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Background: Subcortical ischemic vascular dementia (SIVD) is very common among the older people, but has no approved treatment. Preclinical trials show that remote ischemic conditioning (RIC) reduces recurrence of ischemic stroke. We hypothesize that RIC may also be an effective therapy for patients with SIVD. Methods: Thirty-seven consecutive SIVD cases were enrolled in this randomized control study. Eighteen RIC patients underwent five brief cycles of conditioning (bilateral upper limb compression at 200 mmHg) followed by reperfusion twice daily over 6 consecutive months. Nineteen control patients underwent the same process, but at a pressure of 60 mmHg which caused no restriction on the blood flow of the upper limb. The primary outcome measures were changes in neuropsychological assessments. The secondary outcomes included the changes in high-sensitive Creactive protein (hs-CRP) concentration, white matter lesion volume (WMLV), diffusion tension imaging (DTI) metrics of white matter. All data were collected at baseline and follow-up. Results: A significant treatment difference favoring RIC at 6 months was observed on performance of Hopkins Verbal Learning Test-Revised (HVLT-R), Controlled Oral Word Association Test (COWAT), Trail Making Test A and B (TMT-A & TMT-B), and Judgment of Line Orientation (JLO) (p < 0.05). The control group did not show much improvement after the treatment, and only with a slight change in HVLT-R and TMT-R (p < 0.05). Covariance analysis of efficacy between the two groups suggested that RIC patients performed better on JLO than control patients at the 6-month follow-up (RIC 23.10 vs. control 18.56; p = 0.013). Although DTI metrics were comparable, Hs-CRP levels and WMLV in RIC patients showed a declining trend. Conclusions: Over the 6-month treatment period, we found that RIC was safe and effective for improving cognitive function in SIVD patients.

ObjectivesThis study was performed to determine whether multimodal biomarkers are more strongly associated with the Montreal Cognitive Assessment (MoCA) scores compared with the Mini-Mental State Examination (MMSE) scores, and whether they are correlated with the Clinical Dementia Rating (CDR) in patients with subcortical ischemic vascular dementia (SIVD).MethodsPatients diagnosed with SIVD were enrolled. Peripheral blood hypersensitive C-reactive protein, white matter lesion volume (WMLV), fractional anisotropy (FA)/mean diffusivity (MD) of whole brain white matter (WBWM), and normal-appearing white matter (NAWM) were measured and correlated with MMSE, MoCA, and CDR scores.ResultsBivariate analyses of data from 48 included patients revealed that both MoCA and MMSE were significantly associated with age, education, and FA of NAWM. Only MD of NAWM was correlated with MoCA scores. In partial correlation analysis adjusted for demographic and neuroimaging variables, MD/FA of NAWM and the MoCA scores were significantly correlated. FA/MD of NAWM had a modest trend toward a correlation with the CDR, but it was not significant.ConclusionsIn the patients with SIVD, FA/MD of NAWM were more strongly related to MoCA scores compared with MMSE scores.