Pentoxifylline in Cerebrovascular Dementia

Black, Ronald S.; Barclay, Laurie; Nolan, Karen; Thaler, Howard T.; Hardiman, S. T.; Blass, John P.

doi:10.1111/j.1532-5415.1992.tb02075.x

Cited by 73 publications

(32 citation statements)

References 35 publications

(48 reference statements)

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“…Several studies have investigated the use of pentoxifylline, which has been approved for use in peripheral vascular disease (intermittent claudication) and is reported to have a 'hemorheological' mode of action, i.e. it is thought to affect the microcirculation, increasing capillary blood flow and thereby improving tissue oxygenation [22,23]. These studies suggested that the treatment may be beneficial but the differences between patients receiving treatment and those given the placebo were small and often not statistically significant.…”

Section: Curative Treatmentmentioning

confidence: 99%

Is It Possible to Treat Vascular Dementia?

Zekry¹

2009

Dementia in Clinical Practice

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Randomized controlled trials of primary and secondary prevention of vascular dementia demonstrate real effects on the cause or progression of disease (disease-modifying treatment). These strategies lead to a reduction in all cerebrovascular risk factors, in particular hypertension. Such treatment may prevent dementia by reducing stroke and possibly by other mechanisms that remain undetermined, such as those involved in neurodegeneration and cell death. Curative treatment of vascular dementia, particularly given recent studies on cholinesterase inhibitors (rivastigmine, donepezil and galantamine) and memantine, is still ineffective. There is insufficient evidence to support widespread use of these drugs in vascular dementia. Particular considerations should be taken into account in clinical trials. Vascular dementia is a heterogeneous disease with different subtypes and mechanisms. Therefore, well-designed, adequately powered trials accounting for this heterogeneity, with better clinical definitions and an assessment and detection of cognitive and global changes specific to vascular dementia, are needed.

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Section: Curative Treatmentmentioning

confidence: 99%

Is It Possible to Treat Vascular Dementia?

Zekry¹

2009

Dementia in Clinical Practice

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“…• Métodos de neuroimagem (TC, RM -volume lesional, número e topografia das lesões, gravidade de leucoaraiose, grau de atrofia e dilatação ventricular) 7,9,20,76 • Eletrofisiológicos (EEG espectral, coerência eletrencefalográfica, eletro-oculografia, análise do ciclo sonovigília, potenciais cognitivos, potenciais motores) 1,19,23,35,44,45,48,67,72,76 • Bioquímicos e hormonais (interleucina-1, histamina, fator de necrose tissular, complexos imunes circulantes, alfa-1-antitripsina e alfa-2-macroglobulina, GH, PRL, androsterona, cortisol urinário; CRH, neuropeptídeos, endotelina-1 e colinesterase no LCR) 5,[11][12][13][14]37,47,57,58,71,82 • Neuropsicológicos (vários conjuntos de testes, baterias de testes, escalas de gravidade de demê-ncia) 6,8,26,35,53,59,60,67,68,79 • Provas funcionais (SPECT, PET, espectroscopia por RM) 10,20,21,49,50,81…”

Section: Tabela 1 Métodos Complementares Utilizados Em Estudos Recenunclassified

“…Um número muito pequeno de pacientes é habitualmente estudado, com divisões em subgrupos que tornam ainda mais difícil a interpretação dos resultados (p.ex. pentoxifilina 6 , citidina 29 , CDP-colina 13 , bifemelane 72 ). Como mencionado, uma miríade de métodos de avaliação de eficácia é utilizada, tornando difícil a comparação de diversas intervenções.…”

Section: Tratamento Medicamentoso Da Dvaunclassified

Demência vascular: dificuldades diagnósticas e tratamento

André

1998

Arq. Neuro-Psiquiatr.

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RESUMO -Justificativa: O tratamento dos pacientes com síndrome demencial depende do diagnóstico correto de sua etiologia e da utilização de critérios objetivos de avaliação do curso da doença. O diagnóstico preciso da demência vascular (Dva) é difícil e nossos conhecimentos sobre a organização neuropsicológica do cérebro em estados de doença e a evolução da doença são precários, tornando penosa a avaliação das respostas a diferentes intervenções. Métodos: São discutidos os critérios diagnósticos, os instrumentos de avaliação do curso da Dva e as diferentes intervenções terapêuticas atualmente em estudo. Resultados: O uso de critérios diagnósticos estritos e a otimização dos métodos de avaliação evolutiva são passos importantes para otimizar o tratamento dos pacientes com DVa. A prevenção de novos eventos cerebrovasculares é a única medida comprovadamente eficaz para promover estabilização e talvez regressão das alterações cognitivas e comportamentais nestes pacientes. As evidências de possível benefício de estimulantes inespecíficos do metabolismo cerebral e de drogas neuroprotetoras não são suficientes para indicar seu uso rotineiro. Medidas de estruturação do ambiente, o uso racional e parcimonioso de medicamentos em geral, e a definição através de testes neuropsicológicos de rotas terapêuticas adaptadas às necessidades de cada paciente são também importantes. Conclusões: Critérios diagnósticos e de acompanhamento evolutivo da DVa são ainda inadequados. A prevenção de novos episódios cerebrovasculares é a base do tratamento dos pacientes com DVa. O uso criterioso de drogas psiquiátricas, uma abordagem neurocognitiva dirigida aos déficits de cada paciente e a estruturação do ambiente para reduzir demandas desnecessárias e cansaço são importantes medidas complementares, mas deixam grande margem para otimização do tratamento. PALAVRAS-CHAVE: Isquemia cerebral, prevenção e controle; demência vascular, diagnóstico; demência vascular, reabilitação; demência vascular, tratamento medicamentoso. Vascular dementia: a critical review of diagnosis and treatmentABSTRACT -Background: Treatment of vascular dementia depends on accurate diagnosis and criteria for evaluation of therapeutic responses that are not well standardized. Methods: Diagnostic criteria for vascular dementia, tools for the assessment of its clinical course and current treatment options are sequentially reviewed. Results: Strict diagnostic criteria with high specificity should be selected in clinical trials. Tools for sequential assessment are not standardized. Clinical endpoints of real value for patients and caregivers are usually excluded from analysis. Prevention of recurrent cerebrovascular events is the only known treatment for stabilization and eventually recovery of cognitive and behaviour disturbances. Benefit may be obtained by adapting hospital or home environment and introducing daily routines minimizing stress and fatigue. The use of non-specific cerebral stimulants and so-called neuroprotective drugs is controversial. Careful neuropsychologic...

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“…169 It has been widely used in the treatment of intermittent claudication and it has also been claimed to slow the progression of vascular dementia. 170 Pentoxifylline has also been marketed and used as a treatment for acute stroke in several countries, although its efficacy and safety in this situation have never been established. 169,171 Many other treaments with potential but inadequately evaluated neuroprotective actions are widely used in some countries.…”

Section: Other Potential Neuroprotective Drugsmentioning

confidence: 99%

Neuroprotection in acute ischaemic stroke. II: Clinical potential

Davis

Barer

1999

Vasc Med

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Abstract:In the 4 years since our first article, there has been considerable progress in our understanding of the pathophysiology of acute ischaemic stroke, and the results of well-conducted trials have at last begun to change everyday clinical practice. The timing of the various processes of the ischaemic cascade and the potential time windows for different interventions are better understood. Furthermore, the importance of maintaining cerebral perfusion and optimizing systemic physiological and biochemical factors in order to prevent neurological deterioration ('progressing stroke') is increasingly being realized.Numerous antithrombotic and neuroprotective drugs have been evaluated in clinical trials, and while none has shown unequivocal benefits on its own, prospects for successful intervention are still good. This will probably involve different combinations of treatments targeted on different pathophysiological stroke types, so that the management of acute stroke will offer a considerable challenge to the stroke physicians of the future.

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Pentoxifylline in Cerebrovascular Dementia

Abstract: Treatment with pentoxifylline may slow the progression of dementia in patients who meet DSM-III criteria for "multi-infarct dementia" and who also have clinical and neuroradiological evidence of cerebrovascular disease.

Cited by 73 publications

References 35 publications

Is It Possible to Treat Vascular Dementia?

Is It Possible to Treat Vascular Dementia?

Demência vascular: dificuldades diagnósticas e tratamento

Neuroprotection in acute ischaemic stroke. II: Clinical potential

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