Report from Symposium on Medical Comorbidities in Elderly Patients held at the 9th International Congress “Neurorehabilitation 2017”

           The symposium started with a welcome speech and greetings to the participants of the delivered by the symposium Co-chairs, Prof. Andrey V. Strutynskiy, ScD (Head of the Department of Internal Medicine Propaedeutics at the Pirogov Russian National Research Medical University) and Prof. Vladimir A. Parfenov, ScD (Head of the Department of Nervous Diseases and Neurosurgery and Director of the Nervous Diseases Clinic at the Sechenov First Moscow State Medical University.

           Prof. Strutynskiy spoke on the diagnosis and treatment of comorbid conditions in elderly patients. He stressed that the management of cerebrovascular disease requires joint efforts by GPs, cardiologists and neurologists.

          The next speaker, Prof. Parfenov, remarked that CCVD (chronic cerebrovascular disease) is one of the most common neurological diagnoses made in Russia and, although unfamiliar to most of the world, appears to correspond to some degree to VCI (vascular cognitive impairment). CCVD is often a “disguise” for other medical conditions, such as anxiety and depressive disorders, primary headache, peripheral vestibulopathy, Alzheimer’s disease, etc., which present a challenge for clinical diagnosis and therefore leave the patients with little chance to receive an effective treatment. Treating CCVD primarily involves attenuation of stroke risk factors, normalization of blood pressure and lowering of cholesterol levels and requires the use of antithrombotic therapy and drugs that improve cognitive function. Acetylcholinesterase inhibitors and (or) glutamate receptor blockers are indicated as cognitive enhancers for patients with vascular dementia. Effectiveness of cognitive enhancers in mild to moderate VCI is still contentious. In Russia, treatment of CCVD involves the use of a large number of medications, yet only a few of them have been studied in placebo-controlled randomized trials for cerebrovascular disease and Divaza is among these. 

             During the presentation, Prof. Parfenov cited literature data and results of his own research on the diagnosis and treatment of CCVD. Among others, these included interim data from a multicenter, open-label trial of the efficacy and safety of Divaza in elderly and geriatric patients with asthenoneurotic and cognitive disorders. The speaker emphasized that the study is being performed on an unprecedented scale in terms of extensiveness compared to all previous multicenter trials.  

           Presenting next was Prof. Ella Y. Solovyova, ScD. Her talk focused on differential diagnosis and treatment of “small vessel disease”. She also described the major diagnostic signs of chronic cerebral ischemia. Non-amnestic cognitive impairments are the primary ones. Next in importance is an acute or stepwise progression of the cognitive defect, linked to a vascular genesis. These manifestations require neuropsychological evaluation. Other tell-tale signs are those related to brain vascular lesion, like infarction, hemorrhage, asymptomatic lacunae, or subcortical leukoaraiosis – not accompanied by clinical, medical history or neuroimaging evidence for other neurological conditions.