Cognitive status in elderly patients with chronic cerebral ischemia treated with Mexidol

Objective. To evaluate the efficacy of sequential Mexidol therapy, administered intravenously and orally over 74 days as part of a comprehensive treatment regimen, on cognitive status in elderly patients with chronic cerebral ischemia (CCI) and cognitive impairments. Material and methods. AThis prospective open-label study included 90 elderly patients with CCI (mean age 81±3 years). The main group (MG, n=43) received standard therapy plus Mexidol, and the comparison group (CG, n=47) received standard therapy alone. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), Stroop test, and Schulte test at baseline and after three months. Results. At baseline, the groups were comparable in sex, age, and clinical and cognitive status. After three months of therapy, the median MMSE score in the main group (MG) was 27 points, significantly higher than the 26 points observed in the comparison group (CG) (p<0.001; Δ=8.0%). In the MG, no patients had mild dementia, whereas the percentage in the CG remained unchanged at 18.6%. In the Stroop test, the increase in the number of words named in the MG was 7 (95% CI 5; 8), compared to 2 (95% CI 0; 3) in the CG; the median was 70 and 66 words, respectively (Δ=8.0%; p<0.001). Nine patients (21.9%) in the CG scored fewer than 65 words, while none in the MG did so. The interference ratio decreased by 5.5% in the MG compared to 2.5% in the CG (p=0.004). The time to complete the Schulte test in the MG decreased by 8.0 seconds (95% CI –10.9; –5.1), compared to 2.0 seconds (95% CI –4.8; 0.8) in the CG; the difference between groups was 6.0 seconds (95% CI –9.2; –2.8). Work efficiency (WE) increased from 0.14 to 0.19 in the MG (35.7%), and by 6.7% in the CG. Four patients in the MG (9.3%) and nine in the CG (19.1%) had WE >0.25. Mental stability improved by –4.0% (95% CI –6.3%; –1.7%) in the MG versus –1.0% (95% CI –3.2%; +1.2%) in the CG, with a difference of 3.0% (95% CI –6.2%; +0.2%; p>0.05). Conclusions. Sequential administration of Mexidol as part of comprehensive therapy in elderly patients with chronic cerebral ischemia led to greater improvements in cognitive status, speed and efficiency of mental performance, cognitive control, and mental resilience than standard therapy alone. These findings indicate pro-cognitive and neuroprotective effects of Mexidol.