Outpatient management of patients with dyscirculatory encephalopathy

Abstract

There is outpatient hyperdiagnosis of dyscirculatory encephalopathy (DE) frequently masked by other diseases. Objective: to improve the differential diagnosis of DE on the basis of a comprehensive patient examination, including neuropsychological testing. Patients and methods. Fifty patients, including 10 men and 40 women, aged 45 to 75 years (mean age 68.8±9.0 years), who had been followed up at the polyclinic with a diagnosis of DE for an average of 1.5 years, were examined. All the patients underwent evaluations of cognitive functions and emotional status and otoneurological examination (in case of headache); a psychiatrist consulted patients with anxiety and/or depressive disorders. Results and discussion. Only 9 (18%) patients were found to have vascular cognitive impairments (CIs) and signs of cerebrovascular lesions, as shown by neuroimaging, which may be regarded as DE. Five (10%) patients had CIs and neuroimaging changes that were more characteristic of Alzheimer’s disease (AD) than those of DE. The remaining 36 (72%) patients were established to have other diseases (primary headache, peripheral vestibulopathy, primary anxiety and depressive disorders, etc.), in which CIs were not detected. The diagnosis and effective treatment of these diseases yielded a rapid positive result in most cases. The management of patients with DE and AD was aimed at preventing stroke and improving cognitive functions; moreover, akatinol memantine was noted to be effective in the combination therapy of both DE and AD.

Keywords

• dyscirculatory encephalopathy
• vascular cognitive impairments
• alzheimer’s disease
• primary headache
• benign paroxysmal positional vertigo
• anxiety and depressive disorders
• prevention of stroke
• akatinol memantine.