Network meta-analysis of the efficacy of pharmacological treatments for post-stroke cognitive impairment and vascular cognitive impairment

Does your competent? doctor agree with this treatment for stroke cognitive impairment? Y/N?

with expert consensus supporting donepezil(sic) and rivastigmine for PSCI.

"Donepezil vs donepezil" essentially compares different forms, dosages, or brand names of the same medication.

Ok, I looked back at my earlier posts and you don't want to use donepezil for mild cognitive impairment.

When people experience memory loss that looks a little like Alzheimer's but isn't, doctors diagnose it as "Mild Cognitive Impairment (MCI)". Some prescribe the Alzheimer's drug donepezil (Aricept®). New research shows why it should not be prescribed for people with mild cognitive impairment (MCI) without a genetic test.
UCLA School of Nursing researchers discovered that for people who carry a specific genetic variation — the K-variant of butyrylcholinesterase, or BChE-K — donezpezil could accelerate cognitive decline. 

 Network meta-analysis of the efficacy of pharmacological treatments for post-stroke cognitive impairment and vascular cognitive impairment

Wenting LiXinyu LiuCong GaoWenbo LiXiaoling Liao^*

• Department of Neurology, Tiantan Hospital, Capital Medical University, Beijing, China

Background: Based on recent reviews, vascular cognitive impairment (VCI) encompasses a spectrum of cognitive deficits caused by cerebrovascular disease and its risk factors, ranging from mild cognitive impairment to dementia, and often coexists with neurodegenerative conditions like Alzheimer’s disease. VCI is categorized into four clinical-imaging subtypes, including post-stroke cognitive impairment (PSCI)—a common stroke complication and major VCI subtype. Current guidelines recommend cholinesterase inhibitors and NMDA receptor antagonists as first-line treatments for VCI, with expert consensus supporting donepezil and rivastigmine for PSCI. However, existing evidence primarily derives from placebo-controlled or head-to-head drug comparisons, lacking comprehensive evaluations of multiple cognitive enhancers. This study aims to systematically assess the efficacy and safety of cognitive-enhancing drugs in VCI, with a focused analysis on PSCI, to better inform clinical decision-making and improve patient outcomes.

Methods: We systematically searched four databases using predefined search strategies. Eligible studies were selected based on predetermined criteria. The included studies were analyzed with StataSE 16.0, RevMan 5.3, and Grade software to compare the efficacy and safety of cognitive-enhancing drugs to identify the optimal treatment for VCI and PSCI.

Results: Sixteen studies (5,599 participants) were included. In terms of cognitive outcomes, sailuotong was superior to placebo on the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog) (MD = −3.00, 95% CI: −4.50, −1.50) and ranked best (SUCRA 88.5%). Memantine was most effective on the Mini-Mental State Examination (MMSE) (MD = 1.23, 95% CI: 0.23–2.23; SUCRA 80.8%). For the secondary outcome, the MoCA assessment showed that Ginkgo biloba extract significantly improved Montreal Cognitive Assessment (MoCA) scores compared to placebo (MD = 1.29, 95% CI: 1.24, 1.35). Regarding safety, donepezil significantly increased the risk of overall adverse events compared to placebo (OR: 1.57; 95% CI: 1.19–2.06).

Conclusion: Our network meta-analysis suggests that memantine might have the best effect for PSCI, with sailuotong potentially serving as a secondary option. However, these estimates are based on a small randomized controlled trial and a sparse network. Therefore, the current evidence is limited, highlighting the need for more high-quality studies to robustly validate the therapeutic potential of these interventions for VCI and PSCI.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier in PROSPERO (CRD420250627957).

A tailored phytosomes based nose-to-brain drug delivery strategy: Silver bullet for Alzheimer's disease

 

This is in rats so your competent? doctor will need to contact non-existent stroke leadership to get human testing done. But that won't occur, will it?

A tailored phytosomes based nose-to-brain drug delivery strategy: Silver bullet for Alzheimer's disease

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https://doi.org/10.1016/j.bioactmat.2024.09.039

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Highlights

• •
  Designing a Ginseng RG3-based phytosomes for the delivery of rivastigmine hydrogen tartrate.
• •
  Proposing a nose-to-brain delivery strategy for bypassing the blood-brain barrier.
• •
  Providing a novel insight into the treatment of Alzheimer's disease.

Abstract

With the aging of the population, the incidence of Alzheimer's disease (AD) has increased dramatically, causing severe medical, care, and economic burdens on society and families. The efficacy of rivastigmine hydrogen tartrate (RHT), the first-line clinical treatment, is severely limited by the complex and multiple pathogenesis of AD and low brain bioavailability caused by the blood-brain barrier (BBB). Confronting such two bottlenecks, the development of multi-target agents encapsulated BBB-bypassing drug delivery systems offer tremendous therapeutics possibilities for AD. In this study, a tailored phytosomes based nose-to-brain drug delivery system with appropriate plume was successfully designed and developed. On the one hand, Ginseng RG3-based phytosomes loaded with RHT was designed for the co-delivery of GRg3 and RHT, achieving the multi-target pharmacology for AD treatment. On the other hand, a tailored nose-to-brain drug delivery system was established for the satisfactory nose-to-brain delivery efficiency, avoiding the obstacle of BBB through bypassing it. In the pharmacodynamic study based on AD rat model, GRg3@RHT exhibited obviously synergic effect, effectively break the vicious cycle of AD progression, ultimately markedly ameliorating learning and memory ability as well as behavioral dysfunctions, and delaying the neurodegenerative process associated with AD. In addition, the strong correlation of viscosity-droplet size-plume geometry-olfactory deposition was also established, and further proved by the in vivo pharmacokinetic study, which is proposed to provide evidence to enhance nose-to-brain delivery efficiency. This study is anticipated to provide novel insights into AD treatment strategies while offering innovative ideas for drug delivery approaches targeting nervous system disorders.

Graphical abstract

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Galantamine Slashes Heart Attacks and Death

For your doctor to analyze and report back to you.

Galantamine Slashes Heart Attacks and Death

A new study has found that subjects taking the highest recommended doses of cholinesterase inhibitors (ChEIs)—including donepezil (at 10 mg/day), rivastigmine (at 6 mg/day), and galantamine (at 24 mg/day)—had significantly lower levels of myocardial infarction (MI, aka heart attack) or significantly reduced risk of death from any cause.¹ The research was conducted at Karolinska University Hospital, Stockholm, Sweden where over 7000 subjects (mean age 79 years) from the Swedish Dementia Registry with the diagnoses of Alzheimer’s dementia or Alzheimer’s mixed dementia since 2007 were followed for a mean period of 503 days. In the study, those who used ChEI, compared to those who did not, experienced:

• 38% lower risk of heart attack
• 26% lower risk of death from stroke and other cardiovascular diseases
• 36% lower risk of death from any cause

More at link.