r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2020-25-6-40-46r-n-j-131Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSТерапия недементной стадии болезни Альцгеймера, осложнившейся развитием гипоактивного делирияManagement of the predementia stage of Alzheimer’s disease, complicated with hypoactive deliriumhttps://orcid.org/0000-0002-4193-688XТкачёваО. Н.TkachevaO. N.tkacheva@rgnkc.ruhttps://orcid.org/0000-0002-9054-0881ЧердакМ. А.CherdakM. A.maria.cherdak@yandex.ruhttps://orcid.org/0000-0003-2597-981XМхитарянЭ. А.MkhitaryanE. A.melen99@mail.ruФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, особое структурное подразделение «Российский геронтологический научно-клинический центр»РоссияPirogov Russian National Research Medical University (RNRMU), Russian Clinical and Research Center of GerontologyRussian Federation2020070120212564046Copyright © Ткачёва О.Н., Чердак М.А., Мхитарян Э.А., 20212021Ткачёва О.Н., Чердак М.А., Мхитарян Э.А.Tkacheva O.N., Cherdak M.A., Mkhitaryan E.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/131

Болезнь Альцгеймера (БА) является наиболее распространенным нейродегенеративным заболеванием у лиц старшей возрастной группы, приводящим к синдрому деменции. Диагностика БА до развития тяжелого когнитивного дефекта (деменции) позволяет исследовать эффективность терапии с патогенетической направленностью или нейропротективными свойствами на додементной стадии заболевания. Приведено описание клинического наблюдения больной с умеренным когнитивным расстройством амнестического типа на протяжении более чем двух лет. Наличие БА у нее было подтверждено с использованием специфических клинических, лабораторных и инструментальных биомаркеров заболевания. Терапия препаратом акатинол мемантин, используемым в качестве одного из основных базисных противодементных средств при БА, в дозе 20 мг/сут сопровождалась стабилизацией когнитивного дефекта на протяжении двух лет. Затем у больной развился эпизод тяжелой декомпенсации, связанный с развитием гипоактивного делирия на фоне острой респираторной вирусной инфекции, после которого когнитивный статус резко ухудшился. Было продолжено применение акатинола мемантина в более высокой дозе (30 мг/сут), на фоне чего когнитивный статус больной восстановился. Обсуждаются механизмы действия акатинола мемантина и его роль в терапии лиц пожилого возраста с БА, включая возможности применения препарата при делирии.

Alzheimer’s disease (AD) is the most common neurodegenerative disorder in elderly population leading to the development of dementia. The emergence of modern diagnostic approaches makes possible reveal AD at predementia stage and study new drugs with pathogenetic and neuroprotective properties before severe cognitive impairment (dementia) arises. We present a description of patient with amnestic type of mild cognitive impairment with subsequent follow-up for more than two years. AD presence in mentioned patient was confirmed by evaluation of specific clinical, laboratory and instrumental biomarkers. Therapy with akatinol memantine (one of the main antidementia drugs in AD) at dose 20 mg/day was accompanied by cognitive defect stabilization. After two years of therapy acute severe decompensation related to hypoactive delirium due to respiratory infection was observed, which was followed by marked cognitive status deterioration. Daily dose of akatinol memantine was increased to 30 mg with subsequent restoration of baseline cognitive status. Possible mechanisms of akatinol memantine action and its effects in management of geriatric patients with AD including role in delirium therapy are discussed.

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The authors declare that there are no conflicts of interest present.