Abstract:

Introduction: research is dedicated to use of intracerebral laser photobiomodulation therapy (PBMT) in treatment of ischemic stroke after-effects in comparison with conservative therapy methods.

Aim: was to evaluate effectiveness of intracerebral transcatheter laser PBMT in patients with previous ischemic stroke.

Materials and methods: 836 patients were included in study, within the period from 6 months to 6 years after ischemic strokes of various severity, aged 29-81 (mean age 74,9): 593 men (70,93%), 243 women (29,07%). Test Group - 511 (61,12%) patients with distal lesions of intracerebral arteries who underwent transcatheter intracerebral laser PBMT; control Group - 325 (38,88%) patients with similar distal lesions of intracerebral arteries who received conservative treatment.

Results: Test Group: good clinical results were obtained in 259 (87,21%) cases after small focal strokes; in 94 (60,26%) after midfocal strokes; in 12 (20,69%) after macrofocal strokes. Satisfactory clinical results were obtained in 33 (11.11%) cases after small focal strokes; 39 (25,00%) after midfocal strokes; 22 (37,93%) after macrofocal strokes.

Control Group: 51 (21,07%) patients after small focal strokes showed good clinical results; patients after midfocal strokes and macrofocal strokes did not have good results; 60 (24,79%) patients after small focal strokes and 8 (19,05%) patients after midfocal strokes showed satisfactory clinical results; patients after macrofocal strokes did not have satisfactory results.

Conclusions: transcatheter intracerebral laser photobiomodulation therapy is an effective, pathogenetically substantiated method of treatment in patients with ischemic stroke after-effects, leading to restoration of activities of daily living, of cognitive and mental functions and returning patients to fully active life.

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Abstract

The research is devoted to the clinical study of disorders in cerebral blood flow and microcirculatior in the development of Alzhelmer's disease in comparison with other neurodegenerative and ischemic diseases.

Materials and methods: 1117 patients with various types and stages of neurodegenerative ancischemic diseases were examined. 93 (8.33%) of them had various stages of Alzhelmer's disease - Test Group. Other 1024 (91.67%) had different types and stages of other cerebral neurodegenerative and ischemic lesions - Control Group. Control Group patients were divided: 23 (2.25%) suffered from Binswanger disease; 55 (5.37%) suffered from vascular Parkinsonism; 27 (2.64%) had initial signs of chronic cerebrovascular insufficiency of atherosclerotic origin; 577 (56.35%) had marked signs of chronic cerebrovascular insufficiency of atherosclerotic origin; 342 (33.40%) had a severe form of chronic cerebrovascular insufficiency accompanied by small-focal single or multiple strokes. Examination included: laboratory diagnostics, assessment of scales «The Clinical Dementia Rating scale» (CDR), «Mini-Mental State Examination» (MMSE), IB, cerebral scintiography (SG), rheoencephalography (REG), cerebral CT, MRI, MR angiography, digital angiography (DA).

Results: all patients with Alzheimer's disease, regardless of the stage of the disease, had a specific cerebral small vessel disease (CSVD) in temporal and frontoparietal regions, which manifests itself with dyscirculatory angiopathy of Alzheimer's type (DAAT), which is not found in control group patients.

Conclusions: DAAT is a specific to Alzheimer's disease lesion of cerebral angioarchitectonics and microvessels, which changes hemodynamics, causes cerebral hypoxia and contributes to disorders in beta-amyloid metabolism. The combination of deposition of amyloid beta in the cerebral tissue and the vascular wall, as well as specific microcirculation disorders, cause together neurodegeneration and the development of Alzheimer's disease. In patients with other neurodegenerative and ischemic diseases, CSVDs are of a different nature, with no DAAT phenomena observed.

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Abstract:

Integrated approach to radiologic diagnostics of the Alzheimer's disease used in 87 patients, 42 of which were at risk or at different stages of the disease, and 45 patients had various cerebral pathology not connected to the Alzheimer's disease. Computed tomography (CT) with temporal lobe volume calculation followed by scintigraphy, rheoencephalography and digital subtractional angiography (DSA) were done in all the patients.

Temporal and hippocampal atrophy (1), fronto-parietal and temporal capillary vascular bed reduction (2) with multiple arteriovenous shunts (3), as well as venous congestion with anomalous fronto-parietal veins formation (4) were the characteristic radiological features of the Alzheimer's disease. It is important that the above were seen not only in patients with late, but also in early and preclinical stages. These phenomena were also shown to be specific for the Alzheimer disease.

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34.   Mirra S.S., Gearing M., McKeel D.W. et al.Interlaboratory comparison of neuropathology assessments in Alzheimer's disease: a studyof the Consortium to Establish a Registry forAlzheimer's Disease (CERAD).J. Neuropathol.Exp. Neurol. 1994; 3 (53): 303-315.

35.   Corey-BloomJ.,Thal L., Galasko D. et al. Diagnosis and evaluation of dementia. Neurology.1995; 45: 211-218.

36.   Morris J.C. The Clinical Dementia Rating(CDR): current version and scoring rule.Neurology. 1993; 11 (43): 2412-2414.

           37.   Kesslak J.P., Nalcioglu O., Cotman C.W. Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer's disease. Neurology. 1991; 41: 51-54.

Abstract:

Aim. For determination of Alzheimer's disease (AD) stages, we offer a morphologically determined scale - The Tomography Dementia Rating scale (TDR) based on the severity of atrophic changes in the temporal lobes of the brain revealed during CT and MRI. Materials and methods. The research involved 140 patients aged 28-79. The Test Group included 81 patients aged 34-79 with AD various stages. The Control Group included 59 patients aged 28-78 with various types of brain lesions accompanied by manifestations of dementia and cognitive impairment, but not suffering from AD.

Results. CT and MRI data allowed to compose the TDR scale determining the severity of atrophic changes in the temporal lobes at each AD stage:

•          Pre-clinical AD stage TDR-0: temporal lobes atrophy with 4-8% tissue mass decrease (26-28 MMSE points).

•          Early AD stage - mild dementia TDR-1: temporal lobes atrophy with 9-18% tissue mass decrease (corresponds to CDR-1; 20-25 MMSE points).

•          Middle AD stage - mild dementia TDR-2: temporal lobes atrophy with 19-32% tissue mass decrease (corresponds to CDR-2; 12-19 MMSE points). 

References

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2.     Alzheimer’s Disease Facts and Figures 2009 Alzheimer’s Association. http://www.alz.org/national/documents/report_alzfactsfigures2009.pdf.

3.     Alzheimer's Disease Facts and Figures

3.     2010 Alzheimer’s Association. http://www.alz.org/ documents_custom/report_alzfactsfigures2010.pdf.

4.     2011 Alzheimer’s Disease Facts and Figures. http://www.alz.org/downloads/facts_figures_2011.pdf.

5.     Generation Alzheimer’s: The Defining Disease of the Baby Boomers http://act.alz.org/site/Doc-Server/ALZ_BoomersReport.pdf/docID=521.

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7.     Saykin A.J, Wishart H.A. Mild cognitive impairment: conceptual issues and structural and functional brain correlates. Seminars in Clinical. Neuropsychiatry. 2003; 8 (1): 12-30.

8.     Saykin A.J., Wishart H.A., Rabin L.A., et all. Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. Neurology. 2006; 12 No. 67 (2): 834-842.

9.     Shen L., Fipri H.A., Saykin AJ.,West J.D. Parametric surface modeling and registration for comparison of manual and automated segmentation of the hippocampus. Hippocampus. 2009; 19 (6): 588-595.

10.   Maksimovich I.V. Vozmoznosti covremennoy kompiuternoy tomografii v diagnostike bolezni Alzheimra.[Possibilities of computed tomography in diagnostics of Alzheimer’s diseases.] Nevrologicheskiy vestnik .2009; 1: 5-10 [In Russ].

29.   Maksimovich I.V. Dyscirculatory Angiopathy of the Brain of Alzheimer's Type. Eurointerventional. 2011; 7: M 253.

30.   Maksimovich I.V. Endovascular Application of Low-Energy Laser in the Treatment of Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2012; 2 (1): 67-81.

11.   Mayeux R., Reitz C., Brickman A.M., Haan M.N., Manly J.J. et. all. “Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 1. Alzheimers & Dementia. 2011; 7 (1): 15-34.

12.   Seashadri S., Beaser A., Au R., Volf P.A., Evans D.A. et.al. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 2. Alzheimers & Dementia. 2011; 7 (I): 35-52.

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14.   National Plan to Address Alzheimer's Disease http: / /www.whitehouse.gov/ blog/2012/05/17/national-plan-address- alzheimers-disease.

15.   Morris J.C. The clinical dementia rating (CDR): current version and scoring rule. Neurology. 1993; 43 (II):2412-2414.

16.   Maksimovich I.V. Gotman L.N. Sposob kompleksnoy luchevoy diagnostiki doklinicheskih I klinicheskih stadiy bolezni Alzheimera. [Method of complex beam-diagnostics of subclinical and clinicas stages of Alzheimer’s disease.] Russian patent, №. 2315559 [In Russ].

17.   Maksimovich I.V., Gotman L.N., Masiuk S.M. Sposob opredelenia razmera visochnich doley golovnogo mozga pri bolezni Alzheimera [Measuring the size of the temporal lobes in patients with Alzheimer's disease] Russian patent № 2306102 [In Russ].

18.   Maksimovich I.V. Luchevaia diagnostika bolezni Alzheimera. [Beam-diagnostics of Alzheimer’s disease.] Diagnosticheskaia i intervencionnaia radiologia [Diagnostic and interventional radiology. ]. 2008; 2 (4): 27-38 [In Russ].

19.   Maksimovich I.V. Dyscirculatory Angiopathy of Alzheimer's Type. Journal of Behavioral and Brain Science. 2011; 1 (2): 57-68.

20.   Dickerson B.C. Functional magnetic resonance imaging of cholinergic modulation in mild cognitive impairment. Current Opinion in Psychiatry. 2006; 19: 299-306.

21.   Chiang G.C., Insel Ph.S, Tosun D., Schuff N., Truran-Sacrey D., Raptentsetsang S., Jack C.R., Weiner M.W. Identifying cognitively healthy elderly individuals with subsequent memory decline by using automated MR temporoparietal volumes. Radiolog. 2011; 259 (3): 844-51.

22.   Schuff N., Insel Ph., Chiang G., Truran D, Gamst A., Jack C., Aisen P., Petersen R., Shaw L., Trojanowski J., Weiner M. Acceleration of brain atrophy rates with advancing cognitive deterioration from normal aging to MCI to Alzheimer's disease. J. Alzheimer's &Dementia. 2011; 7 (4): S223.

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24.   Meyer P.T., Hellwig S., Amtage F., et al. Dual-biomarker imaging of regional cerebral amyloid load and neuronal activity in dementia with PET and 11C-labeled Pittsburgh compound B. J. Nucl. Med. 2011; 52 (3): 393-400.

25.   Perrin R.J., Craig-Schapiro R., Morris J.C., et al. Identification and validation of novelcerebrospinal fluid biomarkers for staging early Alzheimer's disease. Public Library of Science On. 2011; 12 (6): e16032.

26.   Jack C., Vemuri P., Viste H., et al. Ordering of Alzheimer's disease biomarkers. Alzheimer's & Dementia. 2011; 7 (4): S4-S5.

27.   Mayeux R., Reitz C., Brickman A.M., Haan M.N., ManlyJ.J. et. al. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 1. Alzheimers & Dementia. 2011; 7 (1): 15-34.

28.   Folstein M.F., Folstein S.E., McHugh P.R. Minimental state. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975; 12 (3): 189-98.

29.   Maksimovich I.V. Dyscirculatory Angiopathy of the Brain of Alzheimer's Type. Eurointerventional. 2011; 7: M 253.

30.   Maksimovich I.V. Endovascular Application of Low-Energy Laser in the Treatment of Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2012; 2 (1): 67-81. 

Abstract:

The author presents the endovascular technique for treatment of the Alzheimer disease. 40 patients aged 34–78 years were included into the study 4 of them were at risk, 13 had early and moderate stage, 16 – full-scaled stage, and 7 had preterminal stage of the disease.

The survey design included computed tomography with temporal lobes volume calculation, brain scintigraphy, rheoencephalography, and digital cerebral angiography.

Temporal lobes atrophy and capillary flow reduction in fronto-parietal and temporal regions are shown to be the characteristic radiomorphological features of the Alzheimer disease. Indications and contrindications for the treatment are presented.

Interventions were pefformed in terms of 1 to 12 years after the disease manifestation. The aim of treatment was percutaneous revascularization and capillary bed restoration by means of transluminal low-energy laser.

Clinical improvement was seen in all the cases; however, it differed in each group of patients. Thus, it is possible not only suspend the advancement of the Alzheimer disease, but to achieve its regression, with regeneration of the brain tissues and to return the people into the active life.  

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Abstract:

Aim. Was to investigate the efficiency of transluminal laser revascularization of brain in treatment of vascular dementia.

Materials and methods. We have examined and treated 665 patients aged 29 to 81 (average age 75) suffering from various kinds of atherosclerotic lesions of cerebral vessels accompanied by developed vascular dementia. The research included: CT, MRI, scintigraphy, rheoencephalography, poliprojectional angiography To perform endovascular treatment we selected 639 patients: Group 1 (CDR-1) - 352, Group 2 (CDR-2) - 184, Group 3 (CDR-3) - 103 patients. To conduct revascularization of main intracranial arteries high-energy laser systems were used; for revascularization of distal intracranial branches low-energy laser systems were used.

Results. The clinical outcome depended on the severity of dementia and timing of the intervention. A good clinical outcome in Group 1 was obtained in 281 (79.82%) cases, in Group 2 in 81 (44.02%) cases, in Group 3 in 9 (8.73%) cases. A satisfactory clinical outcome in Group 1 was obtained in 53 (15.34%) cases, in Group 2 in 62 (33.70%) cases, in Group 3 in 31 (30.09%) cases. A relatively satisfactory clinical outcome in Group 1 was obtained in 17 (4.83%) cases, in Group 2 in 41 (22.28%) cases, in Group 3 in 63 (61.16%) cases. No negative effects were observed after the interventions.

Conclusions. Evaluating the data obtained it can be concluded that the method of transluminal laser revascularization of cerebral blood vessels is an effective one for the treatment of atherosclerotic lesions of the brain accompanied by dementia.  

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20.  Amb

Abstract:

The research investigates the possibility of restoring the blood supply in patients with atherosclerosis of the brain, as well as the treatment of chronic cerebrovascular insufficiency, both not burdened and the burdened development of small strokes, with use for this method of transcatheter laser revascularization.

The research involves 946 patients aged 29-81 (average age 74) suffering from various types of cerebral atherosclerosis. 568(60,04%) patients underwent transcatheter treatment - Test Group. 378 (39,96%) patients underwent conservative treatment - Control Group. The examination plan included laboratory diagnostics, assessment CDR, MMSE, IB, cerebral SG, REG, CT, MRI, MRA, MUGA. To restore the blood supply, the method of transcatheter laser revascularization was applied; high-energy pulsed lasers were used for major intracranial arteries treatment, and low-energy CW lasers - for distal intracranial branches treatment.

Test Group: 459(80,81%) patients had good clinical outcome, 91(16,02%) - satisfactory clinical outcome, 18(3,17%) - relatively satisfactory clinical outcome; relatively positive clinical outcome was not obtained in any case. Control Group: good clinical outcome was not obtained in any case; 65(17,20%) patients had satisfactory clinical outcome, 121(23,26%) - relatively satisfactory clinical outcome; 192(50,79%) - relatively positive clinical outcome.

The method of transcatheter laser revascularization of cerebral vessels is a physiological, effective and low-invasive treatment for patients suffering from atherosclerosis of the brain. Obtained results last up to 10 years and more; it causes regression of mental and motor disorders, promotes regression of dementia and largely improves patients' quality of life; it has virtually no alternative - which makes the proposed method significantly different from conservative treatment methods. 

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