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Yoo C, Maury J, Gonzalez DE, Ko J, Xing D, Jenkins V, Dickerson B, Leonard M, Estes L, Johnson S, Chun J, Broeckel J, Pradelles R, Sowinski R, Rasmussen CJ, Kreider RB. Effects of Supplementation with a Microalgae Extract from Phaeodactylum tricornutum Containing Fucoxanthin on Cognition and Markers of Health in Older Individuals with Perceptions of Cognitive Decline. Nutrients 2024; 16:2999. [PMID: 39275314 PMCID: PMC11397347 DOI: 10.3390/nu16172999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
Phaeodactylum tricornutum (PT) is a microalgae extract that contains fucoxanthin and has been shown to enhance cognitive function in younger populations. The present study assessed if PT supplementation affects cognition in healthy, young-old, physically active adults with self-perceptions of cognitive and memory decline. METHODS Forty-three males and females (64.3 ± 6.0 years, 79.8 ± 16.0 kg, 27.0 ± 4.0 kg/m2) with perceptions of cognitive and memory decline completed the double-blind, randomized, parallel-arm, placebo-controlled intervention clinical trial. Participants were counterbalanced by sex and BMI and randomly allocated to their respective 12-week supplementation interventions, which were either the placebo (PL) or 1100 mg/day of PT containing 8.8 mg of fucoxanthin (FX). Fasting blood samples were collected, and cognitive assessments were performed during the testing session at 0, 4, and 12 weeks of intervention. The data were analyzed by multivariate and univariate general linear model (GLM) analyses with repeated measures, pairwise comparisons, and mean changes from baseline analysis with 95% confidence intervals (CIs) to assess the clinical significance of the findings. RESULTS FX supplementation significantly affected (p < 0.05) or exhibited tendencies toward significance (p > 0.05 to p < 0.10 with effect sizes ranging from medium to large) for word recall, picture recognition reaction time, Stroop color-word test, choice reaction time, and digit vigilance test variables. Additionally, FX supplementation promoted a more consistent clinical improvement from baseline values when examining mean changes with 95% CIs, although most differences were seen over time rather than between groups. CONCLUSIONS The results demonstrate some evidence that FX supplementation can improve working and secondary memory, vigilance, attention, accuracy, and executive function. There was also evidence that FX promoted more positive effects on insulin sensitivity and perceptions about sleep quality with no negative effects on clinical blood panels or perceived side effects. Additional research should investigate how FX may affect cognition in individuals perceiving memory and cognitive decline. Registered clinical trial #NCT05759910.
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Affiliation(s)
- Choongsung Yoo
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Jonathan Maury
- Research & Development Department, Microphyt, 34670 Baillargues, France; (J.M.); (R.P.)
| | - Drew E. Gonzalez
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Joungbo Ko
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Dante Xing
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Victoria Jenkins
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Broderick Dickerson
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Megan Leonard
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Landry Estes
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Sarah Johnson
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Jisun Chun
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Jacob Broeckel
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Rémi Pradelles
- Research & Development Department, Microphyt, 34670 Baillargues, France; (J.M.); (R.P.)
| | - Ryan Sowinski
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Christopher J. Rasmussen
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
| | - Richard B. Kreider
- Exercise & Sport Nutrition Lab., Department of Kinesiology and Sports Management, Texas A&M University, College Station, TX 77843, USA; (C.Y.); (D.E.G.); (J.K.); (D.X.); (V.J.); (B.D.); (M.L.); (L.E.); (S.J.); (J.C.); (J.B.); (R.S.); (C.J.R.)
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Wang Z, Han B, Qi J, Cao X, Gu H, Sun J. Chuanzhitongluo capsule improves cognitive impairment in mice with chronic cerebral hypoperfusion via the cholinergic anti-inflammatory pathway. Exp Gerontol 2024; 189:112407. [PMID: 38522309 DOI: 10.1016/j.exger.2024.112407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Vascular cognitive impairment (VCI) has become a common disease-causing cognitive deficit in humans, second only to Alzheimer's Disease (AD). Chuanzhitongluo capsule (CZTL) is a Traditional Chinese Medicine (TCM) preparation known for its effective protection against cerebral ischemia. However, its potential to ameliorate VCI remains unclear. This study aimed to investigate the cognitive improvement effects of CZTL in a mouse model of VCI. Chronic cerebral hypoperfusion (CCH) was induced in mice by bilateral common carotid artery stenosis (BCAS) to simulate the pathological changes associated with VCI. Spatial learning and memory abilities were assessed using the Morris Water Maze (MWM). RNA sequencing (RNA-Seq) was employed to identify differentially expressed genes (DEGs) in the hippocampus. Levels of inflammatory factors were measured through enzyme-linked immunosorbent assay (ELISA), while immunofluorescence (IF) determined the expression intensity of target proteins. Western Blot (WB) confirmed the final action pathway. Results indicated that CZTL significantly improved the spatial learning and memory abilities of CCH mice, along with alterations in gene expression profiles in the hippocampus. It also reduced neuroinflammation in the hippocampus and upregulated the choline acetyltransferase (ChAT) and α7 subunit-containing nicotinic acetylcholine receptor (α7nAChR), which are in synaptic plasticity and neuronal development. Moreover, CZTL inhibited the NF-κB signaling pathway. In conclusion, CZTL may alleviate neuroinflammation induced by CCH and improve cognitive impairment in CCH mice by regulating the cholinergic anti-inflammatory pathway (CAIP) involving ChAT/α7nAChR/NF-κB.
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Affiliation(s)
- Zhiyuan Wang
- Institute of Integrative Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Han
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianjiao Qi
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuelei Cao
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huali Gu
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Jinping Sun
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Cui M, You T, Zhao Y, Liu R, Guan Y, Liu J, Liu X, Wang X, Dong Q. Ginkgo biloba extract EGb 761® improves cognition and overall condition after ischemic stroke: Results from a pilot randomized trial. Front Pharmacol 2023; 14:1147860. [PMID: 37063270 PMCID: PMC10090660 DOI: 10.3389/fphar.2023.1147860] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Patients who experienced an ischemic stroke are at risk for cognitive impairment. Quantified Ginkgo biloba extract EGb 761® has been used to treat cognitive dysfunction, functional impairment and neuropsychiatric symptoms in mild cognitive impairment and dementia.Objectives: To assess the cognitive-related effects of EGb 761® treatment in patients after acute ischemic stroke, as well as the feasibility of patient selection and outcome measures.Methods: We conducted a randomized, multicentric, open-label trial at 7 centers in China. Patients scoring 20 or lower on the National Institutes of Health Stroke Scale were enrolled between 7 and 14 days after stroke onset and randomly assigned to receive 240 mg per day of EGb 761® or no additional therapy for 24 weeks in a 1:1 ratio. Both groups received standard treatments for the prevention of recurrent stroke during the trial. General cognitive function and a battery of cognitive tests for sub-domains were evaluated at 24 weeks. All patients were monitored for adverse events.Results: 201 patients ≥50 years old were included, with 100 assigned to the EGb 761® group and 101 to the reference group. The mean change from baseline on the global cognitive function as assessed by the Montreal Cognitive Assessment score was 2.92 in the EGb 761® group and 1.33 in the reference group (between-group difference: 1.59 points; 95% confidence interval [CI], 0.51 to 2.67; p < 0.005). For cognitive domains, EGb 761® showed greater effects on the Hopkins Verbal Learning Test Total Recall (EGb 761® change 1.40 vs. reference −0.49) and Form 1 of the Shape Trail Test (EGb 761® change −38.2 vs. reference −15.6). Potentially EGb 761®-related adverse events occurred in no more than 3% of patients.Conclusion: Over the 24-week period, EGb 761® treatment improved overall cognitive performance among patients with mild to moderate ischemic stroke. Our findings provide valuable recommendations for the design of future trials, including the criteria for patient selection.Clinical Trial Registration:www.isrctn.com, identifier ISRCTN11815543.
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Affiliation(s)
- Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tongyao You
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yangtai Guan
- Department of Neurology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jianren Liu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Ninth People’s Hospital, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tong Ji University Affiliated Tenth People’s Hospital, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Qiang Dong,
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Chen HY, Li MC, Liao D, Li C, Ji QM, Guo P, Su Z, Yang YH, Xiao WH, Zhai WH. The Effect of Computer-Assisted Cognitive Remediation Therapy on Cognitive Function, Social Function and Quality of Life in Patients with Vascular Dementia. J Multidiscip Healthc 2022; 15:2473-2479. [PMID: 36324875 PMCID: PMC9620993 DOI: 10.2147/jmdh.s378079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Our study aimed to investigate the effects of computer-assisted cognitive remediation therapy (CCRT) on cognitive function, social function and quality of life in patients with vascular dementia (VD). METHODS Ninety-eight patients with VD were treated with CCRT in four 45-minute sessions per week over a course of 40 sessions to exercise four cognitive functions, including flexibility, working memory, plan execution and social cognition. The Mini-Mental State Examination (MMSE), Social Disability Screening Schedule (SDSS), Personal and Social Performance Scale (PSP), and Generic Quality of Life Inventory-74 (GQOL-74) were used to assess before and after treatment. RESULTS (1) The scores of orientation (5.60 ± 1.35), calculation (2.20 ± 0.79), verbal ability (7.10 ± 0.36), spatial ability (0.78 ± 0.42), immediate memory (2.42 ± 0.53), short-term memory (1.17 ± 0.78) and MMSE (23.36 ± 2.98) were all improved after treatment (P < 0.05) compared with those before treatment; (2) The scores of SDSS, PSP and Activities of Daily Living (ADL) after treatment were 8.23 ± 0.94, 81.36 ± 14.23, and 32.7 ± 12.1, and all of which improved (P < 0.05); (3) The scores of physical health were 68.24 ± 7.44, mental health were 69.75 ± 7.15, social function were 69.08 ± 7.43, material life were 37.46 ± 4.85 and the total score were 230.79 ± 9.56, all of which improved (P < 0.05). CONCLUSION For patients with VD, CCRT can improve their cognitive function, social function, daily life ability and quality of life.
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Affiliation(s)
- Hai-Ying Chen
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Ming-Chao Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, People’s Republic of China
| | - Dan Liao
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China,Correspondence: Dan Liao; Chi Li, Department of Psychiatry, Wuhan Wudong Hospital, No. 46 of Wudong Street, Qingshan District, Wuhan, 430084, People’s Republic of China, Tel +86 27 5052 8367, Fax +86 27 8643 8247, Email
| | - Chi Li
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Qiu-Ming Ji
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Ping Guo
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Zou Su
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Yu-Hong Yang
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Wen-Hao Xiao
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Wen-Hui Zhai
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
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Tang ECH, Hung C, Lo SHS, Chau JPC, Mok VCT, Lau AYL. Acupuncture on vascular cognitive impairment associated with cerebral small vessel disease: A systematic review and meta-analysis of randomized and non-randomized controlled trials. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2021.101403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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EGb in the Treatment for Patients with VCI: A Systematic Review and Meta-Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:8787684. [PMID: 34504643 PMCID: PMC8422158 DOI: 10.1155/2021/8787684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/06/2021] [Indexed: 01/08/2023]
Abstract
Background Ginkgo biloba extract (EGb) is widely used to treat impairments in memory, cognition, activities of daily living, inflammation, edema, stroke, Alzheimer's dementia, and aging. Aim We aimed to evaluate the safety and efficacy of EGb in treating vascular cognitive impairment (VCI). Methods The systematic review was performed using the latest guidelines. We searched for EGb-related trials up to March 1, 2021, in four Chinese databases, three English databases, and clinical trial registry platforms. Randomized controlled trials (RCTs) were included if the study enrolled participants with VCI. Two reviewers independently extracted the data and critically appraised the study quality. Heterogeneity was quantified with I 2. Both sensitivity and subgroup analyses were used to identify the sources of heterogeneity. Publication bias was assessed with funnel plots. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate the evidence quality. Outcomes included assessments using the Activities of Daily Living (ADL), Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale (HDS), Barthel Index (BI), Functional Activity Questionnaire (FAQ), and adverse events. Results In this study, a total of 2019 patients in 23 RCTs were included. EGb appeared to be more effective than control conditions as assessed by the results of cognitive function evaluation, including MMSE (MDMMSE,EGb vs.blank = 3.04, 95% CI: 0.10-5.98; MDMMSE,EGb vs.drugs for VCI = 2.70, 95% CI: 1.39-4.01; MDMMSE,EGb+drugs for VCI vs.blank = 5.90, 95% CI: 4.21-7.59; and MDMMSE,EGb+drugs for VCI vs.drugs for VCI = 3.14, 95% CI: 2.14-4.15), MoCA (MDMoCA,EGb vs.blank = 5.30, 95% CI: 2.15-8.46; MDMoCA,EGb+drugs for VCI vs.blank = 2.66, 95% CI: 1.82-3.50; and MDMoCA,EGb+drugs for VCI vs.drugs for VCI = 2.56, 95% CI: 1.85-3.27), HDS (MDHDS,EGb vs.blank = 6.50; 95% CI: 4.86-8.14; MDHDS,EGb+drugs for VCI vs.drugs for VCI = 3.60, 95% CI: 2.50-4.70), ADL (MDADL,EGb vs.blank = 7.20, 95% CI: 3.28-11.12; MDADL,EGb+drugs for VCI vs.blank = 10.00, 95% CI: 7.51-12.49; and MDADL,EGb+drugs for VCI vs.drugs for VCI = 9.20, 95% CI: 7.26-11.14), BI (MDBI,EGb+drugs for VCI vs.drugs for VCI = 5.71, 95% CI: 2.99-8.43; MDFAQ,EGb vs.drugs for VCI = -1.43, 95% CI: -2.78 to 0.08), and FAQ (MDFAQ,EGb+drugs for VCI vs.drugs for VCI = -2.17, 95% CI: -4.13 to 0.21). Evidence of certainty ranged from medium certainty to very low certainty. Conclusion This meta-analysis showed that EGb may be an effective and safe treatment in improving MMSE, MOCA, ADL, and BI for VCI patients within three months of diagnosis. However, given the quality of the included RCTs, more preregistered trials are needed that explicitly examine the efficacy of EGb. This systematic review has been registered on PROSPERO, with the registration number CRD42021232967.
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Molecular Factors Mediating Neural Cell Plasticity Changes in Dementia Brain Diseases. Neural Plast 2021; 2021:8834645. [PMID: 33854544 PMCID: PMC8021472 DOI: 10.1155/2021/8834645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022] Open
Abstract
Neural plasticity-the ability to alter a neuronal response to environmental stimuli-is an important factor in learning and memory. Short-term synaptic plasticity and long-term synaptic plasticity, including long-term potentiation and long-term depression, are the most-characterized models of learning and memory at the molecular and cellular level. These processes are often disrupted by neurodegeneration-induced dementias. Alzheimer's disease (AD) accounts for 50% of cases of dementia. Vascular dementia (VaD), Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD) constitute much of the remaining cases. While vascular lesions are the principal cause of VaD, neurodegenerative processes have been established as etiological agents of many dementia diseases. Chief among such processes is the deposition of pathological protein aggregates in vivo including β-amyloid deposition in AD, the formation of neurofibrillary tangles in AD and FTD, and the accumulation of Lewy bodies composed of α-synuclein aggregates in DLB and PDD. The main symptoms of dementia are cognitive decline and memory and learning impairment. Nonetheless, accurate diagnoses of neurodegenerative diseases can be difficult due to overlapping clinical symptoms and the diverse locations of cortical lesions. Still, new neuroimaging and molecular biomarkers have improved clinicians' diagnostic capabilities in the context of dementia and may lead to the development of more effective treatments. Both genetic and environmental factors may lead to the aggregation of pathological proteins and altered levels of cytokines, such that can trigger the formation of proinflammatory immunological phenotypes. This cascade of pathological changes provides fertile ground for the development of neural plasticity disorders and dementias. Available pharmacotherapy and disease-modifying therapies currently in clinical trials may modulate synaptic plasticity to mitigate the effects neuropathological changes have on cognitive function, memory, and learning. In this article, we review the neural plasticity changes seen in common neurodegenerative diseases from pathophysiological and clinical points of view and highlight potential molecular targets of disease-modifying therapies.
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Battle CE, Abdul-Rahim AH, Shenkin SD, Hewitt J, Quinn TJ. Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: a network meta-analysis. Cochrane Database Syst Rev 2021; 2:CD013306. [PMID: 33704781 PMCID: PMC8407366 DOI: 10.1002/14651858.cd013306.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Vascular cognitive impairment (VCI) describes a broad spectrum of cognitive impairments caused by cerebrovascular disease, ranging from mild cognitive impairment to dementia. There are currently no pharmacological treatments recommended for improving either cognition or function in people with VCI. Three cholinesterase inhibitors (donepezil, galantamine, and rivastigmine) are licenced for the treatment of dementia due to Alzheimer's disease. They are thought to work by compensating for reduced cholinergic neurotransmission, which is also a feature of VCI. Through pairwise comparisons with placebo and a network meta-analysis, we sought to determine whether these medications are effective in VCI and whether there are differences between them with regard to efficacy or adverse events. OBJECTIVES (1) To assess the efficacy and safety of cholinesterase inhibitors in the treatment of adults with vascular dementia and other VCI. (2) To compare the effects of different cholinesterase inhibitors on cognition and adverse events, using network meta-analysis. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 19 August 2020. SELECTION CRITERIA We included randomised controlled trials in which donepezil, galantamine, or rivastigmine was compared with placebo or in which the drugs were compared with each other in adults with vascular dementia or other VCI (excluding cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)). We included all drug doses and routes of administration. DATA COLLECTION AND ANALYSIS Two review authors independently identified eligible trials, extracted data, assessed risk of bias, and applied the GRADE approach to assess the certainty of the evidence. The primary outcomes were cognition, clinical global impression, function (performance of activities of daily living), and adverse events. Secondary outcomes were serious adverse events, incidence of development of new dementia, behavioural disturbance, carer burden, institutionalisation, quality of life and death. For the pairwise analyses, we pooled outcome data at similar time points using random-effects methods. We also performed a network meta-analysis using Bayesian methods. MAIN RESULTS We included eight trials (4373 participants) in the review. Three trials studied donepezil 5 mg or 10 mg daily (n= 2193); three trials studied rivastigmine at a maximum daily dose of 3 to 12 mg (n= 800); and two trials studied galantamine at a maximum daily dose of 16 to 24 mg (n= 1380). The trials included participants with possible or probable vascular dementia or cognitive impairment following stroke. Mean ages were between 72.2 and 73.9 years. All of the trials were at low or unclear risk of bias in all domains, and the evidence ranged from very low to high level of certainty. For cognition, the results showed that donepezil 5 mg improves cognition slightly, although the size of the effect is unlikely to be clinically important (mean difference (MD) -0.92 Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) points (range 0 to 70), 95% confidence interval (CI) -1.44 to -0.40; high-certainty evidence). Donepezil 10 mg (MD -2.21 ADAS-Cog points, 95% CI -3.07 to -1.35; moderate-certainty evidence) and galantamine 16 to 24 mg (MD -2.01 ADAS-Cog point, 95%CI -3.18 to -0.85; moderate-certainty evidence) probably also improve cognition, although the larger effect estimates still may not be clinically important. With low certainty, there may be little to no effect of rivastigmine 3 to 12 mg daily on cognition (MD 0.03 ADAS-Cog points, 95% CI -3.04 to 3.10; low-certainty evidence). Adverse events reported in the studies included nausea and/or vomiting, diarrhoea, dizziness, headache, and hypertension. The results showed that there was probably little to no difference between donepezil 5 mg and placebo in the number of adverse events (odds ratio (OR) 1.22, 95% CI 0.94 to 1.58; moderate-certainty evidence), but there were slightly more adverse events with donepezil 10 mg than with placebo (OR 1.95, 95% CI 1.20 to 3.15; high-certainty evidence). The effect of rivastigmine 3 to 12 mg on adverse events was very uncertain (OR 3.21, 95% CI 0.36 to 28.88; very low-certainty evidence). Galantamine 16 to 24 mg is probably associated with a slight excess of adverse events over placebo (OR 1.57, 95% CI 1.02 to 2.43; moderate-certainty evidence). In the network meta-analysis (NMA), we included cognition to represent benefit, and adverse events to represent harm. All drugs ranked above placebo for cognition and below placebo for adverse events. We found donepezil 10 mg to rank first in terms of benefit, but third in terms of harms, when considering the network estimates and quality of evidence. Galantamine was ranked second in terms of both benefit and harm. Rivastigmine had the lowest ranking of the cholinesterase inhibitors in both benefit and harm NMA estimates, but this may reflect possibly inadequate doses received by some trial participants and small trial sample sizes. AUTHORS' CONCLUSIONS We found moderate- to high-certainty evidence that donepezil 5 mg, donepezil 10 mg, and galantamine have a slight beneficial effect on cognition in people with VCI, although the size of the change is unlikely to be clinically important. Donepezil 10 mg and galantamine 16 to 24 mg are probably associated with more adverse events than placebo. The evidence for rivastigmine was less certain. The data suggest that donepezil 10 mg has the greatest effect on cognition, but at the cost of adverse effects. The effect is modest, but in the absence of any other treatments, people living with VCI may still wish to consider the use of these agents. Further research into rivastigmine is needed, including the use of transdermal patches.
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Affiliation(s)
- Ceri E Battle
- Welsh Centre for Emergency Medicine Research, ABM University Health Board, Swansea, UK
| | - Azmil H Abdul-Rahim
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Susan D Shenkin
- Geriatric Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jonathan Hewitt
- 3rd Floor, Academic Building, Llandough Hospital., Cardiff University and Aneurin Bevan Health Board, Cardiff, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Park HK, Song MK, Kim JH, Han JY. A randomized controlled trial to evaluate the effectiveness and safety of electro acupuncture and transcranial direct current stimulation with computerized cognitive rehabilitation in patients with vascular cognitive impairment. Medicine (Baltimore) 2020; 99:e21263. [PMID: 32702911 PMCID: PMC7373529 DOI: 10.1097/md.0000000000021263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vascular cognitive impairment (VCI) refers to all cognitive disorders caused by cerebrovascular disorders. For the treatment, many types of pharmacologic and nonpharmacologic treatments are used but their underlying mechanisms and effects are unclear. Regarding nonpharmacologic treatment, electroacupuncture (EA), transcranial direct current stimulation (tDCS), and computerized cognitive rehabilitation treatment (CCRT) are effective. Here, we report the protocol for a randomized controlled trial of the effect and safety of combination therapy of EA or tDCS and CCRT in patients with VCI. METHODS This study will be a prospective, outcome assessor-blinded, parallel-arm, randomized controlled clinical trial. Participants with cognitive impairment caused by stroke after 3 months of onset (n = 45) will be randomly assigned to a CCRT, combination therapy with EA and computerized cognitive rehabilitation treatment, or combination therapy with tDCS and computerized cognitive rehabilitation treatment group. All groups will receive treatment 3 times per week for 8 weeks, giving a total of 24 treatments. The CCRT group will perform a training task like shopping, calculating, and others and involving computerized cognitive assessment and brain training system (RehaCom) for 30 minutes. The combination therapy with EA and computerized cognitive rehabilitation treatment group will receive EA using 8 acupuncture points - baekhoe, sinjeong, both sides of pungji, 4 sites of sishencong - and will be applied using an EA stimulator and receive CCRT for 30 minutes at the same time. The combination therapy with tDCS and computerized cognitive rehabilitation treatment group will receive tDCS treatment and receive CCRT for 30 minutes at the same time. The primary outcome will be evaluated using the Lowenstein occupational therapy cognitive assessment, while other scales assessing walking ability, activities of daily living, and quality of life are considered secondary outcome measures. Outcomes will be evaluated before intervention, at the end of intervention 8 weeks after the first intervention, and 4 weeks after completion of the intervention program. DISCUSSION This study aims to examine the effect and safety of combination therapy with EA or tDCS and CCRT in patients with VCI. This study can be useful in developing new treatment technologies using collaborative research with combined traditional Korean and conventional medicines. TRIAL REGISTRATION This trial has been registered with cris.nih.go.kr (registration number, KCT 0003644 Registered 01 April 2019, http://cris.nih.go.kr).
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Affiliation(s)
- Hyeng Kyu Park
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
| | - Min Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
| | - Jae Hong Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Dongshin University, Naju City, Republic of Korea
| | - Jae Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
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Effect and Neuroimaging Mechanism of Electroacupuncture for Vascular Cognitive Impairment No Dementia: Study Protocol for a Randomized, Assessor-Blind, Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7190495. [PMID: 32184898 PMCID: PMC7061121 DOI: 10.1155/2020/7190495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 12/18/2022]
Abstract
Vascular cognitive impairment no dementia (VCIND) is likely to develop into vascular dementia (VD) without intervention. The clinical efficacy of electroacupuncture (EA) for VCIND has been previously demonstrated. However, the neuroimaging mechanism of EA for VCIND has not been elucidated clearly. This trial is designed to provide solid evidence for the efficacy and neuroimaging mechanism of EA treatment for patients with VCIND. This ongoing study is an assessor-blind, parallel-group, randomized controlled trial. 140 eligible subjects will be recruited from the General Hospital of Ningxia Medical University and randomized into either the electroacupuncture (EA) group or the control group (CG). All subjects will receive basic treatment, and participants in the CG will receive health education performed weekly. Except for basic treatment and health education, participants in the EA group will receive treatment 5 times per week for a total of 40 sessions over 8 weeks. The primary outcome in this study is Montreal Cognitive Assessment (MoCA), and the secondary outcomes are Auditory Verbal Learning Test (AVLT), Stroop color-naming condition (STROOP), Rey–Osterrieth Complex Graphics Testing, and resting-state functional magnetic resonance imaging (rs-fMRI). All of the outcome measures will be assessed at baseline and 8 weeks of intervention. The medical abstraction of adverse events will be done at each visit. The results of this trial will demonstrate the efficacy and neuroimaging mechanism of EA treatment for VCIND, thus supporting EA treatment as an ideal choice for VCIND treatment. The trial was registered at the Chinese Clinical Trial Registry on 28 July 2018 (ChiCTR1800017398).
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Lam BYK, Mok VCT. Is vascular cognitive impairment more common in Asia? Asian J Psychiatr 2019; 43:202-204. [PMID: 29150388 DOI: 10.1016/j.ajp.2017.03.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Bonnie Yin Ka Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong Special Administrative Region
| | - Vincent Chung Tong Mok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong Special Administrative Region.
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Battle CE, Abdul‐Rahim AH, Shenkin SD, Hewitt J, Quinn TJ. Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: a network meta‐analysis. Cochrane Database Syst Rev 2019; 2019:CD013306. [PMCID: PMC6457432 DOI: 10.1002/14651858.cd013306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of each cholinesterase inhibitor in the treatment of adults with VCI To compare cholinesterase inhibitors for efficacy and safety in people with VCI
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Affiliation(s)
- Ceri E Battle
- ABM University Health BoardWelsh Centre for Emergency Medicine ResearchMorriston HospitalSwanseaUK
| | - Azmil H Abdul‐Rahim
- University of GlasgowInstitute of Neuroscience and PsychologyRoom 0.07, Ground Floor, Office BlockQueen Elizabeth University HospitalGlasgowUKG51 4TF
| | - Susan D Shenkin
- University of EdinburghGeriatric Medicine, Department of Clinical and Surgical SciencesRoyal Infirmary of Edinburgh51 Little France CrescentEdinburghUKEH16 4SB
| | - Jonathan Hewitt
- Cardiff University and Aneurin Bevan Health Board3rd Floor, Academic Building, Llandough Hospital.Penlan RoadLlandough HospitalCardiffUKCF64 2XX
| | - Terry J Quinn
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister CampusGlasgow Royal InfirmaryGlasgowUKG4 0SF
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Avrov MV, Alifirova VM, Kovalenko AV. An effect of complex therapy on cognitive impairment in patients with chronic cerebral ischemia. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:23-27. [DOI: 10.17116/jnevro201911902123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jongsiriyanyong S, Limpawattana P. Mild Cognitive Impairment in Clinical Practice: A Review Article. Am J Alzheimers Dis Other Demen 2018; 33:500-507. [PMID: 30068225 PMCID: PMC10852498 DOI: 10.1177/1533317518791401] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The spectrum of cognitive decline in the elderly ranges from what can be classified as normal cognitive decline with aging to subjective cognitive impairment to mild cognitive impairment (MCI) to dementia. This article reviewed the up-to-date evidence of MCI including the diagnostic criteria of MCI due to Alzheimer's disease, vascular cognitive impairment and MCI due to Parkinson disease, management and preventive intervention of MCI. There are various etiologies of MCI, and a large number of studies have been conducted to ascertain the practical modalities of preserving cognition in predementia stages. Lifestyle modification, such as aerobic exercise, is an approved modality to preserve cognitive ability and decrease the rate of progression to dementia, as well as being recommended for frailty prevention.
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Affiliation(s)
| | - Panita Limpawattana
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Sun MK. Potential Therapeutics for Vascular Cognitive Impairment and Dementia. Curr Neuropharmacol 2018; 16:1036-1044. [PMID: 29046153 PMCID: PMC6120112 DOI: 10.2174/1570159x15666171016164734] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As the human lifespan increases, the number of people affected by agerelated dementia is growing at an epidemic pace. Vascular pathology dramatically affects cognitive profiles, resulting in dementia and cognitive impairment. While vascular dementia itself constitutes a medical challenge, hypo-perfusion/vascular risk factors enhance amyloid toxicity and other memory- damaging factors and hasten Alzheimer's disease (AD) and other memory disorders' progression, as well as negatively affect treatment outcome. METHODS Research and online content related to vascular cognitive impairment and dementia is reviewed, specifically focusing on the potential treatment of the disorder. RESULTS Few therapeutic options are currently available to improve the prognosis of patients with vascular dementia and cognitive impairment, mixed AD dementia with vascular pathology, or other memory disorders. Emerging evidence, however, indicates that, like AD and other memory disorders, synaptic impairment underlies much of the memory impairment in the cognitive decline of vascular cognitive impairment and vascular dementia. CONCLUSION Effective rescues of the memory functions might be achieved through synaptic and memory therapeutics, targeting distinct molecular signaling pathways that support the formation of new synapses and maintaining their connections. Potential therapeutic agents include: 1) memory therapeutic agents that rescue synaptic and memory functions after the brain insults; 2) antipathologic therapeutics and an effective management of vascular risk factors; and 3) preventative therapeutic agents that achieve memory therapy through functional enhancement. These therapeutic agents are also likely to benefit patients with AD and/or other types of memory disorders.
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Affiliation(s)
- Miao-Kun Sun
- Blanchette Rockefeller Neurosciences Institute, 8 Medical Center Drive, Morgantown, West Virginia26505, USA
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16
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Guekht A, Skoog I, Edmundson S, Zakharov V, Korczyn AD. ARTEMIDA Trial (A Randomized Trial of Efficacy, 12 Months International Double-Blind Actovegin): A Randomized Controlled Trial to Assess the Efficacy of Actovegin in Poststroke Cognitive Impairment. Stroke 2017; 48:1262-1270. [PMID: 28432265 PMCID: PMC5404405 DOI: 10.1161/strokeaha.116.014321] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Poststroke cognitive impairment is a debilitating consequence of stroke. The aim of this study was to assess whether Actovegin confers cognitive benefit in patients who have had an ischemic stroke. Methods— This was a 12-month, parallel-group, randomized, multicenter, double-blind, placebo-controlled study. Eligible patients were ≥60 years of age with a Montreal Cognitive Assessment test score of ≤25 points. Patients were randomized into 2 groups within 1 week of acute supratentorial ischemic stroke in a 1:1 ratio: Actovegin (a deproteinized hemoderivative of calf blood, 2000 mg/d for ≤20 intravenous infusions followed by 1200 mg/d orally) or placebo for 6 months. Patients were treated in accordance with standard clinical practice for a further 6 months. The primary end point was the change from baseline in Alzheimer’s Disease Assessment Scale, cognitive subscale, extended version at 6 months. Results— Two-hundred forty-eight patients were randomized to Actovegin and 255 patients to placebo. At month 6, the least squares mean change from baseline in Alzheimer’s Disease Assessment Scale, cognitive subscale, extended version was −6.8 for Actovegin and −4.6 for placebo; the estimated treatment difference was −2.3 (95% confidence interval, −3.9, −0.7; P=0.005). Recurrent ischemic stroke was the most frequently reported serious adverse event, with a nonsignificantly higher number for Actovegin versus placebo. Conclusions— Actovegin had a beneficial effect on cognitive outcomes in patients with poststroke cognitive impairment. The safety experience was consistent with the known safety and tolerability profile of the drug. These results warrant confirmation in additional robustly designed studies. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01582854.
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Affiliation(s)
- Alla Guekht
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.).
| | - Ingmar Skoog
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
| | - Sally Edmundson
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
| | - Vladimir Zakharov
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
| | - Amos D Korczyn
- From the Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University Moscow and Clinical Center for Neuropsychiatry, Russia (A.G.); Sahlgrenska Academy, University of Gothenburg, Sweden (I.S.); Takeda Development Centre Europe, London, United Kingdom (S.E.); Department of Neurology, First Moscow State Medical University, Russia (V.Z.); and Department of Neurology, Tel Aviv University, Israel (A.D.K.)
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Bordet R, Ihl R, Korczyn AD, Lanza G, Jansa J, Hoerr R, Guekht A. Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report. BMC Med 2017; 15:107. [PMID: 28539119 PMCID: PMC5444106 DOI: 10.1186/s12916-017-0869-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/06/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vascular cognitive impairment (VCI) is a complex spectrum encompassing post-stroke cognitive impairment (PSCI) and small vessel disease-related cognitive impairment. Despite the growing health, social, and economic burden of VCI, to date, no specific treatment is available, prompting the introduction of the concept of a disease modifier. CONSENSUS AND SUGGESTIONS Within this clinical spectrum, VCI and PSCI remain advancing conditions as neurodegenerative diseases with progression of both vascular and degenerative lesions accounting for cognitive decline. Disease-modifying strategies should integrate both pharmacological and non-pharmacological multimodal approaches, with pleiotropic effects targeting (1) endothelial and brain-blood barrier dysfunction; (2) neuronal death and axonal loss; (3) cerebral plasticity and compensatory mechanisms; and (4) degenerative-related protein misfolding. Moreover, pharmacological and non-pharmacological treatment in PSCI or VCI requires valid study designs clearly stating the definition of basic methodological issues, such as the instruments that should be used to measure eventual changes, the biomarker-based stratification of participants to be investigated, and statistical tests, as well as the inclusion and exclusion criteria that should be applied. CONCLUSION A consensus emerged to propose the development of a disease-modifying strategy in VCI and PSCI based on pleiotropic pharmacological and non-pharmacological approaches.
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Affiliation(s)
- Régis Bordet
- University of Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', Lille, France.
- Département de Pharmacologie Médicale, Faculté de Médecine, 1 place Verdun, 59045, Lille Cedex, France.
| | - Ralf Ihl
- University of Duesseldorf, Alexian Research Center, Krefeld, Germany
| | - Amos D Korczyn
- Department of Neurology, Tel Aviv University, Ramat Aviv, Israel
| | - Giuseppe Lanza
- Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Jelka Jansa
- University Medical Centre Ljubljana, Neurologic Hospital, Neurorehabilitation Unit, Ljubljana, Slovenia
| | - Robert Hoerr
- Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Alla Guekht
- Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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Jiang C, Yang S, Tao J, Huang J, Li Y, Ye H, Chen S, Hong W, Chen L. Clinical Efficacy of Acupuncture Treatment in Combination With RehaCom Cognitive Training for Improving Cognitive Function in Stroke: A 2 × 2 Factorial Design Randomized Controlled Trial. J Am Med Dir Assoc 2016; 17:1114-1122. [DOI: 10.1016/j.jamda.2016.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/15/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
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Huang KY, Liang S, Yu ML, Fu SP, Chen X, Lu SF. A systematic review and meta-analysis of acupuncture for improving learning and memory ability in animals. Altern Ther Health Med 2016; 16:297. [PMID: 27543143 PMCID: PMC4992193 DOI: 10.1186/s12906-016-1298-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/17/2016] [Indexed: 01/02/2023]
Abstract
Background Memory loss is the most prominent symptoms of brain aging, but there is currently no evidence-based treatment strategy. Acupuncture has been widely used in China and the effectiveness for improving learning and memory has been mentioned in previous studies. We conducted this systematic review and meta-analysis to evaluate the effectiveness of acupuncture for improving learning and memory in animal experiments. Methods We searched Pubmed, Embase, Ovid Medline(R), the China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP) and Wanfang data Information Site to collect studies published up to December 2015. Study quality for each included article was evaluated according to the CAMARADES 10-item checklist. Outcome measure is Morris water maze. A meta-analysis was conducted according to the Cochrane systematic review method by using RevMan 5.3 software. Results Forty-two studies involving 944 animals were included. The quality score of the studies ranged from 2 to 8, with a mean of 5.3. Meta-analysis results showed that 24 studies reported significant effect of acupuncture for decreasing escape latency (−3.00, 95 % CI: −3.78 ~ −2.23, P < 0.00001), 14 studies reported significant effect of acupuncture for increasing frequency of cross platform (2.57, 95 % CI: 1.92 ~ 3.22, P < 0.00001), and 7 studies reported significant effect of acupuncture for increasing time in target quadrant (2.00, 95 % CI: 1.10 ~ 2.91, P < 0.00001) compared with the control group. Conclusions These findings show acupuncture has a potential role in improving learning and memory ability in animal models, suggesting it as a candidate therapy for memory loss of aged brain.
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Feng M, Lu J, May BH, Liu S, Guo X, Zhang AL, Xue CC, Lu C. Chinese herbal medicine for patients with vascular cognitive impairment no dementia: protocol for a systematic review. BMJ Open 2016; 6:e010295. [PMID: 27016244 PMCID: PMC4809105 DOI: 10.1136/bmjopen-2015-010295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this systematic review is to assess the efficacy and safety of Chinese herbal medicine for the treatment of patients with vascular cognitive impairment but no dementia. METHODS AND ANALYSIS We will perform a comprehensive retrieval in the following electronic databases: PubMed, Cochrane Library, EMBASE, CINAHL, Chinese Biomedical Literature Service System (SinoMed), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang database and other sources. After screening the studies, the methodological quality of all included trials will be assessed according to the risk of bias instrument provided by the Cochrane Collaboration. A meta-analysis of randomised controlled trials will be conducted using RevMan V.5.3 software. Funnel plot analysis and Egger's test will be used to assess publication bias, if possible. The quality of evidence will be assessed by the GRADE system. DISSEMINATION This systematic review will be disseminated in a peer-reviewed journal and a relevant conference presentation. TRIAL REGISTRATION NUMBER PROSPERO CRD 42015023682.
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Affiliation(s)
- Mei Feng
- Evidence-based Medicine and Clinical research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingmin Lu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Brian H May
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Shaonan Liu
- Evidence-based Medicine and Clinical research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- Evidence-based Medicine and Clinical research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Charlie Changli Xue
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Chuanjian Lu
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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Abstract
Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms--including inflammation, oxidative stress, and endothelial dysfunction--are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.
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