Mishchenko V. Silent brain infarcts (risk factors, pathogenesis, clinical features, diagnosis, therapy)

The dissertation is devoted to investigations of clinical-neurological, cognitive, and emotional impairments, brain structural changes and bioelectric activity, cerebral hemodynamics, and metabolic impairments in patients with silent brain infarcts (SBI) in order to develop a conception of SBI pathogenesis, diagnostic criteria, prognosis and therapeutic strategies on this basis. On the base of an integrative comparative study of 202 patients with SBI and 202 patients with dyscirculatory encephalopathy of II stage (without SBI), peculiarities of vascular risk factors, brain structural-functional changes, and metabolic impairments were determined in patients with SBI. Connections between clinical-neurological manifestations of the disease, cognitive functions and number and localization of SBI nidi, functional conditions of vascular endothelium, and levels of ?-amyloid peptides were defined. It was found out, that arterial hypertension, diabetes mellitus II, metabolic syndrome, sleep apnea were the main risk factors for SBI formation. On the base of the discriminant analysis, a model of SBI development was proposed. New biomarkers of SBI development were determined. These markers could be used in SBI diagnosis. On the basis of 2-year dynamic clinical-instrumental and neuroimaging investigation, peculiarities of SBI course have been defined. The main prognostic criteria for development of symptomatic brain stroke and dementia were revealed in these patients. It was worked out a SBI formation pathogenetic conception based on brain small vessels disease. A strategy of treatment for patients with SBI was grounded pathogenetically. On the base of clinical, instrumental, neuroimaging, and biochemical investigations it was proven efficacy of medications influencing on functional conditions of endothelium and medication with neuroprotective effects in treatment of patients with SBI.