Neurotrophins and Neurotrophic Therapy (Based on the Cerebrolysin Model) in the Treatment of Elderly Patients with Cognitive Disorders and Depression. Part 1

Abstract

Background: Alzheimer’s disease (AD) is the most common neurocognitive disorder and a global health problem. The prevalence of AD is increasing dramatically, and will double in two decades to reach 100 million cases worldwide. Therefore, the development of disease-modifying therapies that can delay or even prevent the onset and progression of AD has become a global priority.Objective: to present a review of domestic and foreign modern studies covering the pathogenesis of AD and disease-modifying therapy.Material and methods: the keywords “Alzheimer’s disease, late age, mild cognitive impairment, depression, therapy, cerebrolysin, effectiveness” were used to search for scientifi c articles in MEDLINE and PUBMED databases for the period 1980–2020.Results and conclusions: since the pathophysiology of AD is multifactorial, it is not surprising that all attempts to change the course of the disease with drugs aimed at a single therapeutic goal were unsuccessful. Thus, combined multimodal therapy using several drugs with a single mechanism of action or multi-purpose drugs seems to be the most promising strategy for both effective therapy of AD and its prevention. Cerebrolysin, acting as a multimodal peptidergic drug with a proven neurotrophic effect, has not only an immediate therapeutic effect on AD, which may refl ect its potential benefi t for modifying the course of the disease. Numerous clinical trials have shown that cerebrolysin is safe and effective in the treatment of AD, and can also enhance and prolong the effectiveness of cholinergic drugs, especially in patients with moderate AD. In this review, we summarize the achievements in the study of the therapeutic signifi cance of the drug and its effect on the pathogenesis of AD, paying special attention to the mechanisms of neurotrophic action. The review presents the results of both preclinical and clinical studies of cerebrolysin in the treatment of AD and pre-dementia cognitive disorders, as well as late depression.