P = P = P. 0.007 and p = 0.02, respectively). In patients with diabetes, the level of everyday activity (p = 0.023) has also increased statistically significantly significantly increased and the quality of life has improved (p = 0.045). There were no reliable differences in the frequency of unwanted phenomena in all studied groups. Conclusion. It is recommended that the use of Mexidol in the acute and early recovery periods of ischemic stroke in all age groups, including patients with diabetes mellitus. Key words: ischemic stroke, Mexidol, ethylmethylhydroxypyridine succinate, effectiveness and safety, ischemic stroke, acute period, early recovery period, epic.