Vascular dementia (VaD) is associated with a large amount of heterogeneity, as it groups together a broad category of patients in whom various manifestations of cognitive decline are attributed to cerebrovascular or cardiovascular disease. Thus, a study was designed to determine the effects of rivastigmine on cognitive function, global daily living performance, and behavioral disorders in VaD patients versus an active control (nimodipine), stratifying patients according to the type of VaD, subcortical vascular dementia (sVAD), and multi-infarct dementia (MID). The trial was a prospective study. This study shows that long-term treatment with rivastigmine, at dosages approved for therapeutic use in Alzheimer's disease, produces significant improvement in all behavioral symptoms in 2 forms of VaD, MID and sVaD, except delusions. It also suggests that rivastigmine may enable a reduction in concomitant neuroleptics and benzodiazepines in VaD, especially in MID. The results are discussed with an overview of the literature.
Román GC, Tatemichi TK, Erkinjuntti T., et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology . 1993;43:250-260.
2.
Chui HC, Victoroff JI, Margolin D., Jaqust W., Shankle R., Katzman R.Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers . Neurology. 1992;42:473-480.
3.
American Psychiatric Association.American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association; 1994.
4.
Erkinjuntti T.Vascular dementia: challenge of clinical diagnosis . Int Psychogeriatr. 1997;9:77-83.
5.
Cummings JLFronto-subcortical circuits and human behaviour. Arch Neurol . 1993;50:873-880.
6.
Moretti R., Torre P., Antonello RM, Vilotti C., Pizzolato G.New treatment options for vascular dementia. Aging Health . 2007;3:209-222.
7.
McPherson SE , Cummings JLNeurospychological aspects of vascular dementia . Brain Cogn. 1996;31:261-282.
8.
Looi JCL , Sachdev PSDifferentiation of vascular dementia from AD on neuropsychological tests. Neurology. 1999;53:670-678.
Devanand DP , Sano M., Tang MX, et al. Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Arch Gen Psychiatry. 1996;53:175-182.
11.
Meyer JS, Rogers RL, McClintic K., Mortel KF, Lotfi J.Randomized clinical trail of daily aspirin therapy in multi-infarct dementia . A pilot study. J Am Geriatr Soc. 1989;37:549-555.
12.
Doody RS, Stevens JC, Beck C., et al. Practice parameter: management of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56: 1154-1166.
13.
Pantoni L., Rossi R., Inzitari D., et al. Efficacy and safety of nimodipine in subcortical vascular dementia: a subgroup analysis of the Scandinavian Multi-Infarct Dementia Trial. J Neurol Sci. 2000;175:124-134.
14.
López-Arrieta JBNimodepine for primary degenerative, mixed and vascular dementia. Cochrane Database Syst Rev. 2002;(3):CD00147.
15.
Roman GC, Wilkinson DG, Doody RS, Black SE, Salloway SP, Schindler RJDonepezil in vascular dementia: combined analysis of two large-scale clinical trials. Dement Geriatr Cogn Disord. 2005;20:338-344.
16.
Malouf R., Birks J.Donepezil for vascular cognitive impairment. Cochrane Database Syst Rev. 2004;(1): CD004395.
17.
Moretti R., Torre P., Antonello RM, Cazzato G., Bava A.Rivastigmine in vascular dementia. Expert Opin Pharmacother . 2004;5:1399-1410.
18.
Farlow MRUpdate on rivastigmine. Neurologist. 2003;9: 230-234.
19.
Craig D., Birks J.Rivastigmine for vascular cognitive impairment. Cochrane Database Syst Rev. 2005;(2): CD004744.
20.
Moretti R, ed. Subcortical Vascular Dementia. New York, NY: Novascience; 2006.
21.
Hughes CP, Berg L., Ganziger WL, Coben LA, Martin RLA new clinical scale for the staging of dementia. Br J Psychiatry . 1982;15:211-214.
22.
Folstein M. , Folstein S., McHugh P.Mini-Mental state. A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12: 189-198.
23.
Wechsler D.Wechsler Adult Intelligence Scale-R Manual. New York, NY : Psychological Corp; 1981 .
24.
Manos PJThe utility of the ten-point clock test as a screen for cognitive impairment in general hospital patients. Gen Hosp Psychiatry . 1997;8:469-476.
25.
Tinetti MEPerformance-oriented assessment of mobility problems in elderly patients . J Am Geriatr Soc. 1986;34: 119-126.
26.
Reisberg B., Borenstein J., Salob SP, Ferris SH, Franssen E., Georgotas A.Behavioural symptoms in Alzheimer's disease: phenomenology and treatment . J Clin Psychiatry. 1987;48(suppl):9-15.
27.
Ryden MBAggressive behaviour in persons with dementia who live in the community . Alzheimer Dis Assoc Disord. 1988;2:342-355.
28.
Yesavage JA , Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report . J Psychiatr Res. 1983;17:37-49.
29.
Conwell Y., Forbes NT, Cox C., Caine EDValidation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc. 1993 ;41:38-41.
30.
Parmalee PA , Thuras PD, Katz IR, Lawton MPValidation of the cumulative illness rating scale in a geriatric residential population . J Am Geriatr Soc. 1995;43:130-137.
31.
Assmann SF, Pocock SJ, Enos LE, Kasten LESubgroup analysis and other [mis]uses of baseline data in clinical trials . Lancet. 2000;355:1064-1069.
32.
Kock GG, Tangen CM, Jung JW, Amara IAIssues for covariance analysis of dichotomous and ordered categorical data from randomized clinical trials and non-parametric strategies for addressing them. Stat Med. 1998;17:1863-1892.
33.
Teri L., Logsdon RG, Uomoto J., McCurry SMBehavioral treatment of depression in dementia patients: a controlled clinical trial. J Gerontol B Psychol Sci Soc Sci. 1997 ;52:P159-P166.
34.
Moretti R., Torre P., Antonello RM, Cazzato G.Behavioral alterations and vascular dementia. Neurologist . 2006; 12:43-47.
35.
Finkel SIEffects of rivastigmine on behavioral and psychological symptoms of dementia in Alzheimer's disease. Clin Ther. 2004;26:980-990.
36.
Moretti R., Torre P., Antonello RM, Cazzato G., Bava A.Rivastigmine in subcortical vascular dementia: an open 22-month study. J Neurol Sci. 2002;203-204: 141-146.
37.
Venneri A., Shanks MF, Staff RT, et al. Cerebral blood flow and cognitive responses to rivastigmine treatment in Alzheimer's disease. Neuroreport. 2002;13:83-87.
