UNASSIGNED: Post-diagnostic care for people with vascular cognitive impairment (VCI) typically involves multiple professions and disjointed care pathways not specifically designed to aid VCI needs.
UNASSIGNED: Exploring perspectives of healthcare professionals on post-diagnostic care for people with VCI.
UNASSIGNED: We conducted a qualitative focus group study. We used purposive sampling to include healthcare professionals in different compositions of primary and secondary care professionals per focus group. Thematic saturation was reached after seven focus groups. Transcripts were iteratively coded and analyzed using inductive thematic analysis.
UNASSIGNED: Forty participants were included in seven focus groups (4-8 participants). Results showed knowledge and awareness of VCI as prerequisites for adequate post-diagnostic care, and for pre-diagnostic detection of people with VCI (theme 1). In light of perceived lack of differentiation between cognitive disorders, participants shared specific advice regarding post-diagnostic care for people with VCI and informal caregivers (theme 2). Participants thought current care for VCI was fragmented and recommended further integration of care and collaboration across settings (theme 3).
UNASSIGNED: People with VCI and their caregivers risk getting stuck in a \"no man\'s land\" between post-diagnostic care pathways; challenges lie in acknowledgement of VCI and associated symptoms, and alignment between healthcare professionals. Education about the symptoms and consequences of VCI, to healthcare professionals, people with VCI and caregivers, may increase awareness of VCI and thereby better target care. Specific attention for symptoms common in VCI could further tailor care and reduce caregiver burden. Integration could be enhanced by combining expertise of dementia and stroke/rehabilitation pathways.

miR-135 is a highly conserved miRNA in mammals and includes miR-135a and miR-135b. Recent studies have shown that miR-135b is a key regulatory factor in cardio-cerebrovascular diseases. It is involved in regulating the pathological process of myocardial infarction, myocardial ischemia/reperfusion injury, cardiac hypertrophy, atrial fibrillation, diabetic cardiomyopathy, atherosclerosis, pulmonary hypertension, cerebral ischemia/reperfusion injury, Parkinson\'s disease, and Alzheimer\'s disease. Obviously, miR-135b is an emerging player in cardio-cerebrovascular diseases and is expected to be an important target for the treatment of cardio-cerebrovascular diseases. However, the crucial role of miR-135b in cardio-cerebrovascular diseases and its underlying mechanism of action has not been reviewed. Therefore, in this review, we aimed to comprehensively summarize the role of miR-135b and the signaling pathway mediated by miR-135b in cardio-cerebrovascular diseases. Drugs targeting miR-135b for the treatment of diseases and related patents, highlighting the importance of this target and its utility as a therapeutic target for cardio-cerebrovascular diseases, have been discussed.

Posterior reversible encephalopathy syndrome (PRES) is characterized by nonspecific symptoms, including not only pronounced non-focal and various focal neurological signs but also specific neuroimaging features, including vasogenic edema affecting predominantly the posterior area. PRES usually develops in the setting of acute arterial hypertension. However, it is not uncommon for PRES to develop in non-hypertensive patients, including people with autoimmune disorders (multiple sclerosis, neuromyelitis optica spectrum disorder, etc). PRES could also be due to the toxic effects of drugs or other substances. The pathophysiological mechanisms of PRES include impaired autoregulation of cerebral blood flow due to acute arterial hypertension and toxic endotheliotropic effects of endogenous and exogenous factors.
Синдром задней обратимой энцефалопатии (PRES) характеризуется неспецифической симптоматикой в виде выраженных общемозговых и разнообразных очаговых неврологических симптомов, сопровождается характерными нейровизуализационными изменениями (вазогенный отек, поражающий преимущественно теменно-затылочную область). PRES как правило развивается на фоне острой артериальной гипертензии, однако нередки случаи его развития у пациентов с нормальным артериальным давлением, в том числе и при аутоиммунных расстройствах, включая рассеянный склероз, заболевания спектра оптиконейромиелита, а также вследствие токсического воздействия ряда лекарственных препаратов или иных веществ. Патофизиологические механизмы PRES включают нарушение ауторегуляции мозгового кровотока на фоне острой артериальной гипертензии и токсическое эндотелиотропное воздействие эндогенных и экзогенных факторов.

Cerebrovascular diseases (CVDs) are one of the leading causes of death and disability In Russia: they rank second in the structure of mortality from diseases of the circulatory system and in the overall mortality of the population. Successful treatment of CVD involves an integrated approach to the problem, taking into account the compensation of cardiovascular disorders, the elimination of neurological and psychopathological syndromes, the improvement of cerebral circulation and the use of neuroprotective agents that increase the resistance of brain tissue to hypoxia and ischemia. Insufficient clinical efficacy of neuroprotectors is due to a number of objective reasons, of which only two are universal. The first of these reasons is the timing of the start of therapy in the clinic, as a rule, is outside the «therapeutic window»; the second reason is the fact that disturbance of the patency of the cerebral vessels in the affected area makes it difficult or impossible to deliver the drug to the penumbra area. The way out of this situation is the intranasal route of drug administration, which is characteristic for the analogs of regulatory peptides such as for H-Met-Glu-His-Phe-Pro-Gly-Pro-OH (MGHPPGP). The review of clinical studies indicates that MGHPPGP is clinically effective in the treatment of ischemic stroke both in the acute period of stroke and in the recovery period. The clinical efficacy of MGHPPGP was shown both in atherothrombotic and cardioembolic subtypes of stroke, against the background of blood flow disturbances in both the carotid and vertebrobasilar systems.
Цереброваскулярные заболевания (ЦВЗ) — одна из ведущих причин смертности и инвалидизации населения в России: они занимают второе место в структуре смертности от болезней системы кровообращения и в общей смертности населения. Успешное лечение ЦВЗ предполагает комплексный подход к проблеме, учитывающий компенсацию сердечно-сосудистых нарушений, устранение неврологических и психопатологических синдромов, улучшение церебральной циркуляции и применение нейропротективных средств, повышающих устойчивость мозговой ткани к гипоксии и ишемии. Недостаточная клиническая эффективность нейропротекторов обусловлена рядом объективных причин, из которых универсальными являются всего лишь две: первая — сроки начала терапии в клинике, как правило, находятся за пределами терапевтического окна; вторая — нарушение проходимости сосудов мозга в зоне поражения затрудняет или делает невозможным доставку препарата в зону пенумбры. Выходом из данного положения является интраназальный путь применения лекарств, характерный для аналогов регуляторных пептидов, в частности олигопептида с последовательностью метионил-глутамил-гистидил-фенилаланил-пролил-глицил-пролин (H-Met-Glu-His-Phe-Pro-Gly-Pro-OH, MGHPPGP). Проведенный обзор клинических исследований свидетельствует о том, что в терапии ишемического инсульта олигопептид MGHPPGP клинически эффективен как в остром, так и в восстановительном периоде инсульта. Клиническая эффективность MGHPPGP была показана как при атеротромботическом, так и при кардиоэмболическом подтипах инсульта, на фоне нарушения кровотока как в каротидной, так и в вертебрально-базилярной системе.

Calpain, a key member of the Calpain cysteine protease superfamily, performs limited protein hydrolysis in a calcium-dependent manner. Its activity is tightly regulated due to the potential for non-specific cleavage of various intracellular proteins upon aberrant activation. A thorough review of the literature from 2010 to 2023 reveals 121 references discussing cardiovascular and cerebrovascular diseases. Dysregulation of the Calpain system is associated with various pathological phenomena, including lipid metabolism disorders, inflammation, apoptosis, and excitotoxicity. Although recent studies have revealed the significant role of Calpain in cardiovascular and cerebrovascular diseases, the precise mechanisms remain incompletely understood. Exploring the potential of Calpain inhibition as a therapeutic approach for the treatment of cardiovascular and cerebrovascular diseases may emerge as a compelling area of interest for future calpain research.

Central nervous system (CNS)-related diseases have a high mortality rate, are a serious threat to physical and mental health, and have always been an important area of research. Gastrodin, the main active metabolite of Gastrodia elata Blume, used in Chinese medicine and food, has a wide range of pharmacological effects, mostly related to CNS disorders. This review aims to systematically summarize and discuss the effects and underlying mechanisms of gastrodin in the treatment of CNS diseases, and to assess its potential for further development as a lead drug in both biomedicine and traditional Chinese medicine. Studies on the pharmacological effects of gastrodin on the CNS indicate that it may exert anti-neurodegenerative, cerebrovascular protective, and ameliorative effects on diabetic encephalopathy, perioperative neurocognitive dysfunction, epilepsy, Tourette\'s syndrome, depression and anxiety, and sleep disorders through various mechanisms. To date, 110 gastrodin products have been approved for clinical use, but further multicenter clinical case-control studies are relatively scarce. Preclinical studies have confirmed that gastrodin can be used to treat CNS-related disorders. However, important concerns need to be addressed in the context of likely non-specific, assay interfering effects when gastrodin is studied using in vitro and in silico approaches, calling for a systematic assessment of the evidence to date. High-quality clinical trials should have priority to evaluate the therapeutic safety and clinical efficacy of gastrodin. Further experimental research using appropriate in vivo models is also needed, focusing on neurodegenerative diseases, cerebral ischemic and hypoxic diseases, brain damage caused by methamphetamine or heavy metals, and epilepsy.

UNASSIGNED: Several prehospital scales have been designed to aid paramedics in identifying stroke patients in the ambulance setting. However, external validation and comparison of these scales are largely lacking.
UNASSIGNED: To compare all published prehospital stroke detection scales in a large cohort of unselected stroke code patients.
UNASSIGNED: We conducted a systematic literature search to identify all stroke detection scales. Scales were reconstructed with prehospital acquired data from two observational cohort studies: the Leiden Prehospital Stroke Study (LPSS) and PREhospital triage of patients with suspected STrOke (PRESTO) study. These included stroke code patients from four ambulance regions in the Netherlands, including 15 hospitals and serving 4 million people. For each scale, we calculated the accuracy, sensitivity, and specificity for a diagnosis of stroke (ischemic, hemorrhagic, or transient ischemic attack (TIA)). Moreover, we assessed the proportion of stroke patients who received reperfusion treatment with intravenous thrombolysis or endovascular thrombectomy that would have been missed by each scale.
UNASSIGNED: We identified 14 scales, of which 7 (CPSS, FAST, LAPSS, MASS, MedPACS, OPSS, and sNIHSS-EMS) could be reconstructed. Of 3317 included stroke code patients, 2240 (67.5%) had a stroke (1528 ischemic, 242 hemorrhagic, 470 TIA) and 1077 (32.5%) a stroke mimic. Of ischemic stroke patients, 715 (46.8%) received reperfusion treatment. Accuracies ranged from 0.60 (LAPSS) to 0.66 (MedPACS, OPSS, and sNIHSS-EMS), sensitivities from 66% (LAPSS) to 84% (MedPACS and sNIHSS-EMS), and specificities from 28% (sNIHSS-EMS) to 49% (LAPSS). MedPACS, OPSS, and sNIHSS-EMS missed the fewest reperfusion-treated patients (10.3-11.2%), whereas LAPSS missed the most (25.5%).
UNASSIGNED: Prehospital stroke detection scales generally exhibited high sensitivity but low specificity. While LAPSS performed the poorest, MedPACS, sNIHSS-EMS, and OPSS demonstrated the highest accuracy and missed the fewest reperfusion-treated stroke patients. Use of the most accurate scale could reduce unnecessary stroke code activations for patients with a stroke mimic by almost a third, but at the cost of missing 16% of strokes and 10% of patients who received reperfusion treatment.

OBJECTIVE: To study the efficacy and safety of the use of the drug Picamilon with various therapy regimens in patients with stage I of chronic cerebral ischemia (CCI).
METHODS: Material and methods. An open randomized comparative clinical trial included 44 patients with stage CCI aged 46 to 67 years (average age 55.6±6.76 years). Patients were randomized into two groups, patients of group 1 (n=23) received Picamilon orally in tablets of 50 mg 3 times/day for 60 days; group 2 (n=21) received Picamilon first parenterally at 100 mg i/m for 10 days, then in tablets of 50 mg 3 times/day for 50 days. The total duration of therapy was 60 days. The study included 4 visits (before treatment, 10 days later, 60 days later, 1.5 months after completion of treatment). The dynamics of cognitive status were assessed according to the Montreal Cognitive Function Assessment Scale (MoCA), vegetative disorders on the A.M. Wayne scale, neurological disorders on the A.I. Fedin scale, and sleep quality on the Ya.I. Levin scale. The study of the state of cerebral blood flow (dopplerography of intracranial vessels) and endothelial function (assessment of the level of methylation.
RESULTS: During treatment, in the total sample of patients, there was a positive trend in the results of the MoCA scale, increasing in the delayed period (24.9/26.5/28.3 points, p=0.022 and p<0.001); improvement in sleep quality in 50% of patients by visit 3 and in 84% by visit 4, in the 2nd group the effect occurred in 28% of patients, in the 1st - in 11%, by the end of the study the effect was comparable (p=0.508). Improvement according to Fedin A.I. scale noted in 77% of patients, values decreased from 11.9±8.3 to 6±6.1 points (p<0.0001) and to 2.77±4.43 points by visit 4 (p<0.0001). Normalization of autonomic functions was observed in 29% of patients (p=0.024) without intergroup differences. Picamilon therapy showed high efficacy in terms of clinical outcomes (up to 89%), good tolerability (98% of patients) and a favorable safety profile (less than 8.6% of AEs). The use of Picamilon was accompanied by an increase in the linear velocity of blood flow, a decrease in the thickness of the intima-media complex and the resistance index; a decrease in elevated ADMA concentrations and ADMA/MMA and (ADMA+SDMA)/MMA ratios.
CONCLUSIONS: The use of Picamilon is effective in patients with stage I CCI, contributes to a significant regression of neurological deficits, cognitive impairment, improved sleep quality and autonomic function; improves vascular endothelial function, reduces the risk of atherosclerosis and cardiovascular complications in patients. The optimal duration of therapy with Picamilon in stage I of chronic cerebral ischemia is 2 months.
UNASSIGNED: Изучение эффективности и безопасности применения препарата Пикамилон с различными режимами терапии у пациентов с хронической ишемией головного мозга (ХИМ) I стадии.
UNASSIGNED: В открытое рандомизированное сравнительное клиническое исследование включены 44 пациента в возрасте от 46 до 67 лет (средний возраст 55,6±6,76 года) с ХИМ I стадии. Пациенты были рандомизированы в две группы, больные 1-й группы (n=23) получали перорально Пикамилон в таблетках по 50 мг 3 раза/сут в течение 60 дней; 2-й группы (n=21) — получали Пикамилон сначала парентерально по 100 мг в/м в течение 10 дней, затем в таблетках по 50 мг 3 раза/сут 50 дней. Общая продолжительность терапии составила 60 дней. Исследование включало 4 визита: до лечения, через 10 дней, через 60 дней, через 1,5 мес после завершения лечения. Исследование проводилось с использованием Монреальской шкалы оценки когнитивных функций (MoCA), шкалы вегетативных нарушений А.М. Вейна, шкалы неврологических нарушений А.И. Федина, шкалы качества сна Я.И. Левина. Оценивались состояния церебрального кровотока (допплерография интракраниальных сосудов) и функции эндотелия (оценка уровня метилированных форм аргинина — АДМА, ММА, СДМА). Регистрировались нежелательные явления (НЯ) на фоне терапии и переносимость лечения.
UNASSIGNED: На фоне лечения в общей выборке пациентов наблюдалась положительная динамика результатов шкалы MoCA, нарастающая в отсроченном периоде (24,9/26,5/28,3 балла, p=0,022 и p<0,001); улучшение качества сна у 50% пациентов к визиту 3 и у 84% к визиту 4, во 2-й группе эффект имел место у 28% пациентов, в 1-й — у 11%, к концу исследования эффект был сопоставим (p=0,508). Улучшение по шкале А.И. Федина отмечено у 77% пациентов, значения снижались с 11,9±8,3 до 6±6,1 балла на визите 3 (p<0,0001) и до 2,77±4,43 баллов к визиту 4 (p<0,0001). Нормализация вегетативных функций наблюдалась у 29% пациентов (p=0,024) без межгрупповой разницы. Терапия Пикамилоном показала высокую эффективность по оценке клинических исходов (до 89%), хорошую переносимость (98% пациентов) и благоприятный профиль безопасности (менее 8,6% НЯ). Применение Пикамилона сопровождалось повышением линейной скорости кровотока, уменьшением толщины комплекса интима-медиа и индекса резистентности; уменьшением повышенной концентрации АДМА и соотношений АДМА/ММА и (ADMA+SDMA)/MMA.
UNASSIGNED: Применение Пикамилона эффективно у пациентов с ХИМ I стадии, способствует значительному регрессу неврологического дефицита, когнитивных нарушений, улучшению качества сна и вегетативной функции; улучшает функцию эндотелия сосудов, снижает риск атеросклероза и сердечно-сосудистых осложнений у пациентов. Оптимальная продолжительность терапии Пикамилоном при ХИМ I стадии — 2 мес.

Stroke is one of the main causes of permanent disability and death and the risk increases with age. Primary and secondary prevention therefore have a high priority. The treatment of risk factors, such as high blood pressure, diabetes mellitus and hyperlipidemia is just as important as anticoagulation in atrial fibrillation, in addition to optimization of lifestyle and diet. Platelet function inhibitors play a role in the prophylaxis of recurrence, carotid surgery and stenting are used in selected patients. There is little study evidence for old people, individualized treatment planning takes functional status and comorbidities into account.
UNASSIGNED: Der Schlaganfall ist eine der Hauptursachen für bleibende Behinderung und Tod; das Risiko steigt mit dem Alter. Der Primär- und Sekundärprävention kommt eine hohe Priorität zu. Die Behandlung von Risikofaktoren wie Bluthochdruck, Diabetes mellitus und Hyperlipidämie ist neben der Optimierung von Lebensstil und Ernährung ebenso bedeutend wie die Antikoagulation bei Vorhofflimmern. In der Rezidivprophylaxe spielen Thrombozytenfunktionshemmer eine Rolle, Karotisoperation oder Stenting kommen bei ausgewählten Individuen zum Einsatz. Für alte Menschen gibt es nur geringe Studienevidenz; eine individualisierte Therapieplanung berücksichtigt funktionellen Status und Komorbiditäten.

BACKGROUND: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible.
OBJECTIVE: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB.
METHODS: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia.
RESULTS: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (β=-0.65, 95% CI -1.15 to -0.15; P=.01) and simple motor (β=-0.86, 95% CI -1.43 to -0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model.
CONCLUSIONS: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral.