HIM / DEP

To select the optimal therapeutic tactics, the assessment of the severity of SCI is of great importance. The diagnosis of moderate SCI is based on:

• on complaints of the patient and (or) people close to him about memory impairment and other cognitive functions;
• the presence of a syndrome of moderate cognitive impairment according to neuropsychological research methods;
• decrease in cognitive functions compared to the previous higher level;
• the absence of severe violations of daily activity and dementia;
• clinical, anamnestic, neuroimaging signs of cerebrovascular disease;
• lack of data on other diseases, including Alzheimer’s disease [11–14].

It should be noted that, according to the latest international recommendations DSM-V, instead of the usual term “dementia”, the term “pronounced (in the original major – major) neurocognitive disorder” is used. In this condition, cognitive impairment is so pronounced that it interferes with the normal functioning of the patient. The patient is completely or partially deprived of independence and autonomy in everyday life, needs outside help in ordinary situations. This is the main difference between severe and moderate (in the original mild – light) neurocognitive disorder, in which independence and autonomy in everyday life are preserved. Criteria for moderate and severe neurocognitive disorders according to DSM-V are given in Table. [16–18]. These terms apply to the majority of brain diseases with clinical signs of cognitive impairment, including SCI and Alzheimer’s disease.

Treatment

Therapeutic interventions for VCI should be aimed at treating the underlying vascular disease. They provide primarily for the prevention of acute cerebrovascular accidents and chronic cerebrovascular insufficiency. Only under the condition of proper control of the existing risk factors for cerebral ischemia can one count on preventing or slowing the progression of vascular damage to the brain and the development of stroke and / or vascular dementia. The main directions of etiotropic therapy:

• antihypertensive therapy;
• antiplatelet or anticoagulant therapy;
• lipid-lowering therapy ( statins ­);
• methods of vascular surgery (carotid endarterectomy , stenting of the carotid arteries);
• treatment of cardiac arrhythmias;
• a diet low in animal fats;
• sufficient physical activity;
• body weight correction;
• quitting smoking and alcohol abuse.