A randomized controlled trial of rivastigmine in patients with cognitive impairment no dementia because of cerebrovascular disease

Narasimhalu, Kaavya; Effendy, Shufrie; Sim, Christopher; Lee, J. M.; Chen, I.; Hia, S. B.; Xue, Huiping; Corrales, Marilyn; Chang, Hsin-Te; Wong, Michael; Chen, C. P.; Tan, Eng‐King

doi:10.1111/j.1600-0404.2009.01263.x

Cited by 65 publications

(40 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11,38 Neither of those reviews found any significant improvements in cognition, and both reviews found significantly more harms associated with these agents. The most recent Cochrane review included 9 studies, 11 3 of which were excluded from our review because they included mixed patient populations with vascular dementia 39,40 or did not include our outcomes of interest. 41 Conversely, we included 3 studies that were not included in the recent Cochrane review.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis

Tricco

Soobiah

Berliner

et al. 2013

CMAJ

180

117

View full text Add to dashboard Cite

O lder adults experiencing memory and cognition deficits without substantial limitations in activities of daily living may be given a diagnosis of mild cognitive impairment.1 These patients often present with subjective memory loss, impairment of cognitive function and no change in their basic daily functioning. Mild cognitive impairment has recently been recognized as a distinct condition, with a prevalence that ranges from 3% to 42% and increases with age.2 Because of the growing proportion of older adults worldwide, the prevalence of this condition will only increase in the future.3 Each year, 3%-17% of people with mild cognitive impairment experience progression to dementia, 4-6 a rate that increases to between 11% and 33% by 2 years after the initial diagnosis.7 More than 4.6 million new cases of dementia are diagnosed each year, 3 and efforts to reduce this public health burden are essential. Strategies to delay the progression of mild cognitive impairment are being sought to meet this challenge.One strategy that has been hypothesized to delay the progression from mild cognitive impairment to dementia is the use of cognitive enhancers, agents that are often used to treat dementia. These medications include cholinesterase inhibitors (e.g., donepezil, rivastigmine and galantamine) and the N-methyl-d-aspartic acid receptor antagonist memantine.8 donepezil, rivastigmine and galantamine increase the concentration of acetylcholine at neurotransmitter sites, 9 enhancing the brain's cholinergic function. Galantamine also influences activity at nicotinic receptors, 9 whereas memantine modulates the neurotransmitter glutamate. We conducted a systematic review to examine the efficacy and safety of cognitive enhancers for mild cognitive impairment.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis

Tricco

Soobiah

Berliner

et al. 2013

CMAJ

180

117

View full text Add to dashboard Cite

show abstract

“…135 The benefits of memantine and rivastigmine in vascular cognitive impairment are less well established. [137][138][139][140] A treatment-responsive form of nonhemorrhagic CAA is spontaneous CAA-related vascular inflammation. The CAA-related inflammation occurs in a distinct subgroup of patients with CAA in response to the vascular A deposits and is characterized by diffuse WMH on brain MRI attributed to vasogenic edema, seizures, and cognitive decline.…”

Section: Treatmentmentioning

confidence: 99%

Ischemic brain injury in cerebral amyloid angiopathy

Reijmer

Veluw

Greenberg

2015

J Cereb Blood Flow Metab

124

102

View full text Add to dashboard Cite

Cerebral amyloid angiopathy (CAA) is a common form of cerebral small vessel disease and an important risk factor for intracerebral hemorrhage and cognitive impairment. While the majority of research has focused on the hemorrhagic manifestation of CAA, its ischemic manifestations appear to have substantial clinical relevance as well. Findings from imaging and pathologic studies indicate that ischemic lesions are common in CAA, including white-matter hyperintensities, microinfarcts, and microstructural tissue abnormalities as detected with diffusion tensor imaging. Furthermore, imaging markers of ischemic disease show a robust association with cognition, independent of age, hemorrhagic lesions, and traditional vascular risk factors. Widespread ischemic tissue injury may affect cognition by disrupting white-matter connectivity, thereby hampering communication between brain regions. Challenges are to identify imaging markers that are able to capture widespread microvascular lesion burden in vivo and to further unravel the etiology of ischemic tissue injury by linking structural magnetic resonance imaging (MRI) abnormalities to their underlying pathophysiology and histopathology. A better understanding of the underlying mechanisms of ischemic brain injury in CAA will be a key step toward new interventions to improve long-term cognitive outcomes for patients with CAA.

show abstract

“…105 Thus, AChEI have been shown to be effective and safe for the treatment of cognitive symptoms in vascular dementia. However, no AChEI has been licensed for the treatment of vascular dementia due to concerns as to the aetiological heterogeneity of patients included in the trials as well as lack of consistent effects on domains other than cognition.…”

mentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

View full text Add to dashboard Cite

Level Type of Evidence + +High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. +Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. -Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + +High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, e.g. case reports, case series 4 Expert opinion Levels of evidence and grades of recommendation Statement of IntentThese guidelines are not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatment options available. ForewordDementia represents a major public health concern in Singapore and worldwide. Being the most prevalent neurodegenerative disease, dementia is expected to affect 55,000 patients in Singapore by the year 2020. The commonest cause of dementia is Alzheimer's disease with vascular dementia being the next most important cause. Right from the stage of mild dementia up to the stages of severe dementia, this condition poses a significant health and socio-economic burden to patients, caregivers and the nation as a whole. Early diagnosis will allow appropriate use of pharmacological and non-pharmacological management. Along with disease stabilization, efforts to address caregiver burden, patient safety and medico legal concerns should form the principles of management. Clear practise guidelines will allow holistic and optimal care in dementia.I am pleased to present the revised clinical practise guidelines for dementia. In this regard the workgroup has performed a thorough review of the existing literature to recommend both pharmacological and nonpharmacological aspects of management for patients ranging from mild cognitive impairment to severe dementia. This revised guidelines also highlights issues related to the management of mild cognitive impairment, young onset dementia and e...

show abstract

A randomized controlled trial of rivastigmine in patients with cognitive impairment no dementia because of cerebrovascular disease

Cited by 65 publications

References 20 publications

Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis

Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis

Ischemic brain injury in cerebral amyloid angiopathy

Systematic review of recent dementia practice guidelines

Contact Info

Product

Resources

About