Abstract
In Western countries, vascular dementia (VaD) is the most common form of cognitive
deterioration after Alzheimer’s disease. Therapeutic trials in VaD have so far failed
to yield satisfactory results. One explanation of this failure may be the etiological
and clinical heterogeneity of the included patients. Patients with subcortical VaD,
defined on a clinical and radiological basis, may constitute a more homogeneous group.
Thus, we conducted a post-hoc subgroup analysis of the Scandinavian Multi-Infarct
Dementia Trial that evaluated the efficacy and safety of oral nimodipine administered
for 6 months in 259 patients. The original patients sample was divided on the basis
of head CT in those with subcortical VaD (n=92, 45 nimodipine, 47 placebo) and those with multi-infarct dementia (n=167, 83 nimodipine, 84 placebo). While in the total trial population a treatment
effect could not be proved, in this subgroup analysis, the subcortical VaD patients
treated with nimodipine performed better on the majority of neuropsychological tests
and functional scales in comparison with patients on placebo. No trend could be evidenced
in the multi-infarct dementia patients. Treatment efficacy was in particular suggested
for the Zahlen-Verbindungs-Test, Fuld-Object-Memory Evaluation, Word Fluency, and
for the Instrumental Activities of Daily Living scale. The results did not reach statistical
significance in this small sample. Our study preliminarily indicates that nimodipine
could be effective in patients with small vessel subcortical VaD and supports the
rationale for a further controlled and adequately powered trial to test nimodipine
in patients with subcortical VaD.
Keywords
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Article info
Publication history
Accepted:
February 28,
2000
Received in revised form:
February 25,
2000
Received:
July 20,
1999
Identification
Copyright
© 2000 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
