Prior stroke plays an important role in the development of cognitive impairment (CI), the prevention of which requires detailed study. Patients and methods . A total of 350 patients (mean age, 65±17.7 years; 49% men) who had experienced a stroke with a small degree of neurological deficit were followed up. Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE), Mattis dementia rating scale, the clock drawing test, the test on memorizing 12 words, and the Schulte table. During 5 years of follow-up, 61 (17.4%) patients died, including 45 (12.8%) from recurrent stroke; 89 recurrent strokes developed. Results . The first examination did not reveal CI in 59 (17%) patients; 73 (21%) were found to have marked CI (mild or moderate dementia). After 1, 3, and 5years of follow-up, the proportion of patients with marked CI increased up to 23.2, 29.5, and 34.5%, respectively. Within 5 years, there was an average decline of 2 MMSE scores. The maximum decrease in cognitive functions was seen in patients who had experienced a recurrent stroke, but this also occurred in the absence of a stroke. Cognitive functions were substantially better in a group of patients with blood pressure (BP) normalization. Conclusion . The 5-year follow-up has shown that post-stroke CI gradually progresses, which is associated with the progression of both vascular disease and a concomitant neurodegenerative process. BP normalization during antihypertensive therapy contributes to the prevention of progressive post-stroke CI.

Prevention of ischemic stroke (IS) and cognitive impairment (CI) in patients after IS or transient ischemic attack is discussed. The efficacy of non-pharmacological methods for the prevention of IS and CI (cessation of smoking and alcohol abuse, balanced diet, losing excess weight, regular physical activity) along with administration of medicines (antithrombotic agents, antihypertensives, statins) is highlighted. The results of a 5.5-year follow-up of 350 patients after stroke are described which demonstrate that non-pharmacological methods and regular drug therapy reduce the risk of recurrent stroke, though they are not effective in preventing the growing CI. The article tells about the widespread use of Divaza in this country in patients with cerebrovascular disease and the results of a multicenter study are demonstrated; a placebo-controlled Divaza study for secondary prevention of IS and CD is planned.

The article is a review of literature on antiplatelet (antiagregant) therapy in the secondary prevention of ischemic stroke (IS). The latest guidelines (2014) from the American Heart Association and stroke experts are discussed. The efficacy of acetylsalicylic acid (ASA), extended-release dipyridamole in combination with ASA, clopidogrel, a slight superiority of extended-release dipyridamole in combination with ASA and of clopidogrel over ASA in reducing the risk of recurrent ischemic events. The possibility of using clopidogrel in combination with ASA in patients after transient ischemic attack or small IS in the first 90 days of illness is considered. The problems of antiplatelet therapy in clinical practice are analyzed. The authors note that clinical application of the global guidelines for the secondary prevention of IS could reduce the incidence of stroke and the associated mortality.

The article reviews the international recommendations for prevention of ischemic stroke in patients after ischemic stroke or transient ischemic attacks in anamnesis. The recommendations include non-drug therapy (stop smoking and alcohol abuse, diet, regular physical activity) and medicine treatment with antitrombotic, antihypertensive drugs and statins. Some patients with significant artery stenosis require carotid endarterectomy or stenting/ stent angioplasty. The aspects of management of secondary prevention inRussiawith analysis of own experiences are discussed. The study demonstrates that adherence to the international recommendations leads to significant decrease of morbidity and mortality from ischemic stroke inRussia.

Ischemic stroke (IS) prevention in non-valvular atrial fibrillation (NVAF) patients who already had IS or Transient Ischemic Attack (TIA) is the actual problem of up-to-date neurology. The article analyses methods of IS secondary prevention in AF, particularly usage of vitamin Kantagonist – warfarin and new oral anticoagulants: inhibitors of Xa factor (apixaban, rivaroxaban) and direct thrombin inhibiror – dabigatran.Presented results ARISTOTLE study, where have defined preference apixaban vs warfarin, and AVEEROES study, where have shown preference apixaban vs ASA in AF patients. It was noted that apixaban demonstrated superiority vs warfarin in all of the 3 key outcomes:stroke/systemic embolism prevention, including recurrent, major bleeding reducing, reduction in all-cause mortality. Optimization of secondary stroke prevention in AF patients can lead to substantial reduction of morbidity and mortality in our country.

The article tells about prevention of ischemic stroke (IS) in patients after IS or transient ischemic attack (TIA) against a background of non-valvular atrial fibrillation (AF). Anticoagulation therapy variants for secondary IS prevention in AF are evaluated, such as vitamin K antagonist warfarin and novel oral anticoagulants: inhibitor of coagulation factor Xa rivaroxaban, apixaban, and the direct thrombin inhibitor dabigatran. There are results of a ROCKET AF subanalysis which compared rivaroxaban and warfarin in patients with AF after IS or TIA. It is noted that widespread clinical use of oral anticoagulants for atrial fibrillation could result in a significant reduction of IS morbidity and mortality in this country.

руется собственный опыт в этом направлении. Отмечается, что широкое использование в клинической практике международных рекомендаций по профилактике ИИ может привести к существенному снижению заболеваемости ИИ и смертности от него в нашей стране.Ключевые слова: вторичная профилактика ишемического инсульта; нелекарственные средства; профилактика инсульта; анти-тромботические средства; антигипертензивные средства; статины; каротидная эндартерэктомия.

The authors give the data available in the literature on and the results of their studies of the epidemiology, risk factors, pathogenesis, diagnosis, and treatment of poststroke cognitive impairment (PSCI). The latter occurs in 35—83% of patients; poststroke does in 6—40%. Different mechanisms of PSCI are under discussion; these are a single infarct in a strategic area of the brain; multiple focal lesion of the brain substance in restrokes; cerebral white-matter lesion as leukoaraiosis; the presence of concomitant Alzheimer’s disease (AD). The capacities for the diagnosis of concomitant AD in PSCI are analyzed. The treatment of the latter involves secondary prevention of stroke and specific therapy for cognitive, emotional-affective, and behavioral disorders. The experience with akatinol memantine used in postischemic dementia has been found to be positive.

Prevention of ischemic stroke (IS) is one of the most pressing healthcare issues, especially in this country, where IS morbidity and mortality are high. The article is a review of literature on secondary prevention of IS in patients after stroke or transient ischemic attack. Recent guidelines for the secondary prevention of IS proposed by the American Heart Association and the American Stroke Association in 2014 are described. Up-to-date methods of secondary prevention of IS will significantly reduce the morbidity and mortality rates in this country.

Stroke is one of the top three causes of death in the population and a leading cause of disability in the elderly; ischemic stroke (IS) constitutes a major portion (70–85%) of all strokes so its prevention s a relevant problem of modern medicine. Among the risk factors RFs) of stroke, nonvalvular atrial fibrillation (AF) is of great ignificance, which occurs in persons over 70 years of age in pproximately 5–10% of cases and increases the risk of IS 3–4-fold. The review analyzes RFs for stroke in AF. The CHA2DS2-VASc scale encompassing several RFs is noted to be informative and easy-to-use. There are data of large-scale randomized trials that show that novel oral anticoagulants (dabigatran, rivaroxaban, apixaban) are as good as warfarin or offer an advantage over the latter, by more substantially decreasing the risk of stroke and reducing the likelihood of profuse bleeding, intracranial hemorrhage in particular. There is evidence for the efficacy of rivaroxaban in the secondary prevention of stroke. The authors provide their experience with patient management to prevent recurrent cardioembolic stroke. In our country, most patients who have sustained IS or transient ischemic attack in the presence of AF do not take warfarin due to the fact that it is difficult to regularly monitor the international normalized ratio (INR). It is noted that the administration of the novel anticoagulants, which differs from that of warfarin, does not require INR monitoring and can increase the number of patients on anticoagulant therapy and therefore reduce the incidence of stroke in the presence of AF.

Arterial hypertension is regarded as an independent and most important risk factor for stroke and its most effective prevention is to lower elevated blood pressure (BP). International guidelines on and the results of large randomized placebo-controlled trials of different antihypertensive drugs used to prevent stroke are given. How to optimize the outpatient prevention of stroke is discussed. The preliminary results of the POWER trial evaluating the safety and efficacy of eprosartan, an angiotensin receptor blocker, in reducing BP are presented.

The management of a post-stroke patient represents is a challenge to modern neurology. Complete recovery of all functions requires only recurrent stroke prevention. If the patient continues to have motor, speech, and/or other disorders that are promising to recover function, there is a need for rehabilitation. Patient care and prevention of recurrent stroke and akinesia-associated complications are required if there are no promises for functional recovery. The paper describes the current methods for the prevention of recurrent stroke, which include lifestyle modification, blood pressure normalization, and the use of surgical procedures (in some patients), antithrombotic agents, and statins (after ischemic stroke). It analyzes the possibilities and methods of treatment in lost motor and speech functions, neuropsychic (cognitive and depressive) disorders, and urination disorders. It is noted that the application of current treatment options makes it possible to substantially reduce the risk of recurrent stroke and to improve recovery of lost functions and quality of life in the patient.

The article is a review of literature on the prognosis and prevention of stroke in patients with atrial fibrillation (AF). It is noted that the simple CHA2DS2-VASc calculator is a good predictor of the risk of stroke in AF. Oral anticoagulants are recommended to patients with one or more risk factors for stroke according to CHA2DS2-VASc. There is data from large randomized trials showing that new oral anticoagulants (dabigatran, rivaroxaban, apixaban) can be as good as or better than warfarin in significantly reducing the risk of stroke, and are associated with lower risk of serious, particularly intracranial, bleeding. Positive experience related to the use of dabigatran (Pradaxa®), in a dose of 150 mg or 110 mg twice in patients with AF, is described. The introduction of new anticoagulants into the national neurological practice which do not require international normalized ratio control, will ensure wider use of anticoagulant therapy in patients with AF and reduce the incidence of cardioembolic stroke.

The paper reviews the data available in the literature on the prevention of ischemic stroke by using antihypertensive therapy. It gives international guidelines and the results of randomized placebo-controlled trials of the use of different antihypertensive drugs in patients with prior stroke or transient ischemic attack. The possible neuroprotective effects of angiotensin II receptor blockers are discussed when analyzing the advantages of eprosartan over nitrendipine in the secondary prevention of stroke. The realities and optimization of secondary prevention of stroke in outpatient practice are analyzed.

The paper reviews the data available in the literature on the prevention of stroke in atrial fibrillation (AF). Until recently, mainly warfarin was noted to be used to prevent stroke in AF, which required regulatory laboratory (hematological) control. The authors give the results of the RE-LY trial that compared the efficacy of the new thrombin inhibitor dabigatran (pradax) in a dose of 150 or 110 mg twice daily and warfarin. The trial has indicated that the use of dabigatran in a dose of 150 mg twice daily results in a reduction in the rate of stroke and systemic embolism as compared to that with warfarin treatment. The administration of dabigatran in a dose of 150 or 110 mg twice daily decreases the rate of deaths from all cases, life-threatening hemorrhages, and hemorrhagic stroke as compared to that of warfarin. The prospects for using different doses of dabigatran in AF patients with prior ischemic stroke (IS) or transient ischemic attack (TIA) are discussed. In our country, most patients with prior IS or TIA in the presence of AF do not take warfarin due to the difficulty of regulatory laboratory control, the introduction of dabigatran into neurological care may increase the number of patients receiving effective anticoagulant therapy to prevent re-stroke.

The paper reviews the data available in the literature on the prevention of ischemic stroke by using antihypertensive therapy. It gives international guidelines and the results of randomized placebo-controlled trials of the use of different antihypertensive drugs in patients with prior stroke or transient ischemic attack. The possible neuroprotective effects of angiotensin II receptor blockers are discussed when analyzing the advantages of eprosartan over nitrendipine in the secondary prevention of stroke. The realities and optimization of secondary prevention of stroke in outpatient practice are analyzed.

The article covers the topic of rehabilitation measures, which are performed in the polyclinic. Regular medical check-up and educational programs will increase the number of patients receiving regular therapy for preventive measures of repeat stroke and other cardiovascular diseases. It is significant to point an important rote of regular check-up, cognitive function evaluation and emotional condition of stroke patients.

Acute back pain is one of the main reasons for referrals to a polyclinic. Eighty-seven patients aged 18 to 75 years, who had acute back pain, were examined to study the spread of its principal causes of acute back pain in the outpatient setting. Of them, two thirds (60 patients) were found to have muscle pain syndromes; the others (27 patients) had specific diseases (ischemic heart disease, vertebral fractures, neoplasms, herpes zoster) that were prevalent in chest pain. Among 60 patients with nonspecific back pain, 30 patients were treated with mirlox (7,5- 15 mg/day) and 30 patients received mirlox and mydocalm in a dose of 150 mg thrice daily. As a result of therapy, back pain disappeared or diminished in all the patients, their routine activity normalized, as assessed by the Oswestry questionnaire. The duration of temporary disability was 3 days shorter in the group of patients taking a combination of mirlox and mydocalm. The use of mirlox and mydocalm is effective and safe in various (cervical, chest, and lumbar) pains caused by muscle syndromes, this promotes rapider recovery