Search

Background Vinpocetine is a synthetic ethyl ester of apovincamine, a vinca alkaloid obtained from the leaves of the Lesser Periwinkle (Vinca minor) and discovered in the late 1960s. Although used in human treatment for over twenty years, it has not been approved by any regulatory body for the treatment of cognitive impairment. Basic sciences studies have been used to claim a variety of potentially important effects in the brain. However, despite these many proposed mechanisms and targets, the relevance of this basic science to clinical studies is unclear. Objectives To assess the efficacy and safety of vinpocetine in the treatment of patients with cognitive impairment due to vascular disease, Alzheimer's disease, mixed (vascular and Alzheimer's disease) and other dementias. Search methods The Cochrane Dementia and Cognitive Improvement Group's Specialized Register was searched on 23 March 2009 using the terms vinpocetin*, cavinton, kavinton, Rgh-4405, Tcv-3B, "ethyl apovincaminate", vinRx, periwinkle, "myrtle vincapervinc" and cezayirmeneksesi. This register contains up to date references from major health care databases like MEDLINE and EMBASE as well as records from trials databases in the field of dementia.The manufacturers of vinpocetine were asked for information on trials of vinpocetine for dementia. In addition we tried to collect articles not listed in MEDLINE or other sources on the Internet (e.g. articles in Hungarian and Romanian). Selection criteria All human, unconfounded, double-blind, randomized trials in which treatment with vinpocetine was administered for more than a day and compared to control in patients with vascular dementia, Alzheimer's dementia or mixed Alzheimer's and vascular dementia and other dementias. Non-randomized trials were excluded. Data collection and analysis Data were independently extracted by the two reviewers (SzSz and PW) and cross-checked. Data from "washout" periods were not used for the analysis. For continuous or ordinal variables, such as cognitive test results, the main outcomes of interest were the change in score from baseline. The categorical outcome of global impression was transformed to binary data (improved or not improved) as was the occurrence of adverse effects; here the endpoint itself was of interest and the Peto method of the "typical odds ratio" was used. A test for heterogeneity of treatment effects between the trials was made if appropriate. Data synthesis and analysis were performed using the Cochrane Review Manager software (RevMan version 4.1). Main results All identified studies were performed before and in the early 1990s and used various terms and criteria for cognitive decline and dementia. The three studies included in the review involved a total of 583 people with dementia treated with vinpocetine or placebo. The reports of these studies did not make possible any differentiation of effects for degenerative or vascular dementia. The results show benefit associated with treatment with vinpocetine 30 mg/day and 60 mg/day compared with placebo, but the number of patients treated for six months or more was small. Only one study extended treatment to one year. Adverse effects were inconsistently reported and without regard for relationship to dose. The available data do not demonstrate many problems of adverse effects but intention-to-treat data were not available for any of the trials. Authors' conclusions Although the basic science is interesting, the evidence for beneficial effect of vinpocetine on patients with dementia is inconclusive and does not support clinical use. The drug seems to have few adverse effects at the doses used in the studies. Large studies evaluating the use of vinpocetine for people suffering from well defined types of cognitive impairment are needed to explore possible efficacy of this treatment.

Background and Purpose?Mannitol is used worldwide to treat acute stroke, although its efficacy and safety have not beenproven by randomized trials.Methods?In a tricenter, prospective study, we analyzed the 30-day and 1-year case fatality with respect to mannitoltreatment status in 805 patients consecutively admitted within 72 hours of stroke onset. Confounding factors werecompared between treated and nontreated patients.Results?Two thirds of the patients received intravenous mannitol as part of their routine treatment (mean dose, 47 22g/d; mean duration ,6 3 days). The case fatality was 25% versus 16% (P0.006) at 30 days and 38% versus 25%(P0.001) at 1 year in the-mannitol treated and nontreated groups, respectively. Mannitol treatment effect was adjustedfor age, stroke severity, fever in the first 3 days, and aspirin treatment (for ischemic strokes) in logistic regressionmodels. Depending on the factors entered into the model, either no effect or harm could be attributed to mannitol. Whenthe analysis was restricted to those admitted within 24 hours (n568), case fatality differed significantly only at 1 year(35% in treated and 26% in nontreated patients, P0.044). Although the prognostic scores of the ScandinavianNeurological Stroke Scale were similar in treated and nontreated patients, both in ischemic and hemorrhagic strokes, thepatient groups differed in several factors that might also have influenced survival.Conclusions?Based on the results of this study, no recommendations can be made on the use of mannitol in acute stroke,and properly randomized, controlled trials should be performed to come to a final conclusion

Cerebrovascular diseases are common in Central and East Europe, and the resulting cognitive impairment is probably also frequent. Although this problem attracted a lot of attention in the last decade, systematic examination of cognitive functions is not routinely performed in cerebrovascular patients. In our study involving cerebrovascular outpatients, we used the MMSE and the Barthel Index combined with a checklist for the evaluation of subcortical features. From a total of 176 cases, 32% had at least one subcortical sign. Except for gait disturbance and unprovoked falls, patients with subcortical dysfunction had lower performances on MMSE and lower Barthel scores. Their mean age did not differ significantly from the age of patients without subcortical signs, except for the subgroups with urinary and gait disturbances. Cognitive deficit could be detected in 27 patients, nine of them fulfilled the criteria for dementia. Subcortical signs and cognitive impairment can also be present in apparently well-being cerebrovascular patients. The routine evaluation of these deficiencies must be an integral part of the management of cerebrovascular patients and in planning their complex rehabilitation. Short, widely usable and easily executable tests are recommended.

Stroke mortality is extremely high in Central-Eastern European countries. The high rate of risk factors and differences in health care services might be among the factors resulting in high stroke morbidity and mortality in this region. As only few prospectively collected information are available from this region, we decided to evaluate some characteristics of stroke services in neurological departments of a Romanian, a Ukrainian and a Hungarian city in the framework of the Mures-Uzhgorod-Debrecen comparative epidemiological study. We registered demographic data, the absence or presence of the most important risk factors, and clinical signs on admission and at discharge. We recorded the application of various diagnostic methods, stroke treatment and recommendations for secondary prevention. Follow-up is planned after 30 days and after 1 year. The paper summarizes the methodology of this prospective epidemiological study of stroke patients hospitalized in neurological departments in Târgu Mures, Uzhgorod and Debrecen, three Central-Eastern European cities in Romania, Ukraine and Hungary, respectively.

Cerebrovascular disease is a major public health problem in Eastern European countries. A Hungarian post-stroke population was examined to estimate the rate of dementia, the risk factors for cognitive impairment, and the applicability of a recently established Canadian diagnostic checklist in this cohort. Chronic cerebrovascular outpatients were screened for cognitive impairment with a combined checklist: the Diagnostic Checklist for Vascular Dementia established by the Consortium of Canadian Centres for Clinical Cognitive Research using the Mini Mental State Examination instead of the detailed neuropsychological part of the Checklist. Of the 247 consecutive patients at a cerebrovascular outpatient unit, 176 had cerebrovascular disorder diagnosed either by computed tomography (CT; n = 126) or by the clinical signs. Of these, 15% were cognitively impaired and 5% fulfilled the criteria of dementia. The mean age of the patients with cognitive impairment was significantly higher than that of patients with normal cognition (68.2 ± 10.2 and 60.5 ± 10.5 years, P < 0.001). The Barthel index was significantly lower in the cognitively affected group than in non-affected patients (92.4 ± 16.0 and 97.1 ± 8.7, P = 0.027). Diabetes and more than two subcortical infarcts on CT or magnetic resonance imaging were more frequent in patients with cognitive loss (P = 0.043 and P = 0.013, respectively). Cognitive performance was also influenced by the level of education. Higher age, diabetes, motor deficits, and multiple subcortical infarcts are risk factors for cognitive impairment after stroke. The combined checklist appears to be a practical screening test for cognitive impairment in patients with chronic cerebrovascular diseases.