Деменции позднего возраста: факторы, ассоциированные со скоростью прогрессирования деменции. Часть 2

Обоснование: неуклонное прогрессирование деменции характеризуется разной скоростью, что обусловило клиническое разграничение деменций с быстрым и медленным нарастанием тяжести когнитивного снижения. Поиск клинических факторов, гипотетически ответственных за различия в скорости прогрессирования деменции, является одним из аспектов исследований проблемы деменций позднего возраста.

Цель: обобщить результаты изучения влияния отдельных клинических факторов на различия в темпе прогрессирования деменций позднего возраста.

Материал и метод: по ключевым словам «поздний возраст», «деменция», «скорость прогрессирования», «возраст начала», «некогнитивные расстройства», «нозомодифицирующая терапия» отобраны и проанализированы статьи в базах MEDLINE/PubMed с 1990 по 2020 г., а также релевантные статьи в списках литературы анализированных работ.

Заключение: различные параметры заболевания исследованы в качестве ассоциированных с паттерном прогрессирования деменции. В отношении части из них результаты достигали согласованности в признании связи со скоростью прогрессирования деменции, в отношении других такие свидетельства неоднозначные. Большие расхождения имеются во взглядах на гендерные различия, в то время как ранний возраст начала заболевания, исходно бóльшая выраженность когнитивного снижения, массивность нейропсихиатрических расстройств согласованно признаются ассоциированными с быстрым прогрессированием деменции. Исследователей объединяет устойчивое представление о нелинейном характере прогрессирования деменции на этапах мягкой, умеренной и тяжелой деменции.

Результаты изучения коморбидности в основном сходны в отношении признания влияния СФР, прежде всего артериальной гипертензии, на скорость прогрессирования деменции. Доказательство эффективности нозомодифицирующей терапии, замедляющей прогрессирование деменции, единодушно считается актуальной задачей, решению которой способствует разработка новых концепций патогенеза деменций и поиск новых мишеней терапии. Результаты изученного направления исследований подтверждают гипотезу о том, что прогрессирование деменции происходит по различным патогенетическим механизмам, которые определяют скорость нарастания деменции. Ведение больных деменцией в практике предполагает учет различных факторов, влияющих на скорость прогрессирования деменции, для планирования объема и характера лечебной помощи.

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