bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTHbekhterev-17Research ArticleВ ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУGUIDELINES FOR THE PRACTITIONERНейротропный подход к лечению мультиинфарктной деменции с применением холина альфосцератаA neurotropic approach to the treatment of multi-infarct dementia using l-a-glycerylphosphorylcholineMuratorioAlbertonoemail@neicon.ruBonuccelliUbaldonoemail@neicon.ruNutiAngelonoemail@neicon.ruBavpistiniNoenoemail@neicon.ruPasseroStefanonoemail@neicon.ruCarusoVittorianoemail@neicon.ruBataniBarbaranoemail@neicon.ruBaroniAlbertonoemail@neicon.ruMayerFedericonoemail@neicon.ruSorbiTiziananoemail@neicon.ruFranciosiAttilionoemail@neicon.ruMoroGianninoemail@neicon.ruAgostiniLucianonoemail@neicon.ruPiccirilliMassimonoemail@neicon.ruScatozzaDiananoemail@neicon.ruIstituto di Clinica Neurologica, Universita di PisaRussian FederationIstituto di Clinica delle Malattie Nervose e Mentali, Universita di SienaRussian FederationCentro di Geriatria Fraticini, I.N.R.C.A., FirenzeRussian FederationServizio di Neurologia, Ospedale Civile di ArzignanoRussian FederationClinica Neurologica, Universita di PerugiaRussian FederationDirezione Medico Scientifica, Italfarmaco S.p.ARussian Federation201619072018025360Copyright © Muratorio A., Bonuccelli U., Nuti A., Bavpistini N., Passero S., Caruso V., Batani B., Baroni A., Mayer F., Sorbi T., Franciosi A., Moro G., Agostini L., Piccirilli M., Scatozza D., 20182018Muratorio A., Bonuccelli U., Nuti A., Bavpistini N., Passero S., Caruso V., Batani B., Baroni A., Mayer F., Sorbi T., Franciosi A., Moro G., Agostini L., Piccirilli M., Scatozza D.Muratorio A., Bonuccelli U., Nuti A., Bavpistini N., Passero S., Caruso V., Batani B., Baroni A., Mayer F., Sorbi T., Franciosi A., Moro G., Agostini L., Piccirilli M., Scatozza D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/17

Было проведено многоцентровое открытое рандомизированное контролируемое клиническое исследование с целью сравнительной оценки эффективности и переносимости холина альфосцерата (L-a-глицерилфосфорилхолина) и цитиколина (ЦДФ-холина), используемых в дозе 1 г/сут внутримышечно, у 112 пациентов с мультиинфарктной деменцией легкой или средней степени тяжести. После 90-дневного периода лечения пациенты находились под наблюдением в течение еще 90 дней без проведения терапии для контроля продолжительности сохранения результатов. Всего 97 пациентов завершили период лечения, из них 73 завершили период наблюдения. Восемнадцать пациентов выбыло из исследования вследствие несоблюдения режима и схемы терапии, а 21 выбывший пациент не находился под наблюдением ни в одном из центров. До начала исследования пациенты находились под наблюдением 2 недели, в течение которых были отменены все другие препараты, которые могли повлиять на результат исследования. Контроль клинической эффективности осуществлялся путем сравнения результатов в начале исследования, через 30 дней, в конце лечения и в конце периода наблюдения по следующим психометрическим тестам: шкале клинической гериатрической оценки компании «Сандоз» (Sandoz Clinical Assessment Geriatric (SCAG) Rating Scale), шкале оценки деменции Блесседа (Blessed Dementia Scale, BDS), шкале Блесседа для оценки информации, памяти и концентрации (Blessed Information, Memory, Concentration test, BIMC), шкала памяти Векслера (Wechsler Memory Scale, WMS), шкале быстрой оценки степени нарушения трудоспособности 2 (Rapid Disability Rating Scale 2, RDRS-2), шкале беглости речи (Word Fluency Test, WFT), жетонному тесту (Token test)*, а также простому копированию рисунков (Simple Drawing Copy, SDC). У пациентов, получавших холина альфосцерат, в конце лечения отмечалось значительное улучшение когнитивных и поведенческих функций, а также способности к самообслуживанию по сравнению с исходными значениями. Это улучшение также было очевидным и в конце периода наблюдения. Сравнение клинических результатов терапии холина альфосцератом и ци-тиколином показывает, что согласно оценкам по BDS, WMS, RDRS-2u SDC, выполненным по окончании терапии, а также согласно оценкам по BDS, WMS, SCAGu Token test, выполненным по окончании периода наблюдения, более эффективной была терапия холина альфосцератом, нежели цитиколином.

A multicenter, unblinded, randomized, controlled clinical trial was conducted to evaluate the efficacy and tolerability of L-aglycerylphosphorylcholine (L-a-GPC) 1 gm/day IM compared with that of cytidine diphosphocholine (CDP-choline) 1 gm/day IM in 112 patients with mild to moderate multi-infarct dementia. A 90-day treatment period with the test drug was followed by a 90-day follow-up period without treatment to observe how long the results obtained with treatment could be maintained. A total of 97 patients completed the treatment period; of these, 73 completed the follow-up period. Eighteen patients did not complete the study because of poor compliance, and 21 patients at one center were not followed up. Treatments were started after a 2-week washout period during which other drugs that could affect cognitive function were withdrawn. Clinical efficacy was evaluated by comparing the results at baseline, after 30 days, at the end of treatment, and at the end of the follow-up period on the following psychometric tests: the Sandoz Clinical Assessment Geriatric (SCAG) Rating Scale, the Blessed Dementia Scale, the Blessed Information, Memory, Concentration test, the Wechsler Memory Scale (WMS), the Rapid Disability Rating Scale 2 (RDRS 2), the Word Fluency test, the Token test, and the Simple Drawing Copy (SDC). The patients receiving L-a-GPC showed a significant improvement of cognitive functions, behaviour, and personality at the end of the treatment, compared with baseline values. This improvement was still apparent at the end of the follow-up period. A comparison of the results obtained with L-a-GPC and CDP-choline shows that the performance of the patients treated with L-a-GPC was significantly better than that of the CDP-choline group on the Blessed Dementia Scale, WMS, RDRS 2, and SDC at the end of treatment and on the Blessed Dementia Scale, WMS, SCAG, and Token test at the end of the follow-up period.

сосудистая деменциямультиинфарктная деменциянейропротективное действиекогнитивная функцияхолинацетилхолинхолина альфосцератvascular dementiamulti-infarct dementianeuroprotectiv actioncognitive functioncholineacetylcholinecholine alfostseratReferencesGovoni S., Battaini F., Lopez C.M. etal. Effetto antiamnesico di alfa-glicerilfosforilcolina: partecipazione di neuroni colinergici e non colinergici // Basi Raz. Ter. 1991; 21 (Suppl. 2): 59Govoni S., Battaini F., Lopez C.M. etal. Effetto antiamnesico di alfa-glicerilfosforilcolina: partecipazione di neuroni colinergici e non colinergici // Basi Raz. Ter. 1991; 21 (Suppl. 2): 59Loeb С. Vascular dementia //Dementia. 1990; 1:175-184.Loeb С. Vascular dementia //Dementia. 1990; 1:175-184.Loeb C. Clinical criteria for the diagnosis of vascular dementia // Eur. Neurol. 1988; 28: 87-92.Loeb C. Clinical criteria for the diagnosis of vascular dementia // Eur. Neurol. 1988; 28: 87-92.Carlsson A. Brain neurotransmitters in ageing and dementia: Similar changes across diagnostic dementia groups // Gerontology. 1987; 33: 159-167.Carlsson A. Brain neurotransmitters in ageing and dementia: Similar changes across diagnostic dementia groups // Gerontology. 1987; 33: 159-167.De Feudis F.V. Central cholinergic system, cholinergic drugs and Alzheimer’s disease. An overview // Drugs Today. 1988; 24: 473-490.De Feudis F.V. Central cholinergic system, cholinergic drugs and Alzheimer’s disease. An overview // Drugs Today. 1988; 24: 473-490.Wesnes K., Simpson P., KiddA. An investigation of the range of cognitive impairments induced by scopolamine 0.6 mg s.c. // Hum. Psychopharmacol. 1988; 3: 27-41.Wesnes K., Simpson P., KiddA. An investigation of the range of cognitive impairments induced by scopolamine 0.6 mg s.c. // Hum. Psychopharmacol. 1988; 3: 27-41.Cohen E.L., Wurtmann R.J. Brain acetyl choline increase after systemic choline administration //Life Sci. 1975; 16:1095-1102.Cohen E.L., Wurtmann R.J. Brain acetyl choline increase after systemic choline administration //Life Sci. 1975; 16:1095-1102.Schmidt D.E., Wecker L. Central nervous system effects of choline administration evidence for temporal dependence // Neuro-pharmacology. 1981; 20: 535-539.Schmidt D.E., Wecker L. Central nervous system effects of choline administration evidence for temporal dependence // Neuro-pharmacology. 1981; 20: 535-539.Wecker L., Schmidt D.E. Central cholinergic function in the rat relationship to choline administration // Life Sci. 1979; 25: 375-384.Wecker L., Schmidt D.E. Central cholinergic function in the rat relationship to choline administration // Life Sci. 1979; 25: 375-384.Wecker L., Goldberg A.M. // International symposium on cholinergic mechanisms. - New York: Plenum Press, 1981.Wecker L., Goldberg A.M. // International symposium on cholinergic mechanisms. - New York: Plenum Press, 1981.Missale C., Sigala S., RizzonelliP., SpanoP.F. Trasmissione colinergica nelratto dopo trattamento acuto e cronico con a-GFC//Missale C., Sigala S., RizzonelliP., SpanoP.F. Trasmissione colinergica nelratto dopo trattamento acuto e cronico con a-GFC//Basi Raz. Ter. 1991; 21 (Suppl. 2): 23-26.Basi Raz. Ter. 1991; 21 (Suppl. 2): 23-26.Imperato A., Zocchi A., Angelucci L. Studio «in vivo» degli effetti e delmeccanismo dazione di colina alfoscerato sulla trasmis-sione colinergica striatale ed ippocampale // Basi Raz. Ter. 1991; 21 (Suppl. 2): 15-22.Imperato A., Zocchi A., Angelucci L. Studio «in vivo» degli effetti e delmeccanismo dazione di colina alfoscerato sulla trasmis-sione colinergica striatale ed ippocampale // Basi Raz. Ter. 1991; 21 (Suppl. 2): 15-22.Canal N., Franceschi M., De Moliner P., Castiglioni С. Ef-fetti di colina alfoscerato nella prevenzione delle amnesie indotte da scopolamina e benzodiazepina//Basi Raz. Ter. 1991; 21 (Suppl. 2): 75-78.Canal N., Franceschi M., De Moliner P., Castiglioni С. Ef-fetti di colina alfoscerato nella prevenzione delle amnesie indotte da scopolamina e benzodiazepina//Basi Raz. Ter. 1991; 21 (Suppl. 2): 75-78.Loeb C., Gandolfo С. Diagnostic evaluation of degenerative and vascular dementia // Stroke. 1983; 14: 399-401.Loeb C., Gandolfo С. Diagnostic evaluation of degenerative and vascular dementia // Stroke. 1983; 14: 399-401.Hachinski V.C., Lassen H.A., Marschal J. Multiinfarct dementia, a cause of mental deterioration in the elderly // Lancet. 1974; 2: 207-209.Hachinski V.C., Lassen H.A., Marschal J. Multiinfarct dementia, a cause of mental deterioration in the elderly // Lancet. 1974; 2: 207-209.Folstein M.F., Folstein S.E., McHug P.R. Mini Mental State // J. Psychiatr. Res. 1975; 12:189-198.Folstein M.F., Folstein S.E., McHug P.R. Mini Mental State // J. Psychiatr. Res. 1975; 12:189-198.Hamilton M. A rating scale for depression // J. Neurol. Neurosurg. Psychiatr. 1960; 23: 56-62.Hamilton M. A rating scale for depression // J. Neurol. Neurosurg. Psychiatr. 1960; 23: 56-62.Reisberg B., Ferris S.H., De Leon M.J. et al. The Global Deterioration Scale for assessment of primary degenerative dementia // Am. J. Psychiatry. 1982; 139:1136-1139.Reisberg B., Ferris S.H., De Leon M.J. et al. The Global Deterioration Scale for assessment of primary degenerative dementia // Am. J. Psychiatry. 1982; 139:1136-1139.Blessed G., Tomlinson B.E., Roth M. The association between quantitative measures of dementia and senile changes in the cerebral grey matter of elderly subjects // Br. J. Psychiatry. 1968; 114: 797-811.Blessed G., Tomlinson B.E., Roth M. The association between quantitative measures of dementia and senile changes in the cerebral grey matter of elderly subjects // Br. J. Psychiatry. 1968; 114: 797-811.Venn R.D. The Sandoz Clinical Assessment Geriatric (SCAG) Scale // Gerontology. 1983; 29: 185-198.Venn R.D. The Sandoz Clinical Assessment Geriatric (SCAG) Scale // Gerontology. 1983; 29: 185-198.Wechsler D. A standardized memory scale for clinical use // J. Psychol. 1945; 19: 87-95.Wechsler D. A standardized memory scale for clinical use // J. Psychol. 1945; 19: 87-95.Barbizet J., Duizabo J., Flavigny R. Role des lobes Frontaux dans le langage. Un etude neuropsychologique experimentale//Rev. Neurol. 1975; 131: 525-544.Barbizet J., Duizabo J., Flavigny R. Role des lobes Frontaux dans le langage. Un etude neuropsychologique experimentale//Rev. Neurol. 1975; 131: 525-544.De Renzi E., Vignolo L.A. The Token test: A sensitive test to detect receptive disturbances in aphasia // Brain. 1962; 85: 665-678.De Renzi E., Vignolo L.A. The Token test: A sensitive test to detect receptive disturbances in aphasia // Brain. 1962; 85: 665-678.Arrigoni C., De Rossi E. Constructional apraxia and hemispheric locus of lesion // Cortex. 1964; 1: 170-197.Arrigoni C., De Rossi E. Constructional apraxia and hemispheric locus of lesion // Cortex. 1964; 1: 170-197.Linn M.W., Linn B.S. The Rapid Disability Rating Scale-2// J. Am. Geriatr. Soc. 1982; 30:378-382.Linn M.W., Linn B.S. The Rapid Disability Rating Scale-2// J. Am. Geriatr. Soc. 1982; 30:378-382.Scheinberg P. Dementia due to vascular disease. A multifacto-rial disorder// Stroke. 1988; 19:12911299.Scheinberg P. Dementia due to vascular disease. A multifacto-rial disorder// Stroke. 1988; 19:12911299.Diagnosis and treatment of old age dementias // Ban Т.А., Lehmann H.E. (eds). Modern problems in pharmacopsychiatry. - Vol. 23. - Basel: Karger, 1989. - 1-20.Diagnosis and treatment of old age dementias // Ban Т.А., Lehmann H.E. (eds). Modern problems in pharmacopsychiatry. - Vol. 23. - Basel: Karger, 1989. - 1-20.Spinnler H., Tognoni G. Standardizzzazione e taratura italiana di test neuropsicologici // Ital. J. Neurol. Sci. 1987; 6 (Suppl. 8): 8-20.Spinnler H., Tognoni G. Standardizzzazione e taratura italiana di test neuropsicologici // Ital. J. Neurol. Sci. 1987; 6 (Suppl. 8): 8-20.Moglia A., Arrigo A., Bono G. et al. Citicoline in patients with chronic cerebrovascular disease (CCVD): Quantitative EEG study// Curr. Ther. Res. 1984; 36: 309-313.Moglia A., Arrigo A., Bono G. et al. Citicoline in patients with chronic cerebrovascular disease (CCVD): Quantitative EEG study// Curr. Ther. Res. 1984; 36: 309-313.Motta L., Fichera G., Tiralosi G. et al. La citicolina nel trattamento delle cerebrovasculopatie croniche // G. Gerontol. 1984; 32: 753-754.Motta L., Fichera G., Tiralosi G. et al. La citicolina nel trattamento delle cerebrovasculopatie croniche // G. Gerontol. 1984; 32: 753-754.Cucinotta D., Romagnoli S., Godoli G. et al. Comparison of sulfomucopolysaccharides andcytidine diphosphocholine in the treatment of multi-infarct dementia // Curr. Ther. Res. 1988; 43:12-20.Cucinotta D., Romagnoli S., Godoli G. et al. Comparison of sulfomucopolysaccharides andcytidine diphosphocholine in the treatment of multi-infarct dementia // Curr. Ther. Res. 1988; 43:12-20.Canonico P.L., Nicoletti F., Scapagnini U. Effetti neurochi-mici e comportamentali di a-GFC (colina alfoscerato)//Basi Raz. Ter. 1990; 20 (Suppl. 1): 53.Canonico P.L., Nicoletti F., Scapagnini U. Effetti neurochi-mici e comportamentali di a-GFC (colina alfoscerato)//Basi Raz. Ter. 1990; 20 (Suppl. 1): 53.Drago F., D’Agata V., Nardo L. et al. Effetti comportamentali di a-GFC in modelli di interazione farmacologica // Basi Raz. Ter. 1991; 21 (Suppl. 2): 67-70.Drago F., D’Agata V., Nardo L. et al. Effetti comportamentali di a-GFC in modelli di interazione farmacologica // Basi Raz. Ter. 1991; 21 (Suppl. 2): 67-70.Schettini G., Florio T., Ventura C. et al. Effetto del trattamen-to prolungato con a-GFC (colina alfoscerato) sull′apprendimento, sulla memoria e sulla trasduzione del segnale recettoriale in animali giovani e invecchiati // Basi Raz. Ter. 1991; 21 (Suppl. 2): 27-34.Schettini G., Florio T., Ventura C. et al. Effetto del trattamen-to prolungato con a-GFC (colina alfoscerato) sull′apprendimento, sulla memoria e sulla trasduzione del segnale recettoriale in animali giovani e invecchiati // Basi Raz. Ter. 1991; 21 (Suppl. 2): 27-34.Frattola L., Piolti R., Bassi S. et al. Multicenter clinical comparison of the effects of choline alphoscerate and cytidine di-phosphocholine in the treatment of multi-infarct dementia // Curr. Ther. Res. 1991; 49: 683-693.Frattola L., Piolti R., Bassi S. et al. Multicenter clinical comparison of the effects of choline alphoscerate and cytidine di-phosphocholine in the treatment of multi-infarct dementia // Curr. Ther. Res. 1991; 49: 683-693.Di Perri R., Coppola G., Ambrosio L.A. et al. A multicentre trial to evaluate the efficacy and tolerability of a -glycerylphosphorylcholine versus cytidine diphosphocholine in patients with vascular dementia // J. Int. Med. Res. 1991; 19: 330-341.Di Perri R., Coppola G., Ambrosio L.A. et al. A multicentre trial to evaluate the efficacy and tolerability of a -glycerylphosphorylcholine versus cytidine diphosphocholine in patients with vascular dementia // J. Int. Med. Res. 1991; 19: 330-341.Bassi S., Albizzati M.G., Piolti R., Frattola L. Esperienza clinica con colina alfoscerato in pazienti affetti da demenza degen-erativa primaria e multinfartuale // Gnosis. 1990; 5: 55-62.Bassi S., Albizzati M.G., Piolti R., Frattola L. Esperienza clinica con colina alfoscerato in pazienti affetti da demenza degen-erativa primaria e multinfartuale // Gnosis. 1990; 5: 55-62.Abbati C., Rondi G., Rosola R. et al. Nootropic therapy of cerebral aging // Adv. Ther. 1991; 8: 251276.Abbati C., Rondi G., Rosola R. et al. Nootropic therapy of cerebral aging // Adv. Ther. 1991; 8: 251276.Amenta F., Bronzetti E., Mancini M. et al. Invecchiamento del sistema colinergico ippocampale. Effetti del trattamento con colina alfoscerato // Basi Raz. Ter. 1991; 21 (Suppl. 2): 35-40.Amenta F., Bronzetti E., Mancini M. et al. Invecchiamento del sistema colinergico ippocampale. Effetti del trattamento con colina alfoscerato // Basi Raz. Ter. 1991; 21 (Suppl. 2): 35-40.Vega J.A., Del Valle M., Amenta F. Aspetti immunocitochimici del sistema nervoso centrale nella senescenza: sensibilita al. trattamento con colina alfoscerato // Basi Raz. Ter. 1991; 21 (Suppl. 2): 47-54.Vega J.A., Del Valle M., Amenta F. Aspetti immunocitochimici del sistema nervoso centrale nella senescenza: sensibilita al. trattamento con colina alfoscerato // Basi Raz. Ter. 1991; 21 (Suppl. 2): 47-54.

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