Efficacy, safety and tolerability of rivastigmine capsules in patients with probable vascular dementia: the VantagE study

Ballard, Clive; Sauter, Mary Elizabeth; Scheltens, Philip; He, Yang; Barkhof, Frederik; Straaten, E.C.W. van; Flier, Wiesje M. van der; Hsu, Chuanchieh; Wu, Shouling; Lane, Roger

doi:10.1185/03007990802328142

Cited by 131 publications

(72 citation statements)

References 47 publications

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“…The efficacy in terms of cognitive outcome was based on effects in older patients likely to have concomitant AD pathology. This is consistent with previous findings suggesting that the putative cholinergic deficit in vascular dementia probably reflects the presence of concomitant AD pathology [36].…”

Section: Curative Treatmentsupporting

confidence: 82%

“…According to the authors, there are insufficient data to support widespread use of these drugs in vascular dementia. The trials meeting the selection criteria for this metaanalysis included three donepezil (307, 308, 319) [31][32][33], two galantamine (GAL-INT-6 and 26) [34,35], one rivastigmine (VantagE) [36], and two memantine trials (MMM300 and 500) [37,38], comprising 3,093 patients on the study drugs and 2,090 patients on placebo (table 1). Cognitive effects on the Alzheimer's Disease Assessment Scale were significant for all drugs, ranging from a mean difference of -1.10 (95% CI -2.15 to -0.05) for rivastigmine to -2.17 for 10 mg daily donepezil (95% CI -2.98 to -1.35).…”

Section: Curative Treatmentmentioning

confidence: 99%

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Is It Possible to Treat Vascular Dementia?

Zekry¹

2009

Dementia in Clinical Practice

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Randomized controlled trials of primary and secondary prevention of vascular dementia demonstrate real effects on the cause or progression of disease (disease-modifying treatment). These strategies lead to a reduction in all cerebrovascular risk factors, in particular hypertension. Such treatment may prevent dementia by reducing stroke and possibly by other mechanisms that remain undetermined, such as those involved in neurodegeneration and cell death. Curative treatment of vascular dementia, particularly given recent studies on cholinesterase inhibitors (rivastigmine, donepezil and galantamine) and memantine, is still ineffective. There is insufficient evidence to support widespread use of these drugs in vascular dementia. Particular considerations should be taken into account in clinical trials. Vascular dementia is a heterogeneous disease with different subtypes and mechanisms. Therefore, well-designed, adequately powered trials accounting for this heterogeneity, with better clinical definitions and an assessment and detection of cognitive and global changes specific to vascular dementia, are needed.

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Section: Curative Treatmentsupporting

confidence: 82%

Section: Curative Treatmentmentioning

confidence: 99%

Is It Possible to Treat Vascular Dementia?

Zekry¹

2009

Dementia in Clinical Practice

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“…135 The benefits of memantine and rivastigmine in vascular cognitive impairment are less well established. [137][138][139][140] A treatment-responsive form of nonhemorrhagic CAA is spontaneous CAA-related vascular inflammation. The CAA-related inflammation occurs in a distinct subgroup of patients with CAA in response to the vascular A deposits and is characterized by diffuse WMH on brain MRI attributed to vasogenic edema, seizures, and cognitive decline.…”

Section: Treatmentmentioning

confidence: 99%

Ischemic brain injury in cerebral amyloid angiopathy

Reijmer

Veluw

Greenberg

2015

J Cereb Blood Flow Metab

118

102

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Cerebral amyloid angiopathy (CAA) is a common form of cerebral small vessel disease and an important risk factor for intracerebral hemorrhage and cognitive impairment. While the majority of research has focused on the hemorrhagic manifestation of CAA, its ischemic manifestations appear to have substantial clinical relevance as well. Findings from imaging and pathologic studies indicate that ischemic lesions are common in CAA, including white-matter hyperintensities, microinfarcts, and microstructural tissue abnormalities as detected with diffusion tensor imaging. Furthermore, imaging markers of ischemic disease show a robust association with cognition, independent of age, hemorrhagic lesions, and traditional vascular risk factors. Widespread ischemic tissue injury may affect cognition by disrupting white-matter connectivity, thereby hampering communication between brain regions. Challenges are to identify imaging markers that are able to capture widespread microvascular lesion burden in vivo and to further unravel the etiology of ischemic tissue injury by linking structural magnetic resonance imaging (MRI) abnormalities to their underlying pathophysiology and histopathology. A better understanding of the underlying mechanisms of ischemic brain injury in CAA will be a key step toward new interventions to improve long-term cognitive outcomes for patients with CAA.

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“…Rivastigmine has been less extensively investigated but has also been shown to have significant cognitive benefits in vascular dementia 104 and on a measure of executive function in patients with vascular cognitive impairment no dementia. 105 Thus, AChEI have been shown to be effective and safe for the treatment of cognitive symptoms in vascular dementia.…”

mentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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Level Type of Evidence + +High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. +Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. -Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + +High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, e.g. case reports, case series 4 Expert opinion Levels of evidence and grades of recommendation Statement of IntentThese guidelines are not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatment options available. ForewordDementia represents a major public health concern in Singapore and worldwide. Being the most prevalent neurodegenerative disease, dementia is expected to affect 55,000 patients in Singapore by the year 2020. The commonest cause of dementia is Alzheimer's disease with vascular dementia being the next most important cause. Right from the stage of mild dementia up to the stages of severe dementia, this condition poses a significant health and socio-economic burden to patients, caregivers and the nation as a whole. Early diagnosis will allow appropriate use of pharmacological and non-pharmacological management. Along with disease stabilization, efforts to address caregiver burden, patient safety and medico legal concerns should form the principles of management. Clear practise guidelines will allow holistic and optimal care in dementia.I am pleased to present the revised clinical practise guidelines for dementia. In this regard the workgroup has performed a thorough review of the existing literature to recommend both pharmacological and nonpharmacological aspects of management for patients ranging from mild cognitive impairment to severe dementia. This revised guidelines also highlights issues related to the management of mild cognitive impairment, young onset dementia and e...

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Efficacy, safety and tolerability of rivastigmine capsules in patients with probable vascular dementia: the VantagE study

Cited by 131 publications

References 47 publications

Is It Possible to Treat Vascular Dementia?

Is It Possible to Treat Vascular Dementia?

Ischemic brain injury in cerebral amyloid angiopathy

Systematic review of recent dementia practice guidelines

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