Use of Gliatilin in inpatient treatment of patients with late-life dementia

According to WHO, in 2022, 466 million people worldwide had disabling hearing loss. By 2030, the number of people with socially significant hearing loss is projected to increase to 630 million people, and by 2050 their number may exceed 900 million people. Among all forms of hearing loss in the world, sensorineural hearing loss (SNHL), caused by damage to the neuroepithelial and nerve cells of the auditory analyzer, dominates. The only method of rehabilitation for patients with bilateral chronic hearing loss of any etiology is hearing aid, and in cases of high degrees of hearing loss and ineffective hearing aid, cochlear implantation [1–4]. At the same time, many patients note insufficient speech intelligibility even with binaural hearing aids, which may be due to a significant decrease in the dynamic range of hearing, the presence of the phenomenon of accelerated increase in volume, subjective tinnitus (SUS), cognitive impairment [1-4, 6-10], and with Such conditions in some cases require the prescription of drug therapy, usually in courses 1-2 times a year, with the use of nootropic drugs [1-4], which affect neuroprotective and cognitive functions, the processes of neurogenesis, and are also important in the processes of auditory-speech rehabilitation and after Kohler implantation. One such drug is Gliatilin (choline alfoscerate). Choline is used for the synthesis of acetylcholine, which primarily affects cholinergic receptors in the central nervous system. Glycerophosphate, which is formed during the cleavage of alfoscerate, after phosphorylation penetrates into the phospholipid pool of the neuron membrane and facilitates the transmission of nerve impulses in cholinergic neurons, improves the plasticity of neuronal membranes and receptor function, and supports the growth and survival of nerve cells [5].

The purpose of the study was to study the effect of the drug Gliatilin on hearing, speech intelligibility, SUS, as well as psycho-emotional status and cognitive function in patients with chronic NCT against the background of cerebrovascular pathology.

Composition and release form

in a blister pack 14 pcs.; in a cardboard pack 1 package.

in ampoules of 4 ml; in a blister pack there are 1 or 3 ampoules, in a cardboard pack there is 1 ampoules.

Pharmacodynamics

Improves the transmission of nerve impulses in cholinergic neurons; has a positive effect on the plasticity of neuronal membranes and receptor function. Improves cerebral blood flow, enhances metabolic processes in the brain, activates the structures of the reticular formation of the brain and restores consciousness in case of traumatic brain injury.

It has a preventive and corrective effect on such pathogenetic factors of involutional psychoorganic syndrome as changes in the phospholipid composition of neuronal membranes and a decrease in cholinergic activity.

Experimental studies have shown that Gliatilin stimulates the dose-dependent release of acetylcholine under physiological conditions of neurotransmission.

When ingested, it is broken down by enzymes into choline and glycerophosphate.

Gliatilin, on the one hand, being a choline donor, increases the synthesis of acetylcholine and has a positive effect on neurotransmission, on the other hand, glycerophosphate is involved in the synthesis of phosphatidylcholine (membrane phospholipid), as a result, both have a positive effect on membrane elasticity and receptor function, which improves synaptic transmission.

Thus, pharmacodynamic studies have shown that Gliatilin acts on the synaptic, incl. cholinergic neurotransmission; plasticity of the neuronal membrane; receptor function.

Medical Internet conferences

Relevance. Due to its high prevalence and severe health consequences, acute cerebrovascular accidents are a major medical and social problem. In addition to high mortality, stroke is the leading cause of disability in the population. About 450 thousand cases of stroke are registered annually in Russia; the ischemic variant of acute cerebrovascular accident occurs predominantly.

One of the most pressing tasks of modern angioneurology is the search for optimal methods for treating cerebral infarction. Insufficiently effective correction of neurological syndromes, which form the core of the clinic of acute circulatory disorders of the brain, leads to a deterioration in the quality of life of patients and a decrease in social and everyday adaptation. Neurometabolic, functional and morphological features of the nervous system, multifactorial pathogenesis, zonality and stages of ischemic damage create extremely difficult conditions for the successful use of neuroprotective drugs. Despite the huge number of works covering the treatment of strokes, there is currently a limited number of drugs with absolutely proven effectiveness in acute cerebral ischemia.

Purpose of the work: to evaluate the effectiveness of the drug "Gliatilin" in patients with primary hemispheric cerebral infarction in the acute period.

Materials and methods. The study was conducted on the basis of the neurological department of the Municipal Clinical Hospital No. 9 in Saratov. We analyzed 122 cases of primary ischemic stroke of hemispheric localization. The criteria for inclusion in the studies were: first-time ischemic stroke of hemispheric localization, duration of the disease - no more than 24 hours, severity of neurological deficit on the NIHSS scale >=2 and <=20, level of consciousness from clear to somnolence (14-15 points on the Glasgow Coma Scale ), age 40-75 years, signed informed consent. Exclusion criteria from the study: ischemic stroke of any other location, recurrent stroke, total aphasia, any other neurological diseases of the central nervous system, somatic diseases in the stage of decompensation, women with childbearing potential, alcohol abuse. By random sampling, the patients were divided into 2 groups: the main group (MG - 62 people) and the comparison group (CG - 60 people). The average age of the subjects was 65.3±8.2 years (67 women, 55 men). Patients with OH , along with the standard treatment regimen for cerebral infarction, were treated with the drug “Gliatilin” according to the regimen of 1000 mg parenterally for 10 days. The study examined the structure of patients' complaints, medical history, indicators of neurological status, and assessed the patients' condition according to the Glasgow Coma Scale, NIHSS, Barthel, Rankin and MMSE. All patients underwent a CT scan of the brain within the first 24 hours from the onset of stroke symptoms. The study design involved conducting neurological and neuropsychological examinations in the first 24-48 hours after an acute vascular accident, as well as on the 5th, 10th and 21st days after the start of gliatilin administration.

Results. Upon admission, all patients had general cerebral symptoms, and a complex of neurological syndromes was determined in accordance with the location of the infarction. Neurological symptoms were represented by sensitivity disorders of the cerebral conduction type and central hemiparesis. When studying the cognitive sphere, all patients had disorders of mnestic function, attention deficit, decreased tempo of mental activity, rapid exhaustion, and anxiety of varying severity was detected. According to computed tomography, 56% of all strokes were assessed as medium in size, 34% as lacunar, and in 10% of cases large infarcts were described. The majority of patients (73.8%) had ischemic stroke in the middle cerebral artery system: 58.9 - right, 41.1 - left; cerebral infarction in the territory of the posterior cerebral artery was registered in 8.2% of patients, in the territory of the anterior cerebral artery - in 18% of patients.

The obtained data from the examination on scales, carried out at different times from the onset of the disease, are shown in Table 1.

The most revealing data were obtained already on the 5th day of the study: in 42 patients with OH, signs of hemiparesis and sensory disturbances in the extremities regressed; in 11 patients with OH, similar dynamics were observed at a later date - by days 10-21. The number of patients with mild neurological disorders (NIHSS < 8 points) by the 5th day of observation was 48% of the total number included in the OG. According to scales that determine the ability to self-care, the number of patients in the MG with moderate dependence in daily activities (total score on the Barthel scale > 75) was 34% by day 5 and 73% by day 10 from the onset of the disease. A similar picture can be seen according to the criteria of patients’ mobility, their ability to self-care, and household activity (Rankin scale). On day 10, patients in the GS had moderately pronounced signs of disability, while in the OG, patients receiving the drug “Gliatilin” noted mild signs of disability and were able to take care of themselves without outside help. Positive changes also occurred in the GS, but they were less pronounced.

In all subjects, the MMSE scale revealed cognitive deficits of varying severity. In the first 48 hours, the average values ​​on the MMSE scale in the MG were 24.1±5.3 points, in the GS - 24.3±5.3 points, which corresponds to the presence of cognitive impairment. On the 5th day in the MG after gliatilin therapy, the MMSE score increased by an average of 3.2 points, in the GS by 1.3. Subsequently, the regression of cognitive deficit was less pronounced: in the OG the average score increased by 0.8 points on the 10th day and by 0.6 points on the 21st day, in the GS by the 10th day the scores increased by 0.5 points, by the 21st day by 0.2 points.

Table 2 shows the dynamics of recovery of neurological deficit depending on the duration of drug administration in MG patients.

The analysis showed that in MG patients who were prescribed gliatilin on the 1st day from the onset of the disease, there was a statistically significant advance in the recovery of neurological functions by the 10th day of the disease compared to patients who received the drug later than 24 hours after the first symptoms of stroke.

Conclusions. An overall assessment of the treatment effect revealed a clear prevalence of positive results in the group where the drug “Gliatilin” was used compared to the group that received only basic therapy.

The use of the drug "Gliatilin" in the treatment of ischemic stroke of hemispheric localization in the acute period contributes to the regression of neurological symptoms and an increase in the patient's functional activity, which is determined already on the 5th day from the moment of the disease. The most significant positive dynamics in the patient’s condition can be seen in the acute period of cerebral ischemia. Prescribing the drug "Gliatilin" allows you to achieve the best therapeutic result and generally helps to increase the effectiveness of medical rehabilitation for this category of patients.

Indications

acute period of TBI with a predominantly brain stem level of damage (impaired consciousness, coma, focal hemispheric symptoms, symptoms of brain stem damage);

ischemic (acute and recovery period) and hemorrhagic stroke (recovery period);

degenerative and involutional psychoorganic syndromes and consequences of cerebrovascular insufficiency, such as primary and secondary disorders of mnestic functions, characterized by memory impairment, confusion, disorientation, decreased motivation, initiative, and ability to concentrate;

changes in the emotional and behavioral sphere: emotional lability, increased irritability, decreased interest, senile pseudomelancholy;

multi-infarct dementia.

Directions for use and doses

Injections: IM or IV (drops).

Capsules: orally, before meals.

Adults, in acute conditions: IM - at a dose of 1000 mg/day (1 amp.) or IV - 1000-3000 mg/day. For intravenous administration, the contents of 1 amp. (4 ml) diluted in 50 ml of saline, infusion rate - 60-80 drops per minute. The duration of treatment is usually 10 days, but if necessary, treatment can be continued until positive dynamics appear and it is possible to switch to oral capsules.

For chronic cerebrovascular insufficiency, changes in the emotional and behavioral sphere and multi-infarct dementia: orally - 400 mg (1 capsule) 3 times a day.

Duration of therapy is 3–6 months.

Use of Gliatilin in inpatient treatment of patients with late-life dementia

1. Gavrilova S.I., Kalyn Ya.B., Mikhailova N.M. and others. Pharmacoeconomic aspects of Alzheimer's disease. Let's lie. ter. to a psychiatrist. and neurol. 2014;2:10-15. https:// logospress.ru/

2. Russ TC, Stamatakis E, Hamer M et al. Association between psychological distress and mortality: Individual participant pooled analysis of 10 prospective cohort studies. Br. Med. J. 2012;345. doi: 10.1136/bmj.e4933

3. Gavrilova S.I., Kolykhalov I.V. Development of a standard therapy for Alzheimer's disease. Let's lie. ter. to a psychiatrist. and neurol. 2012;1:5-9. https://logospress.ru/

4. Curtin F., Schulz P. Assessing the benefit: risk ratio of a drug—randomized and naturalistic evidence. Dial. Clin. Neurosci. 2011;13(2):183-192

5. Leon AC Evaluation of psychiatric interventions in an observational study: issues in design and analysis. Dial. Clin. Neurosci. 2011;13(2):191-198

6. Moller H.-J. Effectiveness studies: advantages and dis- advantages. Dial. Clin. Neurosci. 2011;13(2):199-207

7. Patsopoulos NF A pragmatic view on pragmatic trials. Dial. Clin. Neurosci. 2011;13(2):217-224

8. Satlin A., Bodick N., Offen WW, Renshaw PF Brain proton magnetic resonance spectroscopy (1H-MRS) in Alzheimer's disease: changes after treatment with xanomeline, an M1 selective cholinergic agonist. Am. J. Psychiat. 1997;154(10):1459-1461

9. Barbagallo Sangiorgi G., Barbagallo M., Giordano M. et al. Alpha-Glycerophosphocholine in the mental recovery of cerebral ischemic attacks: An Italian multicenter clinical trial. Acad. Sci. 1994;717:253-269

10. Odinak M.M., Emelin A.Yu., Lobzin V.Yu., Kolcheva Yu.A. Therapy of vascular cognitive disorders. RMJ. 2009;20(359):1295-1297

11. Parnetti L. et al. Multicentre study of l-alpha-glyceryl-phosphorylcholine vs ST200 among patients with probable senile dementia of Alzheimer's type. Drugs Aging. 1993; 3(2):159-164

12. Selezneva N.D., Kolykhalov I.V., Gerasimov N.P. and others. Use of gliatilin for the treatment of dementia of the Alzheimer’s type. Social wedge. psychiatrist 1998;4:42-51

13. De Jesus Moreno Moreno M. Cognitive improvement in mild to moderate Alzheimer's dementia after treatment with the 62 acetylcholine precursor choline alfoscerate: a multicenter, double-blind, randomized, placebo-controlled trial. Clin. Ther. 2003;25(1):178-193

14. Leonard BE Pharmacother apy in the treatment of Alzheimer's disease: an update. World Psychiat. 2004;3(2):84-89. Issues of clinical and biological psychiatry

15. Parnetti L., Amenta F., Gallai V. Choline alphoscerate in cognitive decline and in acute cerebrovascular disease: an analysis of published clinical data. Mech. Ageing Dev. 2001;122(16):2041-2055

16. Parnetti L., Mignini F., Tomassoni D. et al. Cholinergic precursors in the treatment of cognitive impairment of vascular origin: ineffective approaches or need for re-evaluation? J. Neurol. Sci. 2007;257(1-2):264-269

17. Suchy J., Chan A., Shea TB Dietary supplementation with a combination of alpha-lipoic acid, acetyl-L-carnitine, glycerophosphocoline, docosahexaenoic acid, and phosphatidylserine reduces oxidative damage to murine brain and improves cognitive performance. Nutr Res. ;29(1):70-74. doi: 10.1016/j.nutres.2008.11.004

18. Odinak M.M., Voznyuk I.A. Modern means of treating ischemic stroke. Terra medica. 1999;2

19. Seregin V.I. The use of gliatilin and mexidol in intensive care of severe acute ischemic stroke. Pharmateka. 2006;5:24-25

20. Odinak M.M., Emelin A.Yu., Lobzin V.Yu., Kolcheva Yu.A. Therapy of vascular cognitive disorders. RMJ. 2009;20(359):1295-1297

21. Batysheva T.T., Zaitsev K.A., Kamchatnov P.R. and others. The effectiveness of choline alfoscerate (gliatilin) ​​in mild cognitive impairment of vascular origin. Journal neurol. and psychiatrist. them. S.S. Korsakov. 2011;8:29-32

22. Di Perri R., Coppola G., Ambrosio LA et al. A multicentre trial to evaluate the efficacy and tolerability of alpha-glycerylphosphorylcholine versus cytosine diphosphocholine in patients with vascular dementia. J. Int. Med. Res. 1991;19(4):330-341

23. Muratorio A., Bonuccelli U., Nuti A. et al. Neurotropic approach to the treatment of multi-infarct dementia using choline alfoscerate. International neurol. magazine 2014;3(65):10-17

24. Bachinskaya N.Yu. Cholinergic strategy in the treatment of cognitive impairment in elderly and senile patients. International neurol. magazine 2014;2(64)

25. Skoromets A.A., Shabalina I.G., Beltseva Yu.A. The use of anticholinergic drugs and post-stroke dementia in elderly and senile people who survived the siege of Leningrad. Reviewed psychiatrist and honey psychol. 2014;2:109-115

26. Amenta F., Carotenuto A., Fasanaro AM et al. The ASCOMALVA trial: association between the cholinesterase inhibitor donepezil and the cholinergic precursor choline alphoscerate in Alzheimer's disease with cerebrovascular injury: interim results. J. Neurol. Sci. 2012;322(1-2):96- 101. doi: 10.1016/j.jns.2012.07.003

27. Amenta F., Carotenuto A., Fasanaro AM et al. The ASCOMALVA (Association between the Cholinesterase Inhibitor Donepezil and the Cholinergic Precursor Choline Alphoscerate in Alzheimer's Disease) Trial: interim results after two years of treatment. J. Alzheimer's Dis. 2014;42(Suppl. 3):S281-288. doi: 10.3233/JAD-140150

28. Tayebati SK, Amenta F. Choline-containing phospholipids: relevance to brain functional pathways. Clin. Chem. Lab. Med. 2013;51(3):513-521. doi: 10.1515/cclm-2012-0559

29. Scapicchio PL Revisiting choline alphoscerate profile: a new, perspective, role in dementia? Int. J. Neurosci. - 2013;123(7):444-449. doi: 10.3109/00207454.2013.765870

30. Kolykhalov I.V. Behavioral and psychopathological symptoms in Alzheimer's disease: epidemiological, psychopathological and neurobiological aspects. Psychiatry. 2015;3:74-84