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Target. To study the factors that determine the commitment of optimal therapy of elderly patients with chronic heart failure (COM) observed on an outpatient basis.

Material and methods. In an open, comparative simultaneous, incomplete study, 80 patients with heart failure at the age of ≥60 years were included. The comparison group consisted of 40 patients (18 men and 22 women) with diseases of the cardiovascular system without heart failure. Patients were evaluated by the Comorbidity index, laboratory and echocardiographic parameters, a 6-minute walk test, cognitive status, adherence to treatment, and a two-photon X-ray absorption was carried out. The criteria of senile asthenia was considered the presence of 3 signs according to the Frail scale (Fatigue, Resistance, Ambulation, Illnesses, Loss of Weight).

Results. The committed treatment was 40% of patients with heart failure and 75% - comparison groups (p <0.001). In a single-factor analysis, a relationship of adherence to treatment with the level of cognitive status by the Mini-Mental State Examination questionnaire is established-the ratio of chance (OS) 1.5; 95% confidential interval (DI) 1.2-1.9 (p <0.001), senile asthenia-Osh 3.5; 95% DI 1.3-9.5 (p = 0.011), osteoporosis-Osh 2.98; 95% DI 1.0-8.9 (p = 0.050), Cherlson coomorbitability-Osh 1.21; 95% DI 1.0-1.5 (p = 0.050).

Conclusion. 40% of outpatient patients with heart failure at the age of ≥60 years were committed to treatment. Multiple concomitant pathology, impaired cognitive status, osteoporosis, senile asthenia have a negative effect on commitment to the treatment of older people with heart failure.

Key words: commitment to treatment, elderly age, heart failure, senile asthenia, osteoporosis.

Target. To study the cognitive status in elderly patients with arterial hypertension observed in clinical conditions.

Material and methods. The study included 356 patients; The average age is 74.9 ± 6.1 years, 80.4% of them are women. To evaluate cognitive functions before and after treatment, neuropsychological testing using MMSE - a brief scale for assessing mental status was performed; watch drawing test; The test of literal and categorical associations.

Results. In the group of patients <80 years, the severity of cognitive disorders by MMSE correlated with blood pressure (blood pressure): for systolic blood pressure (r = -0.22, p = 0.0003), for diastolic blood pressure (R = -0,13, p = 0.03), i.e. In patients with higher blood pressure, low points were noted on the scale of assessing the cognitive status based on the results of the correlation analysis of Spearman. While in group ≥80, both correlations were insignificant, for systolic blood pressure (r = -0.05, p = 0.64), for diastolic blood pressure (r = -0.13, p = 0.25).

Conclusion. Patients of elderly and senile ages with arterial hypertension should have a differentiated approach to the level of blood pressure depending on age and the presence of cognitive disorders, an integrated approach to therapy in these patients can prevent further progression of cognitive status worsening.

Key words: arterial hypertension, cognitive impairment, dementia, elderly.

Target. The study of the features of biochemical and morphometric indicators in patients with diabetes (diabetes) of type 2 and cognitive disorders (KN).

Material and methods. The main group was 72 patients suffering from type 2 diabetes, 20 people were included in the control group without cognitive violations from type 2 diabetes. Used: Montreal cognitive scale, level 1.5-anglyucitol, continuous monitoring of glucose levels, magnetic resonance imaging of the brain.

Results. As a result of data processing, it was revealed that in patients with type 2 diabetes and KN, a high level of glycated hemoglobin was recorded, however, there was no statistically significant difference in the level of 1.5 anhydroglucitol between the presented groups. Patients with KN have registered a decrease in the surface area of ​​gray and white matter, as well as subcortical structures - hippocampus, a adjacent nucleus and shells on both sides, amygdaly and a pale ball on the right. The severity of KN correlated with the degree of polyneuropathy. In patients with a proliferative stage of retinopathy, a decrease in the volume of the tail nucleus, pale ball, shells and adjacent core is a decrease.

Conclusion. As a result of the study, it was revealed that patients with type 2 diabetes have the worst parameters of carbohydrate metabolism; They also found a decrease in cortical and subcortical structures of the brain. Key words: diabetes, cognitive disorders, variability, morphometry.

Metabolic syndrome (MS) is a factor in the risk of acute and chronic vascular diseases of the brain. Oxidizing stress developing under these conditions contributes to the progression of atherosclerotic lesions of the brachiocephalous arteries, which makes it necessary to correct the identified pathobiochemical disorders. The use of antioxidant drugs in patients with cerebrovascular diseases and MS helps to reduce such manifestations of the latter as insulin resistance, hyperthyglyceridemia, hyperglycemia. The article presents the results of studies of Mexidol in patients with chronic cerebrovascular diseases against the background of atherosclerosis and MS, demonstrating good prospects for the use of drug compounds of this group with the aim of comprehensive correction of various links in the pathogenesis of developing pathology.

A high level of glucose in the blood with a hypoxic-ischemic state is one of the main factors that determine the degree of brain damage. The consequence of a hyperglycemic-ischemic state is an increase in the formation of active forms of oxygen and impaired functioning of the endogenous antioxidant system. To compensate for the forming cerebrovascular disorders against the background of a combination of ischemia and diabetes, drug treatment must be used. The most effective tools are antioxidants from the group of
2-ethyl-6-methyl-3-oxypyrididine derivatives.
Key words: brain ischemia, phospholipids, phosphatidylcholine, diabetes mellitus, neuropathy, free radicals.

By the beginning of 2013, the share of people aged 65 and older amounted to an average of about 13%in Russia, and in some regions - 28%. It is predicted that in the global structure of the population by 2050 it will be 22%. In Russia, by the beginning of 2021, an increase in the number of people aged 65 years and older to 22.9 million people, 80 years and older - 5.5 million people are expected; 100 years and older - 7266 people. The fastest growing group of population in economically developed countries is 80 years of age and older.
The data of evidence -based medicine on the effectiveness and safety of drugs (drugs) in the elderly are extremely limited, since the age> 65 years remains one of the main criteria for non -inclusion in randomized controlled studies (RCTs).
Meanwhile, the effectiveness and safety of therapy in elderly patients can differ significantly from those in middle and young people, which is associated with age -related changes in physiology, leading to changes in pharmacokinetics and pharmacodynamics of many drugs.
Other factors that complicate pharmacotherapy in elderly people include: “fragility” (frailty), somatic and mental comorbidity and polypragmasia associated with it, social factors (loneliness, helplessness, poverty), low learning and low commitment to treatment.

Within the framework of the 17th National Congress of therapists with international participation, which was held in Moscow from October 12 to October 14, 2022, a satellite symposium of the Vectorfarm company-“Brain: Myshin organ of arterial hypertension. Minimization of a negative forecast. ” It discussed the issues of conducting polymorbid patients and the possibilities of the drug therapy used.

With the first report-“The leading of patients with chronic brain ischemia from the perspective of evidence-based medicine”-said the neurologist, professor of the Department of Nervous Diseases Faculty of Faculty of Medicine at the first MGMU named after THEM. Sechenova of the Ministry of Health of Russia, MD V.V. Zakharov. (Read more Read more).

Head of the Department of Therapy and Polymorbid Pathology named after Academician M.S. VLUSI FSBEI HPE RMANPO of the Ministry of Health of the Russian Federation, professor, MD O.D. Ostroumova made a report "Interdisciplinary consultation of a patient with arterial hypertension." (Read more Read more).

Senior Researcher of the Federal State Budgetary Institution "Scientific Center for Neurology", Ph.D. A.A. Zavrzhzhaev presented the report “The neurological characteristics of the patient with arterial hypertension. What should be paid to. " (Read more Read more).

Concluding the symposium, prof. O.D. Ostroumova noted that at present the possibilities of medical specialists in the correction of cognitive disorders are quite wide. Of course, research in this area will continue, since there are still many “white spots” in it. But even what is known now allows you to look with confidence in the future.

Place of publication: a journal of neurology and psychiatry named after S.S. Korsakova / t. 125, No. 1, 2025

Resumes of
arterial hypertension (hypertension) as the main modified risk factor for the development of acute and chronic cerebrovascular accident failure, often leading to a progressive decrease in cognitive status, physical activity, requires early detection and effective pathogenetic therapy. The breadth of the therapeutic effects of the drug Mexidol (ethylmethylhydroxypyridine succinate) contributes to its widespread use. The high security profile of Mexidol and the lack of drug interactions make its use promising in the complex treatment of patients with cardiovascular diseases.

Keywords : arterial hypertension, oxidative stress, cerebrovascular insufficiency, cognitive functions, endothelial sensitivity, G-PROTEIN COUPLED Receptor 91, succinate, ethyl-methylhydroxypyrididine, mexidol.
Information about the authors:
Chukanova E.I. -https://orcid.org/0000-0002-32919615
Chukanova A.S. -https://orcid.org/0000-0003-0940-782X
Andrianov D.D. -https://orcid.org/0009-0000-6917-4277
Author responsible for correspondence: Chukanova E.I. -E-mail: chukanova-lena@yandex.ru
how to quote:
Chukanova E.I., Chukanova A.S., Andrianov D.D. Arterial hypertension is oxidative stress as a pathogenetic target of treatment of chronic cerebrovascular insufficiency. Journal of neurology and psychiatry named after S.S. Korsakova. 2025; 125 (1): 84–90. https://doi.org/10.17116/jnevro202512501184

Information about the authors:
Vlasova A.S. -https://orcid.org/0000-0002-6835-3393
Petrov S.A. -https://orcid.org/0000-0002-1566-2299
Renzyak E.V. -https://orcid.org/0007-0007-2258-2207
Author responsible for correspondence: Vlasova Anastasia Sergeevna-E-mail: okula-83@mail.ru
How to quote:
Vlasova A.S., Petrov S.A., Renzyak E.V. Neuroprotective therapy for age -related macular degeneration. Bulletin of ophthalmology. 2024; 140 (6): 152–158. https://doi.org/10.17116/oftalma2024140061152

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 10

Summary:
The article provides new information about the development of oxidative stress (OS) in chronic headaches (GB). The main biochemical characteristics of the OS are presented. Changes in MRI spectroscopy and biochemical markers are described, confirming the development of OS in migraine. The lack of significant differences in the indicators of the OS for migraine without aura and with aura is emphasized. The pathophysiological differences of migraine and chronic GB of stress are shown, at which the OS is not detected. Possible activation is discussed with the OS TRPA1 and calcitonin-genius peptide, which provokes migraine attacks. The directions of drug correction of the OS in chronic headache are considered. Key words: headache, migraine, chronic headache of tension, oxidative stress, antioxidants.

Place of publication:
cardiology and cardiovascular surgery, 2024, T. 17, No. 5

Summary:
Review of literature is dedicated to the effects of the drug Ethylmethylhydroxypyridine of succinate (reference drug - Mexidol) in patients with arterial hypertension. The analysis of 44 sources of domestic and foreign literature showed a more effective achievement of the target values ​​of blood pressure, the prevention of the development of severe complications with hypertensive crises in patients who received therapy with Mexidol. Evidence of the positive influence of cytoprotective therapy on the state of the left ventricle, the vascular wall is considered. The results of large studies are presented that demonstrate the effective correction of cognitive brain dysfunction using Mexidol. The role of the drug in the stabilization of biochemical processes, including lipid oxidation, metabolism and cholesterol, which causes the playotropic effects of Mexidol in patients with arterial hypertension, is emphasized. Keywords: arterial hypertension, endothelial dysfunction, the stiffness of the vascular wall, lipid oxidation, myocardial ducaming, cognitive impairment, ethylmethylhydroxypyridine, mexidol.

Place of publication: Polyclinic Journal / No. 5, 2023

The demographic situation of recent decades is characterized by an increase in the number of elderly and senile people, for which, due to age -related physiological characteristics, the development of chronic brain ischemia (Khim) is characteristic. Currently, Khim is 60–75% of all cerebrovascular diseases.
Ichechemic strokes in most cases develop against the background of chemical and are a factor leading to the growth of focal and diffuse ischemic or ischemic-depths of the brain that aggravate the course of chemical and accelerating the development of dementia in patients. With ischemia, there is a sharp increase in oxidative processes, which, in combination with the insufficiency of the antioxidant protection system, leads to oxidative stress. It is pathogenetically explainable to include antioxidant drugs in the therapy diagram, one of the bright representatives of which is the drug Mexidol with a convincing evidence base.
If you do not carry out treatment and not eliminate the excess of active forms of oxygen generated by ischemia, the cascade of reactions that cause chaotic (necrosis) or programmable (apoptosis) cell death is activated. The successful solution to this problem is feasible when providing medical workers with the necessary medical information.

Keywords: chronic brain ischemia, aging, elderly, senile age, oxidative stress, antioxidant effect, neuroprotection, Mexidol

Presidium of the Council of Experts:

Martynov A.I., MD, professor, academician of the Russian Academy of Sciences, professor of the Department of Hospital therapy No. 1 of the Federal State Budgetary Institution “Moscow State Medical and Dental University named after A.I. Evdokimova "of the Ministry of Health of Russia, President of the Russian Scientific Medical Society of therapists (RNDMO), Moscow

Tanashian M.M., MD, professor, corresponding member of the Russian Academy of Sciences, deputy. Director for scientific work of the FGBN “Scientific Center of Neurology”, Moscow

Malyavin A.G., MD, professor at the Department of Testions and Pulmonology Faculty of Faculty of Faculty of FSBEI in the Moscow State Medical and Dental University named after A.I. Evdokimova ”of the Ministry of Health of Russia, chief freelance pulmonologist of the Ministry of Health of Russia for the Central Federal District, General Secretary of the RND, Moscow

Participants in the Council of Experts:

Bogolepova A.N. D.M.N., head of the cognitive violations department of the Federal Center for Brain and Neurotechnology, FMBA of Russia, professor of the Department of Neurology, Neurosurgery and Medical Genetics of Faculty of Faculty of Faculty of Medicine in the Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow

Borovkova N.Yu., MD, the first deputy. Director of the Institute of Therapy, Professor of the Department of Hospital Therapy and General Medical Practice of the Volga Research Medical University of the Ministry of Health of Russia, Nizhny Novgorod.

Eliseeva L.N., MD, professor, head. Department of Faculty of Faculty of FSBENSI and Kuban State Medical University of the Ministry of Health of Russia, Chairman of the Krasnodar Regional Branch of the RND, Krasnodar

Zhuravleva M.V., MD, professor, professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases of the FGAOU in the First Moscow State Medical University named after THEM. Sechenova "of the Ministry of Health of Russia (Sechenov University), the main freelance specialist - a clinical pharmacologist of the Department of Health of the city of Moscow, Moscow

Zakharov V.V., MD, professor at the Department of Nervous Diseases and Neurosurgery of the FGAOU in "First Moscow State Medical University named after THEM. Sechenova "of the Ministry of Health of Russia (Sechenov University), Moscow

Koryagina N.A., MD, professor at the Department of Clinical therapy of FSBEI in Perm State Medical University named after Academician E.A. Wagner ”of the Ministry of Health of Russia, Vice-President of the Association of Doctors of the therapeutic Profile of the Perm Territory, Chairman of the Perm Regional Department of the RND, Chief Forest Transportist of the Ministry of Health of the Perm Territory, Perm Perm

Mikhin V.P., MD, professor, head. Department of Internal Diseases No. 2 of the FSBEI in “Kursk State Medical University” of the Ministry of Health of Russia, Kursk

Osipova I.V., MD, professor, head. Department of Faculty Therapy and Professional Diseases of the FSBEI in Altai State Medical University of the Ministry of Health of Russia, Barnaul

Ostroumova O.D., MD, professor, head. Department of Therapy and Polymorbid Pathology of the Federal State Budgetary Institution of the DPO “Russian Medical Academy of Continuing Professional Education” of the Ministry of Health of Russia, Moscow

Poznyak A.O., MD, professor, head. The Department of Therapy, Geriatrics and the General Practice of the Kazan State Medical Academy - a branch of the Federal State Budgetary Institution of the DPO “Russian Medical Academy of Continuing Professional Education” of the Ministry of Health of Russia, Kazan Kazan

Portnyagina U.S., Ph.D., Associate Professor of the Department of Internal Diseases and General Personnel Practice (Family Medicine) of the FGOU FGAOU in North-East Federal University named after M.K. Ammosova ”, the main freelance specialist in therapy and general medical practice of the Ministry of Health of the Republic of Sakha (Yakutia), Yakutsk

Statsenko M.E., MD, professor, head. Department of Internal Diseases of the FSBEI in Volgograd State Medical University of the Ministry of Health of Russia, Volgograd

Tyrenko V.V., MD, professor, head of the department and clinic of the faculty therapy of the Federal State Budgetary Institution “Military Medical Academy named after S.M. Kirov »of the Ministry of Defense of the Russian Federation, chief cardiologist of the Ministry of Defense of the Russian Federation, St. Petersburg St.

Chesnikova A.I., MD, professor, head. Department of Internal Diseases No. 1 of the Federal State Budgetary Institution “Rostov State Medical University” of the Ministry of Health of Russia, the main freelance specialist in therapy of the Southern Federal District, Rostov-on-Don

Place of publication:
therapy No. 10 (72) 2023

Resume by resolution:

• The brain of AH is one of the target organs , the first symptoms of the lesion of which are vascular cognitive impairment (SKN).
• It is necessary to carry out neuropsychological testing to identify and assess the severity of SKN. The management and examination of patients with AG is carried out by the primary outpatient doctor.
• For effective treatment of SKN, antihypertensional therapy is not enough, a neuroprotection program is needed.
• The choice of a neuroprotector should be based on the evidence base and good tolerance of the drug. In order to reduce polypragmasis, it is necessary to focus on drugs with a multimodal action mechanism ( Mexidol ^® ).
• The recommended scheme of sequential therapy with Mexidol, according to the results of clinical studies, including randomized, 200-500 mg/day intravenously or intramuscularly for 14 days with a transition to a periral form, 250 mg 3 times/day for 60 days.
• Neuroprotection should serve as an integral part of patients with AG. It is recommended to supplement the algorithm for drug treatment of patients with hypertension by turning on ethylmethylhydroxypyridine of succinate (Mexidol ^® ) in the clinical recommendations “Arterial hypertension in adults” (i10/i11/i12/i13/i15, according to ICD-10).

Place of publication:
New therapeutic journal Non Nocera, September, 2023

Summary:
arterial hypertension (AH) is currently a very urgent problem of modern society. Its prevalence among an adult population is an average of 30–45%, significantly increasing in older age groups. In addition, due to the expected increase in life expectancy, an increase in the number of patients with AH is predicted. From the point of view of clinical significance, special attention to AH is due to a wide range of complications caused by the disease and involved target organs, including the heart, blood vessels, kidneys, organ of vision and brain. Several large population studies showed that the higher the office blood pressure (blood pressure), the higher the risk of stroke, coronary heart disease, heart failure, peripheral arterial diseases, and the terminal stage of renal failure and sudden death. AH is also recognized as one of the pathogenetic factors of the development of vascular cognitive impairment (KN) and Alzheimer's disease. However, before achieving the final stage - dementia, patients are sequentially intermediate stages between the normal level of cognitive functioning and the very difficult KN, as the cognitive status develops progressively, gradually violating the quality of life and negatively affecting the adaptation of a person in various fields of daily activities. There are many studies that clearly established the relationship between increased blood pressure and KN and demonstrated that the latter are one of the earliest manifestations of brain damage against the background of hypertension.

Place of publication:
therapy No. 9 (61) 2022

Summary:
Cognitive disorders (KN) - a widespread clinical syndrome, with which specialists of various profiles are often found in outpatient reception. Diagnosis of KN is a responsible task, the correct solution of which requires a comprehensive study of the anamnesis, the nature of the clinical picture, the results of a laboratory and instrumental examination. A common cause of KN is cerebrovascular diseases. The article discusses the issues of patients with KN of vascular genesis, in particular, the main aspects of correction of factors of cardiovascular risk, the choice of optimal drug therapy. Information is given about the possibility of using the drug Mexidol to treat this contingent of patients. The results of studies are analyzed by the study of the possibility of the use of Mexidol in chronic cerebrovascular circulation disorders with KN. Key words: chronic brain ischemia, chronic cerebrovascular diseases, a disease of small cerebral arteries, cognitive impairment, Mexidol.