Samartsev I N, Zhivolupov S A, Efimtsev A Y, Ponomarev V V
Kirov Military Medical Academy, St. Petersburg, Russia.
Almazov National Medical Research Centre, St. Petersburg, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2022;122(7):66-73. doi: 10.17116/jnevro202212207166.
To analyze the relationship between the severity of postural instability in patients with CCI (chronic cerebral ischemia) and brain changes according to MRI, as well as to evaluate the efficacy and safety of vinpocetine.
The study included 60 patients with CCI: 40 people with postural instability made up the main group and 20 people without balance disorders - the control group. The severity of manifestations of cerebrovascular pathology was assessed according to the protocol STRIVE. Severity of postural instability was assessed with the VAS, anxiety syndrome - Hamilton Anxiety Rating Scale, asthenia - Asthenic Condition Scale, daytime sleepiness - Epworth Sleepiness Scale, cognitive impairment - Montreal scale assessment of cognitive functions, the overall impression of treatment - Global Rating of Change Scale.
The main group was associated with older age, more significant decrease in cognitive functions, urination disorders, anxiety syndrome and asthenia, changes according to MRI of the brain. CCI burden scale was significantly associated with VAS: β=0.479, P=0.035, 95% CI 0.023-0.928. The presence of lacunae was the most significant marker for the development of severe imbalance: β=0.482, =0.041, 95% CI 0.022-0.925. A significant relationship was found between the total number of lacunae and VAS (=0.509, =0.021), as well as between the number of lacunae in the basal ganglia (=0.793, =0.019), especially the lenticular nuclei (=0.498, =0.036), and VAS. After 3 months of vinpocetine treatment, a significant improvement in statodynamic function was noted in the main group, moreover - absence of anxiety, normalization of daytime sleep, «weak» asthenia, increasement in the value of the MoCA scale. Most of the patients regarded the improvement from the therapy as «moderate» and «pronounced».
The presence of lacunes in the basal ganglia is a most prominent neuroimaging marker of brain damage in patients with CCI and postural instability. The use of vinpocetine can significantly reduce the severity of imbalance, anxiety and asthenia, and normalize the circadian rhythm of sleep.
