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Relationship between Neuroimaging Markers of Brain Injury and the Severity of Postural Instability in Patients with Chronic Cerebral Ischemia (results of the NEMAN open observational study)

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Objectives. To analyze the relationship between the severity of postural instability in patients with chronic cerebral ischemia (CCI) and MRI brain changes and to assess the efficacy and safety of vinpocetine in this category of patients. Materials and methods. The open observational study included 60 patients with CCI: the study group consisted of 40 patients with postural instability and the reference group consisted of 20 patients without balance disorders. The severity of brain changes was assessed using MRI data (the STRIVE protocol), postural instability (the VAS-N scale), anxiety (the Hamilton Anxiety Rating Scale), asthenia (the Asthenic Condition Scale), daytime sleepiness (the Epworth Sleepiness Scale), cognitive impairment (the Montreal Cognitive Assessment), and the effects of treatment (the Global Rating of Change Scale). Results. The study group was dominated by older people, with more significant decreases in cognitive functions, impaired urination, anxiety syndrome, and asthenia, and more marked MRI changes due to periventricular white matter damage and lacunae. The overall severity of cerebrovascular changes was associated with the VAS-N: β = 0.479, p = 0.035, 95% CI 0.023–0.928. The presence of lacunae was found to be the most significant factor for the development of severe balance impairment. Close relationships were found between the total numbers of lacunae and VAS-N and between VAS-N and the number of lacunae in the basal ganglia (r = 0.793, p = 0.019) and lenticular nuclei (r = 0.498, p = 0.036). At three months of vinpocetine therapy, the study group showed a significant improvement in static-dynamic functions and the absence of anxiety; daytime sleep parameters returned to normal, the severity of asthenia decreased, and scores on the MoCA scale increased. Most patients rated treatment-related improvement as moderate or marked. Conclusions. The presence of lacunae in the basal ganglia is a neuroimaging marker for brain damage in patients with CCI and postural instability. Use of vinpocetine can significantly reduce the severity of balance impairment, anxiety, and asthenia and promotes normalization of the circadian rhythm of sleep.

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Authors and Affiliations

  1. Kirov Military Medical Academy, Russian Ministry of Defense, St. Petersburg, Russia

    I. N. Samartsev & S. A. Zhivolupov

  2. Almazov National Medical Research Center, Russian Ministry of Health, St. Petersburg, Russia

    A. Yu. Efimtsev

  3. Belarus Postgraduate Medical Academy, Minsk, Belarus

    V. V. Ponomarev

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  1. I. N. Samartsev
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  2. S. A. Zhivolupov
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  3. A. Yu. Efimtsev
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  4. V. V. Ponomarev
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Correspondence to I. N. Samartsev.

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Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 122, No. 7, pp. 66–73, July, 2022.

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Samartsev, I.N., Zhivolupov, S.A., Efimtsev, A.Y. et al. Relationship between Neuroimaging Markers of Brain Injury and the Severity of Postural Instability in Patients with Chronic Cerebral Ischemia (results of the NEMAN open observational study). Neurosci Behav Physi 53, 295–301 (2023). https://doi.org/10.1007/s11055-023-01424-6

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