Chronic Cerebral Ischemia: From Pathogenesis to Therapy

Currently, there is an increase in the prevalence of cerebrovascular diseases, which significantly reduce the quality of life and often lead to disability of patients. Diseases of small-caliber cerebral vessels account for about 40% of dementias in the world and a fifth of strokes that occur throughout the year worldwide. Structural damage to the brain associated with cerebral microangiopathy (diffuse white matter lesions, multiple lacunar infarctions, microbleeds, secondary cerebral atrophy) can remain clinically unnoticeable for a long time, but significantly increase the risk of dementia and disabling strokes. The main etiopathogenetic factor of cerebral microangiopathy is arterial hypertension, causing arteriosclerosis of small penetrating arteries and arterioles. The most important initiating link in this process is endothelial dysfunction. Available data indicate an increase in circulating markers of endothelial damage in patients with cerebral microangiopathy. Timely complex therapy is a decisive factor in the reverse development of endothelial dysfunction and reliable prevention of cerebrovascular disease. The drug Divaza, which has pleiotropic effects, is a pathogenetically substantiated adjuvant drug for the treatment of anxiety-depressive symptoms associated with cerebral microangiopathy.