The anticoagulant therapy with a priority of direct oral anticoagulants is an approach to the prevention of recurrent stroke in patients with atrial fibrillation (AF) that has presently proved its efficacy and is stated in international clinical guidelines. An extensive evidence-based database demonstrates advantages of rivaroxaban over other drugs of this class in secondary prevention of stroke in AF. Furthermore, these advantages are combined with the optimal safety profile. The rivaroxaban treatment may provide the most favorable prognosis due to the prevention of recurrent stroke in AF, reducing the rate of kidney disease progression, and slowing vascular atherosclerosis. An important beneficial feature of rivaroxaban is once-a-day intake, which is important in the context of a high incidence of cognitive disorders in this patient category, and may improve their compliance and, thus, help achieving the expected profile of treatment efficacy. Thus, rivaroxaban can be regarded as a drug of choice for secondary prevention of stroke in AF.

Objective. Data analysis on modern therapy strategies of chronic heart failure (CHF) and the possibilities of adjuvant therapy with phosphocreatine. Methods. Analysis and systematization of the positions of the year 2020 Russian Ministry of Health clinical guidelines on CHF and modern local and international literature data.Results. Currently, for the treatment of CHF, a wide range of drugs are used that can improve the prognosis and reduce mortality in patients, including β-blockers, blockers of the renin-angiotensin-aldosterone system, diuretics, aldosterone antagonists and neprilisin inhibitors. At the same time, based on the peculiarities of the pathogenesis of CHF and the characteristics of the myocardial energy metabolism in heart failure conditions, a promising direction is the use of additional (adjuvant) drugs in this category of patients. Here, a special place is occupied by phosphocreatine, which is essential in maintaining the energy balance of cardiomyocytes and has been widely studied in a large number of studies that have confirmed its ability not only to increase exercise tolerance in patients with CHF, but also to improve heart systolic function and prognosis, improving patient survival. Conclusion. Based on the reviewed body of evidence, a rational approach in the management of patients with CHF is to add adjuvant phosphocreatine therapy to the standard treatment strategy according to the current clinical guidelines, which provides an additional improvement in prognosis and a decrease in mortality rates in patients.

The development of laboratory diagnostic and neuroimaging methods allows a number of biomarkers to be detected, improving the in-life diagnosis of a very diverse set of types of dementia (Alzheimer’s disease, Lewy body dementia, vascular dementia). Currently, molecular biomarkers in the cerebrospinal fluid (CSF) for detection of Alzheimer’s disease have the greatest diagnostic sensitivity and specificity. At the same time, structural changes detected on MRI scans are more significant for prognosticating the development of changes in the cognitive domain. Cerebral microbleeds provide an additional accessible marker increasing the diagnostic significance of leukoaraiosis and providing evidence of cerebral amyloid angiopathy or hypertensive microangiopathy, especially in cases of mixed pathology and severe cognitive deficit.

The term 'dyscirculatory encephalopathy' (DEP) was proposed in 1958 by Garun Maksudov and Vladimir Kogan for the definition of gradually progressive diffuse brain changes with slowly worsening of cerebral circulation ('dyscirculation') in vascular disorders. The article presents current data on the etiology and pathogenesis of DEP, with the emphasis on its syndromal status, clinical/pathogenetic types of DEP, neuropsychological and neuroimaging signs, which provide a causal relationship to avoid hyperdiagnosis of DEP. In addition, possible methods of treatment and prevention of DEP are considered.

AIM:To study clinical/neuropsychological and neuroimaging characteristics of Alzheimer's disease in the combination with cerebrovascular disease (CVD).MATERIAL AND METHODS:Ninety patients with dementia, including 35 patients with AD, 35 patients with mixed dementia (MD) and 20 patients with vascular dementia, were examined. The character of dementia was established according to NINCDS-ADRDA and NINDS-AIREN criteria. The neuropsychological battery included Addenbrooke's Cognitive Examination (ACE-R), Montreal Cognitive Assessment scale (MoCA), fluency test and the visual memory test (SCT). Affective and behavioral disorders were assessed with the Cornell Depression Scale in patients with dementia and a short version of NPI-4 in AD patients. Focal and diffuse changes were assessed with MRI.RESULTS AND CONCLUSION:Patients with MD were older, had more often pseudobulbar syndrome (74%), postural instability (66%), frontal gait disorders (57%), Neuropsychological profile of patients with MD had mixed amnestic-dysexecutive character and, depending on the severity of vascular pathology, was closer to AD or to vascular dementia. Neuroimaging changes of patients with MD were correlated with clinical manifestations. The authors propose the approaches to the differential diagnosis of MD that allow to determine the main directions of treatment more precisely and to predict disease course.

The role of the cerebral microbleeds (CMB) as a potential predictor of hemorrhagic complications of thrombolytic therapy is discussed. CMB are small perivascular hemosiderin deposits in the brain detected by magnetic resonance imaging in gradient echo T2* or SWI sequences. They are associated (along with leukoaraiosis or lacunes) with cerebral microangiopathies. Most often CMB are associated with hypertensive arteriopathy (the main cause of CMB localization) or cerebral amyloid angiopathy (the main cause of cerebral CMB). Despite the controversies of recent data, most of researchers agree that thrombolytic therapy in patients with multiple CMB increases the risk of hemorrhagic complications. Neuroimaging diagnosis of CMB may be important in making decision for thrombolytic therapy.