2024 American Academy of Neurology Abstract Website

Debankur Dey¹, Vinay Suresh², Muhammad Aaqib Shamim⁴, Binish Javed⁵, Bishal Dhakal⁶, Amogh Verma⁷, Marium Khan⁸, Nandini Singha⁹, Vijayavarshini Tholkappian¹⁰, Archit Goel¹¹, Mainak Bardhan¹², Neeraj Kumar³, Hardeep Malhotra³
¹Medical College and Hospital Kolkata, ²King George's Medical University, ³Department of Neurology, King George's Medical University, ⁴Department of Pharmacology, All India Institute of Medical Science - Jodhpur, ⁵Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India, ⁶Nepalese Army Institute of Health Sciences, ⁷Rama Medical College Hospital and Research Centre, Hapur, ⁸Jinnah Sindh Medical University, Pakistan, ⁹North Bengal Medical College and Hospital, ¹⁰Madras Medical College, Chennai, Tamil Nadu, ¹¹All India Institute of Medical Sciences, Bathinda, ¹²Neuro Medical Oncology, Miami Cancer Institute,Baptist Health South Florida, USA

Objective:

To compare the effectiveness of various pharmacotherapies in improving cognitive function in patients with vascular dementia, by conducting a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Background:

Vascular dementia is the second most common form of dementia and currently has no approved drugs for treatment. Although various pharmacotherapies, including cholinesterase inhibitors, memantine, gingko, and cerebrolysin, have shown promise in enhancing cognitive function in individuals, there is a lack of direct comparisons to determine the most effective option for cognitive improvement.

Design/Methods:

We systematically searched multiple databases, including PubMed/MEDLINE, Cochrane database, SCOPUS, Embase, and Clinicaltrials.gov, to identify RCTs focused on interventions for vascular dementia and their influence on cognitive function. The search was conducted from the earliest available date to September 2023. Utilizing the frequentist approach, pairwise and network meta-analyses (NMA) were conducted to obtain both direct and indirect comparisons of each measure, quantified as the mean difference (MD).

Results:

A total of 13 RCTs with a pooled size of 3880 patients (55.61% males) with vascular dementia were included in the analysis that used the cognitive measures MMSE (10 RCTs) and ADAS-Cog (5 RCTs). Compared to placebo, the ADAS-Cog scores improved significantly with Cerebrolysin (MD, -6.20; 95%CI, -6.39 to -6.01) and Rivastigmine (MD, -1.10; 95%CI, -1.16 to -1.04) in the overall network analysis. In a direct comparative analysis, the NMA showed Cerebrolysin (MD, -5.10; 95%CI, -5.30 to -4.90) to be more effective in improving ADAS-Cog scores than Rivastigmine. Notably, only donepezil (MD, 0.90; 95% CI, 0.70 to 1.10) and Memantine (MD, 0.60, 95% CI, 0.10 to 1.10) exhibited statistically significant, yet slight, improvements in MMSE scores compared to placebo.

Conclusions:

Cerebrolysin demonstrates significant enhancement in cognitive function in vascular dementia, as assessed by the ADAS-Cog score. Rivastigmine also shows improvement. Additionally, Donepezil and Memantine demonstrate cognitive benefits, as measured by MMSE.