Citicoline in Vascular Cognitive Impairment and Vascular Dementia After Stroke

Abstract

Abstract-Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment and vascular dementia. Neuropathological studies in most cases of dementia in the elderly reveal a large load of vascular ischemic brain lesions mixed with a lesser contribution of neurodegenerative lesions of Alzheimer disease. Nonetheless, few pharmacological studies have addressed vascular cognitive impairment and vascular dementia after stroke. Citicoline has demonstrated neuroprotective effects in acute stroke and has been shown to improve cognition in patients with chronic cerebrovascular disease and in some patients with Alzheimer disease. A recent trial lasting 6 months in patients with first-ever ischemic stroke showed that citicoline prevented cognitive decline after stroke with significant improvement of temporal orientation, attention, and executive function. Experimentally, citicoline exhibits neuroprotective effects and enhances neural repair. Citicoline appears to be a safe and promising alternative to improve stroke recovery and could be indicated in patients with vascular cognitive impairment, vascular dementia, and Alzheimer disease with significant cerebrovascular disease. Key Words: citicoline Ⅲ cognition Ⅲ dementia Ⅲ neuroprotection Ⅲ stroke complications Ⅲ stroke recovery Ⅲ vascular cognitive impairment Ⅲ vascular dementia S troke considerably increases the likelihood of dementia in the elderly. For instance, in the Framingham study, stroke doubled the risk of dementia. 1 Poststroke cognitive decline is more common than stroke recurrence. Poststroke vascular dementia (VaD) affects 30% of survivors, and the incidence of new-onset dementia increases from 7% 1 year after stroke to 48% after 25 years. 2 The term vascular cognitive impairment (VCI) 3 refers to the effects of the vascular burden of the brain on higher mental functions; VCI reflects all cognitive effects of cerebrovascular disease on cognition 4 and includes many types of cognitive impairment, except dementia (VCI with no dementia). 5 Patients with dementia as a result of hemorrhagic, ischemic, or hypoperfusive brain injury are included in the VaD category, 6 as are those with mixed vascular-degenerative forms.VCI with no dementia is twice as common as VaD. 7 Six months after stroke, 44% to 74% of patients present some degree of cognitive disturbance. 8 -16 Half of the patients with VCI have dementia develop within 5 years. 11 A recent meta-analysis of 16 studies 12 shows a clear relationship between stroke and dementia. Most of the studies agree that stroke doubles the risk of dementia independently of demographic data or presence of vascular risk factors. Preexisting cognitive impairment is not a determinant factor for the development of poststroke VCI. 17 The risk decreases over time after the index stroke event, but it seems to be higher in patients with the apolipoprotein E 4 allele, suggesting a link with Alzheimer disease.Cerebrovascular lesions, incl...

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Electro-acupuncture ameliorates cognitive impairment via improvement of brain-derived neurotropic factor-mediated hippocampal synaptic plasticity in cerebral ischemia-reperfusion injured rats

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