Cerebrolysin and Recovery After Stroke (CARS)

Mureșanu, Dafin F.; Heiss, Wolf‐Dieter; Hoemberg, Volker; Băjenaru, Ovidiu; Popescu, Cristian D.; Vester, Johannes; Rahlfs, Volker W.; Doppler, Edith; Meier, Dieter; Moessler, Herbert; Guekht, Alla

doi:10.1161/strokeaha.115.009416

Cited by 107 publications

(88 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Acetylcholinesterase inhibitors and memantine may have a beneficial effect on cognition in patients with mild to moderate vascular dementia in general [97], but evidence for both general improvement are limited. Cerebrolysin had a beneficial effect on global outcome, but did not assess cognition, especially in stroke patients [98]. Selective serotonin reuptake inhibitors may be associated with overall recovery after stroke even in the absence of depression [99].…”

Section: Pharmacological Interventions For Prevention Of Psdmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

Self Cite

536

411

View full text Add to dashboard Cite

Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients (‘at risk brains’) from those with better prognosis or to discriminate Alzheimer’s disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing.

show abstract

Section: Pharmacological Interventions For Prevention Of Psdmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

Self Cite

536

411

View full text Add to dashboard Cite

show abstract

“…Cerebrolysin showed a large advantage in patients with severe AIS. Sensitivity analysis detected that the Muresanu et al18 trial was the main source of heterogeneity due to the inclusion of only severe AIS patients in this trial.…”

Section: Resultsmentioning

confidence: 98%

“…Twenty articles were further excluded due to the limitation of the publication types: one protocol study, three systematic reviews, two comments, six retrospective studies, and eight reviews. Ultimately, we identified six RCTs for meta-analysis 13–18. All of the included RCTs were international multicenter trials except for two studies 16,17.…”

Section: Resultsmentioning

confidence: 99%

“…This inspiring efficacy and the wide therapy window prompted an opportunity for clinical studies. Several clinical randomized controlled trials (RCTs) have been performed to examine the effect of cerebrolysin on neurological functional recovery in AIS patients 13–18. However, these trials have had inconsistent outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…These confusing outcomes might be due to limitations in sample size, the selection of the included patients, and the therapeutic regimen. Three RCTs indicated a superiority of cerebrolysin compared with placebo in a subgroup of AIS patients with severe neurological deficits at baseline 14,17,18. Two recent RCTs applied several specific neurological outcome scales to examine the effect of cerebrolysin on motor functional recovery and observed inconsistent outcomes 17,18.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cerebrolysin for functional recovery in patients with acute ischemic stroke: a meta-analysis of randomized controlled trials

Wang¹,

Shi²,

Xu³

et al. 2017

DDDT

View full text Add to dashboard Cite

Cerebrolysin has been shown to have an inconsistent efficacy on functional recovery in patients with acute ischemic stroke (AIS). The present meta-analysis aims to evaluate the value of cerebrolysin and to explore the potential influencing factors. The main electronic databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched. The primary outcome was functional recovery at Day 90. The secondary outcomes included mortality and adverse events. A total of 1,649 patients with AIS were pooled from six randomized controlled trials (RCTs). Cerebrolysin had no significant effect on functional recovery at Day 90 compared with the effect of placebo as shown by the modified Rankin Scale response (relative risk [RR] 1.33, 95% confidence interval [CI] 0.79–2.24, P=0.28), National Institutes of Health Stroke Scale response (RR 1.03, 95% CI 0.83–1.28, P=0.77), and Barthel Index response (RR 0.95, 95% CI 0.84–1.08, P=0.44). In safety analysis, cerebrolysin did not increase the risk of adverse events (RR 0.98, 95% CI 0.88–1.09, P=0.67), risk of serious adverse events (RR 1.20, 95% CI 0.86–1.66, P=0.29), or the mortality rate (RR 0.86, 95% CI 0.57–1.31, P=0.49). In conclusion, routine administration of cerebrolysin to patients with AIS cannot be supported by the available evidence from RCTs.

show abstract