Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-01-24T06:51:36.121Z Has data issue: false hasContentIssue false
  • English
  • Français

Subcortical Vascular Dementia: Survey of Treatment Patterns and Research Considerations

Published online by Cambridge University Press:  18 September 2015

Frank J. Molnar ,
Malcolm Man-Son-Hing ,
Phil John ,
Chris Brymer ,
Kenneth Rockwood  and
Vladimir Hachinski
Frank J. Molnar*
Affiliation:
Division of Geriatric Medicine, University of Ottawa and Geriatric Assessment Unit, Ottawa Civic Hospital, Ottawa, Ontario
Malcolm Man-Son-Hing
Affiliation:
Division of Geriatric Medicine, University of Ottawa and Geriatric Assessment Unit, Ottawa Civic Hospital, Ottawa, Ontario
Phil John
Affiliation:
Section of Geriatric Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba
Chris Brymer
Affiliation:
Division of Geriatric Medicine University of Western Ontario, London, Ontario
Kenneth Rockwood
Affiliation:
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia
Vladimir Hachinski
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario.
*
Geriatric Assessment Unit, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada Kl Y 4E9
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Since few studies have examined the effectiveness of therapies for subcortical vascular dementia, treatment guidelines are not available. Current patterns in the treatment of such dementias have not been studied.

Objective:

To determine the practice patterns of Canadian specialists for the treatment of subcortical vascular dementia, and to survey their opinions regarding issues which are important in the design of a randomized controlled trial (RCT) in this field.

Design:

National survey of all specialists certified in Neurology or Geriatric Medicine.

Results:

Of responding physicians (78%) prescribed antithrombotic therapy for patients with vascular dementia. Most begin treatment with aspirin 325 mg daily (64%). The next three most common initial treatments were; no pharmacotherapy (12%), aspirin 650 mg daily (11%), and aspirin 1300 mg daily (11%). If the dementia continued to progress despite initial therapy, the treatment options were more varied. Most specialists (69%) believed that an RCT to assess the efficacy of aspirin in vascular dementia is warranted. The majority (69%) also felt that serial neuroimaging would be required for participants in such a trial, with magnetic resonance imaging being cited most frequently (41%). The majority of specialists considered three years as the minimum durationb for such a trial.

Conclusions:

Specialist physician practice patterns vary significantly for the treatment of patients with subcortical vascular dementia. Most physicians believe that an RCT testing the efficacy of aspirin in this condition is required. However, before such a trial can be conducted, many methodological difficulties need to be addressed.

Résumé:

RÉSUMÉ: Introduction:

Comme peu d'études ont examiné l'efficacité des traitements de la démence vasculaire sous-corticale, il n'existe pas de lignes directrices pour le traitement de cette condition. Le traitement courant de ces démences n'a pas été étudié.

Objectifs:

Nous voulons déterminer quel est le traitement prescrit par les spécialistes canadiens dans la démence vasculaire sous-corticale et enquêter sur leurs opinions au sujet d'aspects qui sont impor¬tants dans la planification d'une étude contrôlée, randomisée (ECR) dans ce domaine.

Plan de l'étude:

Il s'agit d'une enquête auprès de tous les spécialistes certifiés en neurologie ou en gériatrie

Résultats:

78% des répondants pre¬scrivent une thérapie antithrombotique chez les patients atteints d'une démence vasculaire. La plupart (64%) commen¬cent le traitement par de l'aspirine à la dose de 325 mg i.d. Les trois autres traitements initiaux les plus fréquents étaient: aucune médication (12%), de l'aspirine à la dose de 650 mg i.d. (11%) et de l'aspirine à la dose de 1300 mg i.d. (11%). Si la démence continuait à progresser malgré ce traitement, les options de traitement étaient plus variées. La plupart des spécialistes (69%) croyaient qu'une ECR pour évaluer l'efficacité de l'aspirine dans la démence vascu¬laire est justifiée. La majorité (69%) croyaient également qu'une évaluation des patients participant à une telle étude par imagerie neurologique sériée serait nécessaire. La technique la plus fréquemment (41%) citée était la résonance magnétique. La majorité des spécialistes considérait que la durée minimum d'une telle étude devait être de 3 ans.

Conclusions:

Les modes de traitement des spécialistes varient beaucoup quant au traitement des patients atteints de démence vasculaire sous-corticale. La plupart des médecins croient qu'une ECR évaluant l'efficacité de l'aspirine dans cette maladie est nécessaire. Cependant, avant d'entreprendre une telle étude, plusieurs difficultés méthodologiques doivent être résolues.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 4 , November 1998 , pp. 320 - 324
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

References

REFERENCES

1. Jorm, AF, Korten, AE, Henderson, AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand 1987; 76: 465–479.Google Scholar
2. Hebert, R, Brayne, C. Epidemiology of vascular dementia. Neuroepidemiology 1995; 14: 240–257.Google Scholar
3. Rockwood, K, Parhad, I, Hachinski, V, et al. Diagnosis of vascular dementia: Consortium of Canadian Centres for Clinical Cognitive Research consensus statement. Can J Neurol Sci 1994; 21: 358–364.Google Scholar
4. Amar, K, Wilcock, GK, Scott, M. The diagnosis of vascular dementia in the light of the new criteria. Age Aging 1996; 25: 51–55.Google Scholar
5. Verhey, F, Lodder, J, Rozendaal, N, Jolles, J. Comparison of seven sets of criteria used for the diagnosis of vascular dementia. Neuroepidemiology 1996; 15:166–172.Google Scholar
6. Amar, K, Wilcock, G. Vascular dementia. 1996; 312: 227–231.Google Scholar
7. Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular disease by prolonged antiplatelet treatment.Br Med J 1994; 296: 320–331.Google Scholar
8. Antiplatelet Trialis’ Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. B. Med J 1994; 308: 81–106.Google Scholar
9. Barnett, HJM, Eliasziw, M, Meldrum, HE. Drugs and surgery in the prevention of ischemic stroke. N Engl J Med 1995; 332: 238–248.Google Scholar
10. Bousser, MG, Eschwege, E, Haguenau, M, et al. “AICLA” controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia. Stroke 1983; 14: 5–14.Google Scholar
11. Gent, M, Easton, JD, Hachinski, VC, et al. The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Lancet 1989; 3: 1215–1220.Google Scholar
12. Meyer, JS, Judd, BW, Tawakina, T, et al. Improved cognition after control of risk factors for multi-infarct dementia. JAMA 1986; 256: 2203–2209.Google Scholar
13. Meyer, JS, Roger, KL, McClintic, KL, et al. Randomized clinical trial of daily aspirin therapy in multi-infarct dementia. J Am Geriatr Soc 1989; 37: 549–555.Google Scholar
14. Meyer, JS, Obara, K, Muramatsu, K, et al. Cognitive performance after small strokes correlates with ischemia, not atrophy of the brain. Dementia 1995; 6: 312–322.Google Scholar
15. Mattis, S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellak, L, Karasu, TB, eds. Geriatric Psychiatry: a Handbook for Psychiatrists and Primary Care Physicians. New York: Grune and Stratton, 1976.Google Scholar
16. Rockwood, K. Lessons from mixed dementia. International Psychogeriatrics (in press).Google Scholar
17. Rother, M, Kittner, B, Rudolphi, K, Rossner, M, Labs, KH. HWA 285 (propentofylline) a new compound for the treatment of both vascular dementia and dementia of the Alzheimer type. Ann NY Acad Sci 1996; 777: 404–409.Google Scholar
18. Erkinjuntii, T Clinical criteria for vascular dementia: The NINDS – AIREN criteria. Dementia 1994; 5: 189–192.Google Scholar
19. Wallin, A, Blennow, K. The clinical diagnosis of vascular dementia. Dementia 1994; 5: 181–184.Google Scholar
20. Mohr, E, Feldman, H, Gauthier, S. Canadian guidelines for the development of antidementia therapies: a conceptual summary. Can J Neurol Sci 1995; 22: 62–71.Google Scholar
21. Bergman, H, Chertkow, H, Wolfson, C, et al. HM-POA (CERETEC) SPECT brain scanning in the diagnosis of Alzheimer’s disease. J Amer Geriatr Soc 1997; 45: 15–20.Google Scholar
22. Folstein, MF, Folstein, SE, McHugh, PR. Mini-mental state, a practical method for grading the cognitive status of patients for the clinician. J Psychiatr Res 1975; 12:189–198.Google Scholar
23. Teng, EL, Chui, HC. The Modified Mini-mental State (3MS) Examination. J Clin Psychiatr 1991; 48: 314–318.Google Scholar
24. McDowell, I, Kristjansson, B, Hill, GB, Hebert, R. Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-mental State Exam compared. J Clin Epidemiol 1997; 50: 377–383.Google Scholar
25. Rosen, WG, Mohs, RC, Davis, KL. A new rating scale for Alzheimer’s disease. Am J Psychiatr 1984; 141: 1356–1364.Google Scholar
26. Hachinski, VC, Iliff, LD, lliff, MP. Cerebral blood flow in dementia. Arch Neurol 1975; 32: 632–637.Google Scholar
27. American Psychiatric Association. Diagnostic and Statistical Manual, 3rd ed. Revised. Washington: American Psychiatric Association, 1987.Google Scholar
28. Roman, GC, Tatemichi, TK, Erkinjuntii, T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDSAIREN International Workshop. Neurology 1993; 43: 250–260.Google Scholar
29. Chui, HC, Victoroff, JI, Margolin, D, et al. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer’s Disease Diagnostic and Treatment Centres. Neurology 1992; 42: 473–480.Google Scholar