КЛИНИКА НЕРВНЫХ БОЛЕЗНЕЙ им М.И. АСТВАЦАТУРОВА
ВОЕННО-МЕДИЦИНСКАЯ АКАДЕМИЯ им С.М.КИРОВА
основана в 1897 году
О клиникеДля пациентовДля врачейВозможности клиникиАдрес клиники

Новости

Чтобы руки не болели

У тех, кто много работает за компьютером, часто возникает "синдром запястного канала", или "синдром машинистки" - начинают болеть суставы рук, немеют пальцы.

29.09.2009 00:29

Расстройства сна повышают риск возникновения болезни Паркинсона

У большей половины людей с редкими расстройствами сна возникает такое нейродегенеративное заболевание, как болезнь Паркинсона, сообщили канадские исследователи.

12.05.2009 00:26
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КОРРЕКЦИЯ КОГНИТИВНЫХ НАРУШЕНИЙ МЕМАНТИНОМ (АКАТИНОЛОМ)

Литвиненко И.В., Одинак М.М., Могильная В.И., Перстнев С.В. КОРРЕКЦИЯ КОГНИТИВНЫХ НАРУШЕНИЙ МЕМАНТИНОМ (АКАТИНОЛОМ) УЛУЧШАЕТ ПРОГНОЗ ПРИ БОЛЕЗНИ ПАРКИНСОНА, ОСЛОЖЕННОЙ ДЕМЕНЦИЕЙ: РЕЗУЛЬТАТЫ ОТКРЫТОГО 52-НЕДЕЛЬНОГО ПРОСПЕКТИВНОГО КОНТРОЛИРУЕМОГО ИССЛЕДОВАНИЯ.

Кафедра нервных болезней и кафедра психиатрии Военно-медицинской академии, 194044, Санкт-Петербург, Лесной пр.2, e-mail: litvinenkoiv @ rambler.ru

Litvinenko I.V., Odinak M.M., Mogilnaya V.I., Perstnev S.V. MEMANTINE THERAPY CAN IMPROVE PROGNOSIS IN PARKINSON’S DISEASE, COMPLICATED BY DEMENTIA: RESULTS OF 52 WEEKS OPEN-LABEL RANDOMIZED CONTROLLED STUDY.

Abstract

The pathological basis of dementia associated with PD is not fully understood. Prospective study showed that high plasma homocysteine level is an independent risk factor for dementia. Increasing plasma homocysteine (Hcy) levels are associated also with more hippocampal and cortical atrophy in an older non-demented population. Elevated plasma Hcy concentrations have been reported in PD patients. Hcy acts as an agonist at the glutamate binding site of the NMDA glutamate receptor. The study has investigated the effect of NMDA-glutamate receptor antagonist memantine in 52 weeks therapy of 32 Parkinson’s disease patients with dementia (PDD) compared with control PDD patients group (30 cases). Patients of active group received additionally memantine (20 mg per day) to dopaminergic therapy. Control group patients continued treatment only using dopaminergic therapy. Cognitive, psychiatric and motor symptoms were assessed before and after 12, 24 and 52 weeks of study using clinical assessment as well as rating scales including the Unified Parkinson's disease Rating Scale (UPDRS), the Mini-Mental State Examination (MMSE), ADAS-cog, clock drawing test, D-KEFS Verbal Fluency test, the Frontal Assessment Battery (FAB), the Neuropsychiatric Inventory (NPI-12) and the Disability Assessment for Dementia Scale (DAD). The plasma total Hcy level was determined by high-performance liquid chromatography. Treated patients by memantine had better MMSE (p<0,05), ADAS-cog (p<0,05), clock drawing test (p<0,05) and FAB (p<0,01) scores than did patients in control group at week 24. Patients with elevated Hcy demonstrated significantly better response to memantine therapy versus control group with elevated Hcy at week 24, 52 with respect to all efficacy measures (UPDRS, MMSE, ADAS-cog, D-KEFS Verbal Fluency test, FAB, NPI, DAD p<0,05). NPI individual item scores change from baseline at week 52 showed benefits with memantine treatment compared with control with significant treatment differences for disinhibiton (р=0,006), irritability (р=0,04), anxiety (р=0,04) and hallucinations (р=0,048). Hyperhomocysteinemia may indicate to more rapid cognitive and motor decline in PD. The prolonged therapy by memantine in PDD led to improvements in cognitive functions and preservation of motors functional abilities, as well as the amelioration of neuropsychiatric symptoms, especially in patients with hyperhomocysteinemia. Key words: Parkinson's disease, dementia, memantine, homocysteine.

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