Objective. To conduct a comparative analysis of the clinical efficacy of cholinergic drugs and acetylcholinesterase inhibitors and their combinations in the complex therapy of cerebrovascular pathology and the sequelae of closed craniocerebral trauma (cCCT) using clinical, instrumented, and laboratory follow-up investigations. Materials and methods. A total of 90 patients with cerebrovascular pathology (chronic cerebral ischemia grade 2 (I67; 45 patients) and the sequelae of cCCT (T90; 45 patients) were studied. Groups were divided into three subgroups each of 15 patients. Complex treatment included basal and specific therapy: subgroup 1 received the drug Neuromidin, group 2 received Gliatilin, and group 3 received Neuromidin plus Gliatilin. Treatment duration was two months. All patients underwent complex clinical, neurophysiological, and laboratory investigations before treatment and at one and two months from treatment initiation: plasma cholinesterase activity was estimated, patients were tested on the Mini Mental State Examination (MMSE) and the Hamilton scale, and patients underwent transcranial magnetic stimulation with assessment of the central motor conduction time and evaluation of somatosensory evoked potentials with determination of the central afferent conduction time. Results. Before treatment, a strong positive correlational relationship was found between patients’ age and serum cholinesterase activity (Rs = 0.77; p = 0.0001). On the background of treatment, all study parameters showed significant (p < 0.05) improvements with the exception of the MMSE, which showed only a trend to improvement) in subgroups 1 and 3 of each group as compared with values obtained in subgroups 2 of the corresponding groups. In addition, at two months from treatment initiation, there were significant decreases in serum cholinesterase activity in patients of subgroups 1 and 2. Conclusions. Assessment of deviations in the “cholinergic profile” (blood cholinesterase activity) in patients with cerebral pathology and the strategy of using cholinergic drugs and acetylcholinesterase inhibitors and their combination to correct psychoneurological disorders is among the most important directions in optimizing the combined treatment of patients of this category.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
V. M. Shklovskii, “Neurorehabilitation of patients with the sequelae of stroke and craniocerebral trauma,” Zh. Nevrol. Psikhiat., Spec. Iss., 115, No. 3, 75–81 (2015), https://doi.org/10.17116/jnevro20151153275-81.
Y. Sugiura, N. Zaima, M. Setou, et al., “Visualization of acetylcholine distribution in central nervous system tissue sections by tandem imaging mass spectrometry,” Anal. Bioanal. Chem., 403, No. 7, 1851–1861 (2012), https://doi.org/10.1007/s00216-012-5988-5.
V. Benagiano, D. Virgintino, P. Flace, et al., “Choline acetyltransferase-containing neurons in the human parietal neocortex,” Eur. J. Histochem., 47, 253–256 (2003).
G. A. Reid, N. Chilukuri, and S. Darvesh, “Butyrylcholinesterase and the cholinergic system,” Neuroscience, 234, 53–68 (2013), https://doi.org/10.1016/j.neuroscience.2012.12.054.
B. D. Drever, G. Riedel, and B. Platt, “The cholinergic system and hippocampal plasticity,” Behav. Brain Res., 221, 505–514 (2011), https://doi.org/10.1016/j.bbr.2010.11.037.
N. I. Bohnen, M. Grothe, N. Ray, et al., “Recent advances in cholinergic imaging and cognitive decline – Revisiting the cholinergic hypothesis of dementia,” Curr. Geriatr. Rep., 7, No. 1, 1–11 (2018), https://doi.org/10.1007/s13670-018-0234-4.
N. Richter, I. Allendorf, O. A. Onur, et al., “The integrity of the cholinergic system determines memory performance in healthy elderly,” NeuroImage, 100, 481–488 (2014), https://doi.org/10.1016/j.neuroimage.2014.06.031.
N. I. Bohnen, D. I. Kaufer, R. Hendrickson, et al., “Cognitive correlates of alterations in acetylcholinesterase in Alzheimer’s disease,” Neurosci. Lett., 380, No. 1–2, 127–132 (2005), https://doi.org/10.1016/j.neulet.2005.01.031.
G. A. Jackson, “Drug treatments for Alzheimer’s disease,” Nurs. Times, 110, 9:24–26 (2014).
I. V. Damulin, “The use of ipidacrine (Axamon) in neurological practice,” Trudnyi Patsient, 11, No. 5, 15–20 (2007).
H. Forstl, A. Burns, R. Levy, et al., “Neuropathological correlates of behavioural disturbance in confirmed Alzheimer’s disease,” Br. J. Psychiatry, 163, 364–368 (1993), https://doi.org/10.1192/bjp.163.3.364.
Lokshina, A. B., “Management of patients with dementia: cholinergic deficit and its correction,” Meditsinsk. Sov., 12, 30–35 (2018).
V. V. Gnezditskii and O. S. Korepina, Atlas of Evoked Potentials (a Practical Guide Based on Analysis of Specific Clinical Observations), PresSto, Ivanovo (2011).
S. S. Nikitin and A. L. Kurenkov, Methodological Bases of Transcranial Magnetic Stimulation in Neurology and Psychiatry. Guidelines for Doctors, Moscow (2006).
T. Iizuka and M. Kameyama, “Cholinergic enhancement increases regional cerebral blood flow to the posterior cingulate cortex in mild Alzheimer’s disease,” Geriatr. Gerontol. Int., 17, No. 6, 951–958 (2017), https://doi.org/10.1111/ggi.12818.
S. L. Risacher, B. C. McDonald, E. F. Tallman, et al., “Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults,” JAMA Neurol., 73, No. 6, 721–732 (2016), https://doi.org/10.1001/jamaneurol.2016.0580.
Y. S. Mineur and M. R. Picciotto, “Nicotine receptors and depression: Revisiting and revising the cholinergic hypothesis,” Trends. Pharmacol. Sci., 31, No. 12, 580–586 (2010), https://doi.org/10.1016/j.tips.2010.09.004.
S. A. Zhivolupov, I. N. Samartsev, and Yu. S. Butakova, “The current paradigm for the rational treatment of strokes,” Zh. Nevrol. Psikhiat. (Stroke), 8, No. 2, 82–87 (2016), https://doi.org/10.17116/jnevro20161168282-87.
M. Pohanka, “Acetylcholinesterase inhibitors; a patent review (2008-present),” Exp. Opin. Ther. Pat., 8, 871–886 (2012), https://doi.org/10.1517/13543776.2012.701620.
Translated from, Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 120, No. 2, Iss. 1, pp. 31–38, February, 2020.
About this article
Cite this article
Litvinenko, I.V., Zhivolupov, S.A., Samartsev, I.N. et al. The Cholinergic Profile as a Target for Rational Therapy of Central Nervous System Diseases and Injuries. Neurosci Behav Physi (2020). https://doi.org/10.1007/s11055-020-01012-y
- cholinergic drugs
- acetylcholinesterase inhibitors
- impaired cognitive functions