Remote ischemic conditioning improves cognition in patients with subcortical ischemic vascular dementia

Abstract

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.

Remote Ischemic Conditioning With Exercise (RICE)—Rehabilitative Strategy in Patients With Acute Ischemic Stroke: Rationale, Design, and Protocol for a Randomized Controlled Study

“…RIC has also been used widely in other contexts ( 36 ), including reduction of myocardial injury after ischemia in large animal models and human trials ( 37 ). In studies of cerebral pathologies, RIC has improved cognition in patients with subcortical ischemic vascular dementia ( 38 ) and conferred neuroprotective effects after acute ischemic stroke ( 39 ). It offered neuroprotection through enhanced cerebral perfusion, cerebral collateral formation, and tolerance of cerebral ischemia ( 40 , 41 ).…”

Fibrinolysis and Remote Ischemic Conditioning: Mechanisms and Treatment Perspectives in Stroke

“…[42][43][44][45] In addition, long-term daily RIC was effective in preventing new cerebral vascular lesions in patients with vascular dementia as well as patients with intracranial arterial stenosis. 19,48,55 However, strong evidence supporting the efficacy of RIC as a neuroprotective adjunct to thrombolysis/thrombectomy in AIS is still missing, and no clinical studies investigating potential benefits of RIC have targeted the ICH population specifically.…”

“…No patients experienced new ischemic or bleeding events during the treatment period. 48 Large vessel disease with atherosclerotic stenosis of preor intracerebral arteries is a major cause of stroke. 24,49 Carotid endarterectomy performed within 15 days of AIS/TIA is superior to best medical management in reducing stroke recurrence in patients with significant ipsilateral carotid artery stenosis.…”

The 2019 yearbook of Neurorestoratology

“…Liao et al [74] found that remote ischemic conditioning was effective and safe to improve cognitive function in patients with subcortical ischemic vascular dementia. Tang et al [75] showed that computerized cognitive training significantly improved global cognitive function in patients with subcortical vascular cognitive impairment.…”