Vascular dementia—dementia caused by multiple strokes or other cerebrovascular damage—is the second commonest form of dementia after Alzheimer’s disease (AD); furthermore, vascular factors contribute to the development of dementia in many patients with AD. The drug galantamine has been shown to offer benefit (in relation to cognition, behaviour, and in improving daily living activities) in patients with AD. Timo Erkinjuntti from Helsinki University Central Hospital, Finland, and colleagues report results from an international study which investigated the effects of galantamine in patients with a diagnosis of probable vascular dementia or AD combined with cerebrovascular disease.
Around 600 patients were randomly assigned galantamine 24 mg/day or placebo in a multicentre, 6-month trial. Primary endpoints were cognition (assessed by the AD assessment scale, cognitive subscale [ADAS-cog]) and global functioning (clinician’s interview-based impression of change plus caregiver input [CIBIC-plus]). Daily living activities and behavioural symptoms were also assessed.
After six months, patients given galantamine improved by 1.7 points on the ADAS-cog scale, whereas those on placebo deteriorated by an average of 1 point. 74% of patients given galantamine were stable according to the CIBIC-plus scale compared with 59% of patients given placebo. Activities of daily living and behavioural symptoms were also significantly improved compared with placebo.
Timo Erkinjuntti comments: “Galantamine, being equally effective in dementia due to Alzheimer’s disease and in dementia due to cerebrovascular disease, provides a treatment option to a broad range of patients for whom little pharmacological help has been available. We found that galantamine provides an effective symptomatic treatment for patients with these disorders, offering a range of therapeutic effects that will give important benefits to patients with dementia.”
In an accompanying Commentary (p 1265), Lon Schneider from University of Southern California Keck School of Medicine, USA, concludes: “Before recommending galantamine or other cholinesterase inhibitors for clinical use in vascular dementia, several concerns need to be addressed. Above all there need to be confirmatory trials that are adequately powered to detect both cognitive and global change, and to allow secondary analyses. Trials need to be designed to account for the substantial clinical and biological heterogeneity in vascular dementia.”
Contact: Dr Timo Erkinjuntti, Memory Research Unit, Department of Clinical Neurosciences, Helsinki University Central Hospital, PO Box 300, 00290 HYKS Helsinki, Finland; T) +358 9471 72353; F) +358 9471 75447; E) timo.erkinjuntti@hus.fi
Dr Lon S Schneider, Department of Psychiatry, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA; E) lschneid@usc.edu
Journal
The Lancet