PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.

Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30) were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32) had piribedil in addition to standard therapy. Patients of the control group (n=32) had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.

Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008), categorical association (p=0.002), clock drawing test (Wilcoxon test; p=0,005), while other indices were reduced in comparison with the initial ones.

Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

1. Postnov V.G., Kras’kov V.V., Lomivorotov V.V. Neurology in cardiosurgery: guidelines for doctors. Novosibirsk: Sibregioninfo; 2007. Russian (Постнов В.Г., Караськов В.В., Ломиворотов В.В. Неврология в кардиохирургии: руководство для врачей. Новосибирск: Сибрегионинфо; 2007).

2. Akimova N.S., Martynovich T.V., Persashvili D.G., Shvarts Yu.G. Peculiarities of piribedil use in the treatment of cognitive disorders in patients with chronic cardiac failure. Ration Pharmacother Cardiol 2014; 10 (4); 406-10. Russian (Акимова Н.С., Мартынович Т.В., Персашвили Д.Г., Шварц Ю.Г. Особенности применения пирибедила в лечении умеренных когнитивных расстройств у пациентов с хрони-ческой сердечной недостаточностью. Рациональная Фармакотерапия в Кардиологии 2014;10 (4);406-10).

3. Bokeriya L.A., Goluhova E.Z., Polunina A.G., et al. Cognitive function after coronary artery bypass in thee arly and long-term period. Kreativnaya Kardiologiia; 2011; 2; 71-88. Russian (Бокерия Л.А., Го-лухова Е.З., Полунина А.Г., Лефтерова Н.П., Бегачев А.В. Когнитивные функции после операций с искуственным кровообращением в раннем и отдаленном послеоперационном периоде. Креативная Кардиология; 2011; 2; 71-88).

4. ZaharovV.V. The use of pronoran in the treatment of non-dementia cognitive disorders Nevrologicheskiy Zhurnal; 2008; 2: 38-42. Russian (Захаров В.В. Использование пронорана в лечение неде-ментных когнитивных нарушений. Неврологический Журнал; 2008; 2: 38-42).

5. Eremina O.V., Petrova M.M., Prokopenko S.V., et al. Cognitive disorders in patients with ischemic heart disease. Bjulleten' Sibirskoj Mediciny 2014;13(6): 48-56. Russian (Еремина О.В., Петрова М.М., Про-копенко С.В., Исаева Н.В., Каскаева Д.С. Когнитивные нарушения у пациентов с ишемической болезнью сердца. Бюллетень Сибирской Медицины 2014;13(6): 48-56).

6. Ovezov A.M., Lobov M.A., Nad’kina E.D. et al. Citocoline in the prophylaxis of postoperative cognitive dysfunction in total intravenous anaesthesia. Annaly Klinicheskoy i Eksperimental'noy Nevrologii; 2013; 7: 27–32. Russian (Овезов А.М., Лобов М.А., Надькина Е.Д. и др. Цитиколин в профилактике после-операционной когнитивной дисфункции при тотальной внутривенной анестезии. Анналы Кли-нической и Экспериментальной Неврологии 2013; 7: 27-32).

7. Bonser P.M. Рagano D., Haverich A., eds. Brain Protection in Cardiac Surgery. London: Springer-Verlag; 2011.

8. Evered L., Scott D.A., Silbert B., Maruff P. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg 2011;112; 1179-85.

9. Fontes M.T., Swift R.C., Phillips-Bute B., et al. Neurologic Outcome Research Group of the Duke Heart Center. Predictors of cognitive recovery after cardiac surgery. Anesth Analg 2013;116:435-42.

10. Selnes O.A., Gottesman R.F., Grega M.A., et al. Cognitive and neurologic outcomes after coronaryartery bypass surgery. N Engl J Med 2012;366:250-7.

11. Hudetz J.A., Gandhi S.D., Iqbal Z., et al. Elevated postoperative inflammatory biomarkers are associated with short- and medium-term cognitive dysfunction after coronary artery surgery. J Anesth 2011;25; 1-9.

12. McKhann G.M., Grega M.A., Borowicz L.M .Jr. et al. Is there cognitive decline 1 year after CABG? Comparison with surgical and nonsurgical controls. Neurology 2005;65:991-9.

13. Petrova M.M., Prokopenko S.V., Eremina O.V., et al. Use of cytokolin after coronary artery bypass surgery. Vrach 2014; 8; 75-8. Russian (Петрова М.М., Прокопенко С.В., Еремина О.В, и др. При-менение цитиколина после операции коронарного шунтирования. Врач 2014; 8; 75-8)