Levada O. Subcortical vascular dementia in elderly patients: clinical structure of the disease at the stages of development, neurobiological markers of progression and therapy effectiveness

On the basis of a comprehensive assessment of 189 elderly and senile patients (50 with no cognitive impairment, 70 - with subcortical vascular mild cognitive impairment, SVMCI, 69 - with early subcortical vascular dementia SVD) we proposed an integrative concept of diagnosis of early stages of SVD (algorithm, criteria and tests). It combines categorical (qualitative) and dymensional (quantitative) approaches, neuropsychological, psychopathological, neurological, functional parameters and supported by a number of neurobiological markers. We prove that the early stages of SVD are accompanied by a gradual progression of pathognomonic clinical syndromes: cognitive deficits (executive dysfunction, specific disorders of memory, transcortical motor aphasia), psychopathological disorders (depression, apathy and nighttime behavior disorders), neurological disorders (higher level gait disorders, pyramidal and pseudobulbar syndromes), activity of daily living disturbances, as well as regular changes in a number of neurobiological markers (growth of white matter hyperintensity and frontal-subcortical brain atrophy severity, increased serum concentrations of protein S100?, a decrease in the expression of dopamine D2-type receptors, increased of evoked cognitive potential P300 latency, an increase in changes of carotid arteries according to ultrasound investigation). Diagnostic approaches are grouped into a system of sequential steps (algorithm) that allows solving the diagnostic problem gradually. Presented panels of approved diagnostic tests as well as their quantitative indicators allow differentiating patients with SVMCI and SVD, and optimizing healing and protective strategies and monitoring disease progression and therapy effectiveness.