Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Friday, February 24, 2017

CCB Doesn't Help Cognition After Stroke MMSE scores no better with nimodipine than placebo after 6 months

Just because finding the solution to this is 'vexing' and complicated is no reason to give up.
HOUSTON -- Nimodipine didn't improve cognition when ischemic stroke patients with vascular mild cognitive impairment (MCI) started taking the calcium channel blocker within a week of their event, researchers reported here.
In a randomized controlled trial from 23 sites in China, patients had no differences in change in Mini-Mental State Exam (MMSE) scores at 6 months whether they were on the drug or placebo, Huaguang Zheng, MD, of Beijing Tiantan Hospital in China and colleagues reported at the International Stroke Conference meeting here.
"In our trial, we found that nimodipine didn't benefit vascular MCI patients, but it may have marginal positive effects on specific cognitive domains, such as executive function, and it won't increase the risk of stroke or other adverse events," Zheng said during a press briefing.
More than half of stroke patients develop vascular MCI during the first three months of follow-up, he explained, and about 30% to 50% will develop dementia within 5 years.
While there are currently no effective therapies for vascular MCI and dementia, some studies have suggested that nimodipine may have cognitive benefits, he said.
To assess whether that's the case, Zheng and colleagues randomized 654 patients to either placebo or to 30 mg nimodipine three times a day. The primary endpoint was the change in cognition function on the MMSE and on the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) over 6 months.
Overall, outcomes were similar between the two groups, with no significant advantage for nimodipine, Zheng said.
There was, however, an advantage for nimodipine in terms of the proportion of patients who had an ADAS-Cog score of 0 or greater at 6 months (34% versus 47%), and there was some indication that the drug may benefit specific brain areas, particularly executive function, he noted.
Zheng added that nimodipine didn't increase the risk of stroke and other adverse events.
He acknowledged that the study was limited because it didn't evaluate Global Cognitive Index scores, neurological outcome, or subcortical dementia, and the sample size was too small.
Mark Alberts, MD, of Hartford Healthcare, said it was "reasonable to investigate" nimodipine given that it's been shown to potentially have neuroprotective effects. But the problem of cognitive decline following stroke is a "vexing issue" because the pathophysiology is so complicated.
"If you have a stroke, and you develop dementia after the stroke, is that vascular dementia related to the stroke? Having a stroke, you take out millions of neurons," he told MedPage Today. "Most people, including myself, think it's a combination, that there's some underlying degenerative process, and vascular disease on top of that is just accelerating it perhaps."
Alberts said it's best to focus on risk factor control in patients with cognitive impairment after a stroke -- treating diabetes, hypertension, and hypercholesterolemia, for instance. For patients who progress to dementia, he offers rehabilitation programs or the cholinesterase inhibitor donepezil (Aricept).
Amytis Towfighi, MD, of the University of Southern California and director of neurological services at the Los Angeles County department of health, agreed that risk factor control is the main therapeutic strategy for cognitive impairment following stroke.
"Currently there are no proven treatments. We don't know if medications that have been tested in Alzheimer's would be effective," she told MedPage Today. "Generally we recommend lifestyle changes -- the same things you would recommend to prevent stroke. Prevention is the key."
The study was supported by the National Key Technology Research and Development Program of the Ministry of Science and Technology of China. Bayer provided additional support.
Zheng disclosed no financial relationships with industry.

No comments:

Post a Comment