Stanowisko interdyscyplinarnego zespołu ekspertów dotyczące leczenia pacjentów z nadciśnieniem tętniczym i współistniejącymi zaburzeniami funkcji poznawczych w codziennej praktyce lekarskiej Stanowisko ekspertów
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Opublikowane:
wrz 30, 2017
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nadciśnienie tętnicze, zaburzenia poznawcze i otępienne, winpocetyna
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Abstrakt
Wzrost średniej długości życia to niewątpliwy sukces medycyny, który niesie ze sobą jednak zwiększenie liczby chorób, m.in. coraz częściej spotykamy się z zespołami otępiennymi. Jednym z podstawowych, modyfikowalnych czynników ryzyka otępienia naczyniopochodnego jest nadciśnienie tętnicze, które wywołuje zmiany w mikrokrążeniu mózgowym i przyczynia się do rozwoju zaburzeń funkcji poznawczych i otępienia. Odpowiednia, skuteczna farmakoterapia zapewnia pacjentom właściwą i długotrwałą kardio- i neuroprotekcję.
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Mamcarz , A., Mastalerz-Migas, A., Mirowska-Guzel, D., Szulc , A., Tykarski , A., & Widecka, K. (2017). Stanowisko interdyscyplinarnego zespołu ekspertów dotyczące leczenia pacjentów z nadciśnieniem tętniczym i współistniejącymi zaburzeniami funkcji poznawczych w codziennej praktyce lekarskiej . Medycyna Faktów , 10(3(36), 183-196. Pobrano z https://journalsmededu.pl/index.php/jebm/article/view/2122
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Bibliografia
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2. Tykarski A., Narkiewicz K., Gaciong Z. et al.: Zasady postępowania w nadciśnieniu tętniczym – 2015 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadciśnienie Tętnicze w Praktyce 2015; 1: 1-70.
3. Zdrojewski T., Rutkowski M., Bandosz P. et al.: Prevalence and control of cardiovascular risk factors in Poland. Assumption and objectives of the NATPOL 2011 Survey. Kardiol. Pol. 2013; 71: 381-391.
4. Zdrojewski T., Szpakowski P., Bandosz P. et al.: Arterial hypertension in Poland in 2002. J. Hum. Hypertens. 2004; 18(8): 557-562.
5. Mancia G., Fagard R., Narkiewicz K. et al.: 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 2013; 34: 2159-2219.
6. Tykarski A., Narkiewicz K., Gaciong Z. et al.: 2015 Guidelines for the management of hypertension. Arterial Hypertens. 2015; 19 (2): 53-83.
7. Drygas W., Niklas A., Piwońska A.: Multi-centre National Population Health Examination Survey (WOBASZ II study): assumptions, methods, and implementation. Kardiol. Pol. 2016; 74: 681-690.
8. Ivan C.S., Seshadri S., Beiser A. et al.: Dementia after stroke: the Framingham Study. Stroke 2004; 35: 1264-1268.
9. Wong T.Y., Klein R., Sharrett A.R. et al.: Retinal microvascular abnormalities and cognitive impairment in middle-aged persons. The Atherosclerosis Risk in Communities Study. Stroke 2002; 33: 1487-1492.
10. Vermeer S.E., Longstreth W.T. Jr, Koudstaal P.J.: Silent brain infarcts: a systematic review. Lancet Neurol. 2007; 6(7): 611-619.
11. Fang M., Feng C., Xu Y. et al.: Microbleeds and Silent Brain Infarctions Are Differently Associated with Cognitive Dysfunction in Patients with Advanced Periventricular Leukoaraiosis. Int. J. Med. Sci. 2013; 10(10): 1307-1313.
12. Prabhakaran S., Wright C.B., Yoshita M. et al.: The prevalence and determinants of subclinical brain infarction: the Northern Manhattan Study; Neurology 2008; 70(6): 425-430.
13. Sacco R.L., Adams R., Albers G. et al.: Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke 2006; 37: 577-617.
14. Baumgart M., Snyder H.M., Carrillo M.C. et al.: Summary of the evidence on modifiable risk factors for cognitive decline and dementia. A population- based perspective. Alzheimers Dement. 2015; 11: 718-726.
15. Skoog I., Lernfelt B., Landahi S. et al.: 15-year longitudinal study of blood pressure and dementia. Lancet 1996; 347(9009): 1141-1145.
16. Birns J., Morris R., Donaldson N. et al.: The effects of blood pressure reduction on cognitive function: a review of effects based on pooled data from clinical trials. J. Hypertens. 2006; 24: 1907-1914.
17. Elias P.K., Elias M.F., Robbins M.A. et al.: Blood pressure-related cognitive decline does age make a difference? Hypertension 2004; 44: 631-638.
18. Cuadra A.E., Shan Z., Sumners C. et al.: A current view of brain renin-angiotensin system: Is the (pro)renin receptor the missing link? Pharmacol. Ther. 2010; 125: 27-38.
19. Xia H., Lazartigues E.: Angiotensin-converting enzyme 2: central regular for cardiovascular function. Curr. Hypertens. Rep. 2010; 12: 170-175.
20. Wright J.W., Harding J.W.: Important role for angiotensin III and IV in the brain renin-angiotensin system. Brain Res. Rev. 1997; 25: 96-124.
21. Stragier B., DeBundel D., Sarre S. et al.: Involvement of insulin-regulated aminopeptidase in the effects of the renin-angiotensin fragment angiotensin IV: a review. Heart Fail. Rev. 2008; 13: 321-337.
22. Cesari M., Rossi G.P., Pessina A.C.: Biological properties of the angiotensin peptides other than angiotensin II: implications for hypertension and cardiovascular diseases. J. Hypertens. 2002; 20: 793-799.
23. Inaba S., Iwai M., Furuno M. et al.: Continuous activation of renin-angiotensin system impairs cognitive function in renin/angiotensinogen transgenic mice. Hypertension 2009; 53: 356-362.
24. Kolsch H., Jessen F., Freymann N. et al.: ACE I/D polymorphism is a risk factor of Alzheimer`s disease but not of vascular dementia. Neurosci. Lett. 2005; 377: 37-39.
25. Miners J.S., Ashby E., Van Helmond Z. et al.: Angiotensin-converting enzyme (ACE) levels and activity in Alzheimer`s disease, and relationship of perivascular ACE-I to cerebral amyloid angiopathy. Neuropathol. Appl. Neurobiol. 2008; 34: 181-193.
26. Savaskan E., Hock C., Olivieri G. et al.: Cortical alterations of angiotensin converting enzyme, angiotensin II and AT1 receptor in Alzheimer`s dementia. Neurobiol. Aging 2001; 22: 541-546.
27. Albiston A.L., McDowall S.G., Matsacos D. et al.: Evidence that the angiote nsin IV (AT4) receptor is the enzyme insulin-regulated aminopeptidase. J. Biol. Chem. 2001; 276: 48623-48626.
28. Yamada K., Horita T., Takayama M. et al.: Effect of a centrally active angiotensin converting enzyme inhibitor, perindopril, on cognitive performance in chronic cerebral hypo-perfusion rats. Brain Res. 2011; 1421: 110-120.
29. Yamada K., Uchida S., Takahashi S. et al.: Effect of a centrally active angiotensin-converting enzyme inhibitor, perindopril, on cognitive performance in a mouse model of Alzheimer`s disease. Brain Res. 2010; 1352: 176-186.
30. Braszko J.J.: Participation of D 1-4 dopamine receptors in the pro-cognitive effects of angiotensin IV and des-Phe 6 angiotensin IV. Neurosci. Biobehav. Rev. 2010; 34: 343-350.
31. Braszko J.J.: (+)-UH 232, a partial agonist of the D3 dopamine receptors, attenuates cognitive effects of angiotensin IV and des-Phe(6)-angiotensin IV in rats. Eur. Neuropsychopharmacol. 2010; 20: 218-225.
32. Gard P.R., Olivier G., Golding B. et al.: Assessment of biological activity of novel peptide analogues of angiotensin IV. J. Pharm. Pharmacol. 2011; 63: 565-571.
33. Gałecki P., Szulc A.: Psychiatria. Podręcznik do LEK. Edra 2018.
34. Iadecola C., Yaffe K., Biller J. et al.: Impact of Hypertension on Cognitive Function. Hypertension 2016; 68: e67-e94.
35. Perotta M., Lembo G., Carnevale D.: Hypertension and Dementia: Epidemiological and Experimental Evidence Revealing a Detrimental relationship. Int. J. Mol. Sci. 2016; 17: 347.
36. Gugała M., Łojek E., Lipczyńska-Łojkowska W. et al.: Przegląd metod neuropsychologicznych służących do diagnozy łagodnych zaburzeń poznawczych. Postępy Psychiatrii i Neurologii 2007; 16: 81-85.
37. Mosiołek A.: Metody badań funkcji poznawczych. Psychiatria 2014; 11: 215-221.
38. Raji C.A., Merrill D.A., Eyre H. et al.: Longitudinal Relationships between Caloric Expenditure and Gray Matter in the Cardiovascular Health Study. Journal of Alzheimer’s Disease 2016; 52: 719-729.
39. Rajtar A., Przewoźnik D., Bober-Płonka B. et al.: Montrealski Test do Oceny Funkcji Poznawczych (MoCA) versus Krótka Skala Oceny Stanu Umysłowego (MMSE) – porównanie skuteczności testów w wykrywaniu zaburzeń poznawczych u chorych po udarze mózgu. Geriatria 2014; 8: 5-12.
40. Bilikiewicz A., Matkowska-Białko D.: Zaburzenia funkcji poznawczych a depresja. Udar Mózgu 2004; 6: 27-37.
41. Hess N.C.L., Smart N.A.: Isometric Exercise Training for Managing Vascular risk Factors in Mild Cognitive Impairment and Alzheimer’s Disease. Frontiers in Aging Neuroscience 2017; 9: 68.
42. Długosz-Mazur E., Bojar I., Gustaw K.: Niefarmakologiczne metody postępowania u chorych z otępieniem. Medycyna Ogólna i Nauki o Zdrowiu 2013; 19: 458-462.
43. Jacka F.N., Cherubin N., Anstey K.J. et al.: Western diet is associated with a smaller hippocampus: a longitudinal investigation. BMC Medicine 2015; 13: 215.
44. Magierski R., Antczak-Domagała K., Sobów T.: Dieta jako czynnik protekcyjny otępienia. Aktualn. Neurol. 2014; 14: 167-174.
45. Kiejna A., Pacen P., Trypka E. et al.: Standardy leczenia otępień. Psychogeriatria Polska 2008; 5: 59-94.
46. Michel J.P.: Is it possible to delay or prevent age-related cognitive decline? KJFM 2016; 37: 263-266.
47. Kiss B., Karpati E.: [Mechanism of action of vinpocetine]. Acta Pharm. Hung. 1996; 66: 213-224.
48. Shibota M., Kakihana M., Nagaoka A.: [The effect of vinpocetine on the brain glucose uptake in mice]. Nihon Yakurigaku Zasshi 1982; 80: 221-224.
49. Kakihana M., Suno M., Hamajo K. et al.: [Protective effect of vinpocetine on experimental brain ischemia]. Nihon Yakurigaku Zasshi 1982; 80: 225-229.
50. Kárpáti E., Szporny L.: General and cerebral haemodynamic activity of ethyl apovincaminate. Arzneimittelforschung 1976; 26: 1908-1912.
51. Mchedlishvili G.I., Ormotsadze L.G.: The effect of ethyl apovincaminate on vasospasm of the circulatory isolated internal carotid artery in dogs. Arzneimittelforschung 1981; 31(3): 414-418.
52. van Staveren W.C., Markerink-Vanittersum M., Steinbusch H.W., De Vente J.: The effects of phosphodiesterase inhibition on cyclic GMP and cyclic AMP accumulation in the hippocampus of the rat. Brain Res. 2001; 888: 275-286.
53. Sitges M., Galvan E., Nekrassov V.: Vinpocetine blockade of sodium channels inhibits the rise in sodium and calcium induced by 4-aminopyridine in synaptosomes. Neurochem. Int. 2005; 46: 533-540.
54. Osawa M., Maruyama S.: Effects of TCV-3B (vinpocetine) on blood viscosity in ischemic cerebrovascular diseases. Ther. Hung. 1985; 33: 7-12.
55. Gabryel B., Adamek M., Pudełko A. et al.: Piracetam and vinpocetine exert cytoprotective activity and prevent apoptosis of astrocytes in vitro in hypoxia and reoxygenation. Neurotoxicology 2002; 23: 19-31.
56. Horvath B., Marton Z., Halmosi R. et al.: In vitro antioxidant properties of pentoxifylline, piracetam, and vinpocetine. Clin. Neuropharmacol. 2002; 25: 37-42.
57. Tárnok K., Kiss E., Luiten P.G. et al.: Effects of vinpocetine on mitochondrial function and neuroprotection in primary cortical neurons. Neurochem. Int. 2008; 53: 289-295.
58. Jeon K.I., Xu X., Aizawa T. et al.: Vinpocetine inhibits NF-kappaB-dependent inflammation via an IKK-dependent but PDE-independent mechanism. Proc. Natl. Acad. Sci. USA 2010; 107: 9795-9800.
59. Wu L.R., Liu L., Xiong X.Y. et al.: Vinpocetine alleviate cerebral ischemia/reperfusion injury by down-regulating TLR4/MyD88/NF-κB signaling. Oncotarget 2017; 8: 80315-80324.
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2. Tykarski A., Narkiewicz K., Gaciong Z. et al.: Zasady postępowania w nadciśnieniu tętniczym – 2015 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadciśnienie Tętnicze w Praktyce 2015; 1: 1-70.
3. Zdrojewski T., Rutkowski M., Bandosz P. et al.: Prevalence and control of cardiovascular risk factors in Poland. Assumption and objectives of the NATPOL 2011 Survey. Kardiol. Pol. 2013; 71: 381-391.
4. Zdrojewski T., Szpakowski P., Bandosz P. et al.: Arterial hypertension in Poland in 2002. J. Hum. Hypertens. 2004; 18(8): 557-562.
5. Mancia G., Fagard R., Narkiewicz K. et al.: 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 2013; 34: 2159-2219.
6. Tykarski A., Narkiewicz K., Gaciong Z. et al.: 2015 Guidelines for the management of hypertension. Arterial Hypertens. 2015; 19 (2): 53-83.
7. Drygas W., Niklas A., Piwońska A.: Multi-centre National Population Health Examination Survey (WOBASZ II study): assumptions, methods, and implementation. Kardiol. Pol. 2016; 74: 681-690.
8. Ivan C.S., Seshadri S., Beiser A. et al.: Dementia after stroke: the Framingham Study. Stroke 2004; 35: 1264-1268.
9. Wong T.Y., Klein R., Sharrett A.R. et al.: Retinal microvascular abnormalities and cognitive impairment in middle-aged persons. The Atherosclerosis Risk in Communities Study. Stroke 2002; 33: 1487-1492.
10. Vermeer S.E., Longstreth W.T. Jr, Koudstaal P.J.: Silent brain infarcts: a systematic review. Lancet Neurol. 2007; 6(7): 611-619.
11. Fang M., Feng C., Xu Y. et al.: Microbleeds and Silent Brain Infarctions Are Differently Associated with Cognitive Dysfunction in Patients with Advanced Periventricular Leukoaraiosis. Int. J. Med. Sci. 2013; 10(10): 1307-1313.
12. Prabhakaran S., Wright C.B., Yoshita M. et al.: The prevalence and determinants of subclinical brain infarction: the Northern Manhattan Study; Neurology 2008; 70(6): 425-430.
13. Sacco R.L., Adams R., Albers G. et al.: Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke 2006; 37: 577-617.
14. Baumgart M., Snyder H.M., Carrillo M.C. et al.: Summary of the evidence on modifiable risk factors for cognitive decline and dementia. A population- based perspective. Alzheimers Dement. 2015; 11: 718-726.
15. Skoog I., Lernfelt B., Landahi S. et al.: 15-year longitudinal study of blood pressure and dementia. Lancet 1996; 347(9009): 1141-1145.
16. Birns J., Morris R., Donaldson N. et al.: The effects of blood pressure reduction on cognitive function: a review of effects based on pooled data from clinical trials. J. Hypertens. 2006; 24: 1907-1914.
17. Elias P.K., Elias M.F., Robbins M.A. et al.: Blood pressure-related cognitive decline does age make a difference? Hypertension 2004; 44: 631-638.
18. Cuadra A.E., Shan Z., Sumners C. et al.: A current view of brain renin-angiotensin system: Is the (pro)renin receptor the missing link? Pharmacol. Ther. 2010; 125: 27-38.
19. Xia H., Lazartigues E.: Angiotensin-converting enzyme 2: central regular for cardiovascular function. Curr. Hypertens. Rep. 2010; 12: 170-175.
20. Wright J.W., Harding J.W.: Important role for angiotensin III and IV in the brain renin-angiotensin system. Brain Res. Rev. 1997; 25: 96-124.
21. Stragier B., DeBundel D., Sarre S. et al.: Involvement of insulin-regulated aminopeptidase in the effects of the renin-angiotensin fragment angiotensin IV: a review. Heart Fail. Rev. 2008; 13: 321-337.
22. Cesari M., Rossi G.P., Pessina A.C.: Biological properties of the angiotensin peptides other than angiotensin II: implications for hypertension and cardiovascular diseases. J. Hypertens. 2002; 20: 793-799.
23. Inaba S., Iwai M., Furuno M. et al.: Continuous activation of renin-angiotensin system impairs cognitive function in renin/angiotensinogen transgenic mice. Hypertension 2009; 53: 356-362.
24. Kolsch H., Jessen F., Freymann N. et al.: ACE I/D polymorphism is a risk factor of Alzheimer`s disease but not of vascular dementia. Neurosci. Lett. 2005; 377: 37-39.
25. Miners J.S., Ashby E., Van Helmond Z. et al.: Angiotensin-converting enzyme (ACE) levels and activity in Alzheimer`s disease, and relationship of perivascular ACE-I to cerebral amyloid angiopathy. Neuropathol. Appl. Neurobiol. 2008; 34: 181-193.
26. Savaskan E., Hock C., Olivieri G. et al.: Cortical alterations of angiotensin converting enzyme, angiotensin II and AT1 receptor in Alzheimer`s dementia. Neurobiol. Aging 2001; 22: 541-546.
27. Albiston A.L., McDowall S.G., Matsacos D. et al.: Evidence that the angiote nsin IV (AT4) receptor is the enzyme insulin-regulated aminopeptidase. J. Biol. Chem. 2001; 276: 48623-48626.
28. Yamada K., Horita T., Takayama M. et al.: Effect of a centrally active angiotensin converting enzyme inhibitor, perindopril, on cognitive performance in chronic cerebral hypo-perfusion rats. Brain Res. 2011; 1421: 110-120.
29. Yamada K., Uchida S., Takahashi S. et al.: Effect of a centrally active angiotensin-converting enzyme inhibitor, perindopril, on cognitive performance in a mouse model of Alzheimer`s disease. Brain Res. 2010; 1352: 176-186.
30. Braszko J.J.: Participation of D 1-4 dopamine receptors in the pro-cognitive effects of angiotensin IV and des-Phe 6 angiotensin IV. Neurosci. Biobehav. Rev. 2010; 34: 343-350.
31. Braszko J.J.: (+)-UH 232, a partial agonist of the D3 dopamine receptors, attenuates cognitive effects of angiotensin IV and des-Phe(6)-angiotensin IV in rats. Eur. Neuropsychopharmacol. 2010; 20: 218-225.
32. Gard P.R., Olivier G., Golding B. et al.: Assessment of biological activity of novel peptide analogues of angiotensin IV. J. Pharm. Pharmacol. 2011; 63: 565-571.
33. Gałecki P., Szulc A.: Psychiatria. Podręcznik do LEK. Edra 2018.
34. Iadecola C., Yaffe K., Biller J. et al.: Impact of Hypertension on Cognitive Function. Hypertension 2016; 68: e67-e94.
35. Perotta M., Lembo G., Carnevale D.: Hypertension and Dementia: Epidemiological and Experimental Evidence Revealing a Detrimental relationship. Int. J. Mol. Sci. 2016; 17: 347.
36. Gugała M., Łojek E., Lipczyńska-Łojkowska W. et al.: Przegląd metod neuropsychologicznych służących do diagnozy łagodnych zaburzeń poznawczych. Postępy Psychiatrii i Neurologii 2007; 16: 81-85.
37. Mosiołek A.: Metody badań funkcji poznawczych. Psychiatria 2014; 11: 215-221.
38. Raji C.A., Merrill D.A., Eyre H. et al.: Longitudinal Relationships between Caloric Expenditure and Gray Matter in the Cardiovascular Health Study. Journal of Alzheimer’s Disease 2016; 52: 719-729.
39. Rajtar A., Przewoźnik D., Bober-Płonka B. et al.: Montrealski Test do Oceny Funkcji Poznawczych (MoCA) versus Krótka Skala Oceny Stanu Umysłowego (MMSE) – porównanie skuteczności testów w wykrywaniu zaburzeń poznawczych u chorych po udarze mózgu. Geriatria 2014; 8: 5-12.
40. Bilikiewicz A., Matkowska-Białko D.: Zaburzenia funkcji poznawczych a depresja. Udar Mózgu 2004; 6: 27-37.
41. Hess N.C.L., Smart N.A.: Isometric Exercise Training for Managing Vascular risk Factors in Mild Cognitive Impairment and Alzheimer’s Disease. Frontiers in Aging Neuroscience 2017; 9: 68.
42. Długosz-Mazur E., Bojar I., Gustaw K.: Niefarmakologiczne metody postępowania u chorych z otępieniem. Medycyna Ogólna i Nauki o Zdrowiu 2013; 19: 458-462.
43. Jacka F.N., Cherubin N., Anstey K.J. et al.: Western diet is associated with a smaller hippocampus: a longitudinal investigation. BMC Medicine 2015; 13: 215.
44. Magierski R., Antczak-Domagała K., Sobów T.: Dieta jako czynnik protekcyjny otępienia. Aktualn. Neurol. 2014; 14: 167-174.
45. Kiejna A., Pacen P., Trypka E. et al.: Standardy leczenia otępień. Psychogeriatria Polska 2008; 5: 59-94.
46. Michel J.P.: Is it possible to delay or prevent age-related cognitive decline? KJFM 2016; 37: 263-266.
47. Kiss B., Karpati E.: [Mechanism of action of vinpocetine]. Acta Pharm. Hung. 1996; 66: 213-224.
48. Shibota M., Kakihana M., Nagaoka A.: [The effect of vinpocetine on the brain glucose uptake in mice]. Nihon Yakurigaku Zasshi 1982; 80: 221-224.
49. Kakihana M., Suno M., Hamajo K. et al.: [Protective effect of vinpocetine on experimental brain ischemia]. Nihon Yakurigaku Zasshi 1982; 80: 225-229.
50. Kárpáti E., Szporny L.: General and cerebral haemodynamic activity of ethyl apovincaminate. Arzneimittelforschung 1976; 26: 1908-1912.
51. Mchedlishvili G.I., Ormotsadze L.G.: The effect of ethyl apovincaminate on vasospasm of the circulatory isolated internal carotid artery in dogs. Arzneimittelforschung 1981; 31(3): 414-418.
52. van Staveren W.C., Markerink-Vanittersum M., Steinbusch H.W., De Vente J.: The effects of phosphodiesterase inhibition on cyclic GMP and cyclic AMP accumulation in the hippocampus of the rat. Brain Res. 2001; 888: 275-286.
53. Sitges M., Galvan E., Nekrassov V.: Vinpocetine blockade of sodium channels inhibits the rise in sodium and calcium induced by 4-aminopyridine in synaptosomes. Neurochem. Int. 2005; 46: 533-540.
54. Osawa M., Maruyama S.: Effects of TCV-3B (vinpocetine) on blood viscosity in ischemic cerebrovascular diseases. Ther. Hung. 1985; 33: 7-12.
55. Gabryel B., Adamek M., Pudełko A. et al.: Piracetam and vinpocetine exert cytoprotective activity and prevent apoptosis of astrocytes in vitro in hypoxia and reoxygenation. Neurotoxicology 2002; 23: 19-31.
56. Horvath B., Marton Z., Halmosi R. et al.: In vitro antioxidant properties of pentoxifylline, piracetam, and vinpocetine. Clin. Neuropharmacol. 2002; 25: 37-42.
57. Tárnok K., Kiss E., Luiten P.G. et al.: Effects of vinpocetine on mitochondrial function and neuroprotection in primary cortical neurons. Neurochem. Int. 2008; 53: 289-295.
58. Jeon K.I., Xu X., Aizawa T. et al.: Vinpocetine inhibits NF-kappaB-dependent inflammation via an IKK-dependent but PDE-independent mechanism. Proc. Natl. Acad. Sci. USA 2010; 107: 9795-9800.
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