Cerebrolysin for vascular dementia | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Cerebrolysin for vascular dementia

You can view up to 4 cases without signing up Sign up for unlimited access

Background

Vascular dementia is a common form of dementia caused by poor blood flow to the brain. There are currently no proven and licenced treatments for vascular dementia. Cerebrolysin is a medicine that is made from pig's brains and given as an injection. In some countries, Cerebrolysin is used as a treatment for vascular dementia. A previous summary from 2013 considered all studies of Cerebrolysin and vascular dementia. A definitive conclusion as to whether Cerebrolysin was beneficial could not be made.

Purpose of this review

We wanted to learn whether Cerebrolysin can benefit people living with vascular dementia. We were particularly interested in the effects of the medication on memory and thinking; daily functioning; side effects; and and quality of life for people with vascular dementia and their caregivers. As some time has passed since the last review of Cerebrolysin, we wanted to update the review with a search for any new studies.

What we did

We searched for studies that described the effect of Cerebrolysin in people living with vascular dementia. We searched databases of scientific studies, including resources from countries where Cerebrolysin is commonly used. To be included in our review, the studies had to randomly decide whether people were treated with Cerebrolysin or a comparison. We combined the results of the included studies to estimate the effect of Cerebrolysin. We also assessed how well the studies were conducted and how credible the results were. The evidence is current to May 2019.

What we found

We found six studies including a total of 597 people living with vascular dementia. The method of Cerebrolysin treatment differed across studies, with varying strengths of Cerebrolysin and treatment durations. The studies reported that Cerebrolysin had beneficial effects on memory and thinking and on daily functioning. There was no reported risk of side effects with treatment. None of the studies described quality of life of people living with vascular dementia or their caregivers.

Although the studies suggested a benefit of Cerebrolysin treatment, the results are not definitive. The included studies had several issues that may have led to misleading results. Even if the benefit reported in the studies is real, the effect was modest and may not be important to people living with dementia. There is a need for a large, well‐conducted study to better understand if Cerebrolysin is a useful treatment for people living with vascular dementia.

Read the full Cochrane Review

Comment

Sign up to add a comment

More about this case

ResolvedVerified literature

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Review question\ What is the evidence for cholinesterase inhibitors (medicines designed to improve memory and thinking in people with dementia), when used with people who have vascular dementia?\ Background\ Vascular dementia (or vascular cognitive impairment) is a term used when a person has problems with memory and thinking that are caused by a disruption of blood supply. There are few drug treatments for vascular dementia.\ In this review, we evaluated three drugs from the cholinesterase inhibitor family, donepezil, rivastigmine, and galantamine. These medications are widely used in Alzheimer's dementia but may also be useful in people with vascular dementia. Previous reviews of these cholinesterase inhibitor drugs could not draw definitive conclusions for people with vascular dementia.\ Purpose of this review\ We wanted to learn whether cholinesterase inhibitors benefit people with vascular dementia. We were interested in their effects on memory, thinking, and daily functioning. We wanted to learn of any harms associated with these drugs.\ As some time has passed since the previous reviews, we wanted to update them by searching for new studies. We combined the three previous reviews on donepezil, rivastigmine and galantamine into one review.\ What we did\ We searched for studies that described the effects of donepezil, rivastigmine, and galantamine for people with vascular dementia. We searched databases of scientific studies and contacted drug manufacturers and experts in vascular dementia. Our search is current to 19 August 2020.\ To be included in our review, studies had to randomly assign people with vascular dementia to treatment with a cholinesterase inhibitor, or a dummy pill (placebo) and then compare the two groups. Studies comparing one cholinesterase inhibitor against another were also included. We combined the results of the included studies for each medicine to estimate how effective they were and how likely they were to cause side effects. We assessed how well the studies were conducted and how credible the results were.\ We did not find studies which compared different cholinesterase inhibitors with each other. To see whether the different cholinesterase inhibitor drugs differed in their effects, we used a technique called network meta‐analysis, which can provide an idea of how the medicines might perform if they were compared head‐to‐head.\ What we found\ We found 8 studies including a total of 4373 people with vascular dementia (or vascular cognitive impairment). The studies tested the drug donepezil at two different doses (5mg and 10mg daily), against each other and against placebo. Rivastigmine and galantamine were tested against placebo only. Rivastigmine is available as a skin patch, but the studies only tested the pill version. All eight studies evaluated participants when they first started taking the medicine or placebo and again six months later. Different tests were used to measure the effects. All studies included tests of memory, thinking and reported side effects.\ People taking donepezil or galantamine had better scores on memory and thinking tests than people taking placebo, but the benefits were modest and may not be large enough to be evident in daily life. There was no evidence of a difference for rivastigmine, but the evidence was less certain, and the doses taken by some participants may have been too low to show an effect. We found evidence that when compared to placebo, side effects such as nausea and diarrhoea, were more common in people taking donepezil 10mg and galantamine, but probably not donepezil 5mg. We were unable to draw conclusions about side effects of rivastigmine from the studies.\ No vascular dementia trials comparing the different cholinesterase against each other have been conducted. Using the information from the individual studies, we made indirect assessments of how the drugs would perform if tested head‐to‐head. The results suggested that donepezil 10 mg had the greatest effect on memory and thinking, but caused more side effects than donepezil 5 mg or galantamine.\ There were only a small number of studies for each drug. Certainty in the results varied between drugs and between outcomes, from high to very low certainty. The studies showed only a small benefit at most; however, in the absence of any other treatments, people living with dementia may still wish to consider use of these drugs.](https://app.figure1.com/case-detail/10edca9a-0f4d-4601-beed-79b6281cbf49)

\ \ Background\ Dementia is the term used to describe a group of illnesses, usually developing in late life, in which there is a deterioration in a person’s ability to think, remember, communicate and manage daily activities independently. It can be caused by several different brain diseases, but the most common form is dementia due to Alzheimer’s disease. At the moment, there are no medical treatments which can prevent dementia or stop it from progressing, but there are two classes of drugs – the cholinesterase inhibitors (donepezil, rivastigmine and galantamine) and memantine ‐ which are approved and widely prescribed to treat some of the symptoms. They are used mainly for dementia due to Alzheimer's disease but also sometimes for other types of dementia. Most of the trials studying the effects of these drugs have been quite short (typically six months) even though dementia usually lasts for years. The drugs can have unwanted side effects in some people. There is uncertainty about their long‐term effects and about how useful they are for severe dementia, with different countries making different recommendations. Therefore it can be difficult for doctors and patients to decide if and when these drugs should be stopped once they have been started.\ What was the aim of this review?\ In this review, we aimed to summarise the best evidence about whether stopping cholinesterase inhibitors or memantine was beneficial or harmful to people with dementia who had been taking them for at least two months.\ What we did\ We searched up to October 2020 for trials which had: recruited people with dementia who were taking a cholinesterase inhibitor or memantine, or both; divided them randomly into a group of patients who continued treatment and a group of patients who stopped treatment; and compared what happened in the two groups.\ What we found\ We found seven trials (759 participants) to include in the review. All of the participants had dementia due to Alzheimer’s disease, but in some trials, the disease was mild to moderate and in others, it was moderate to severe or very severe. Six trials investigated the effects of stopping a cholinesterase inhibitor and one trial investigated stopping either a cholinesterase inhibitor (specifically, donepezil) or memantine. We decided not to pool its results with the other six trials. Effects were measured over different periods of time in different trials. We looked separately at effects in the first 2 months (short term), between 3 and 11 months (medium term), and after a year or more (long term).\ When we looked at the effect on thinking skills and memory, we found that, compared to stopping treatment, continuing treatment with a cholinesterase inhibitor may be beneficial in the short term and medium term and is probably beneficial in the long term. For ability to carry out daily activities, there may be little or no effect in the short term, and the effect in the medium term was very uncertain, but there is probably a benefit to continuing treatment over the longer term. For mood and behavioural problems, continuing treatment may have benefits in the short term and medium term, but not in the long term. We found no clear evidence about the effects of stopping these drugs on patients’ physical health or risk of dying. There was very little evidence about effects on quality of life or on the likelihood of moving to a care home to live. There was not enough evidence for us to see whether results differed with the severity of dementia.\ Our certainty in the results varied from moderate to very low, mainly because of small numbers of trials and participants, some problems with the way the trials were conducted, and imprecise statistical results.\ Our conclusions\ Although there was uncertainty about the results, most of the evidence pointed to benefits of continuing treatment with cholinesterase inhibitors. There was no evidence about types of dementia other than Alzheimer’s disease, and we were unable to draw specific conclusions about continuing or stopping treatment at different stages of the illness. We found no trials that just investigated stopping memantine.\ These results may help patients and their doctors to make decisions about whether or not to continue treatment, although other factors, such as side effects in an individual patient and the patient’s preferences, are also important.](https://app.figure1.com/case-detail/198b6951-39ef-4467-8c9e-7b47373aaab7)

\ \ Review question\ Can simulated presence therapy (SPT) treat problem behaviours, and improve quality of life for people with dementia?\ Background\ Dementia is an illness, most common among older people, in which memory and other brain functions deteriorate and people gradually become dependent on others for care. Many people with dementia, particularly in its later stages, show signs of distress at times, or behave in ways which are difficult for their caregivers to manage. There is a lot of interest in finding ways to treat this without using drugs. Simulated presence therapy is a type of treatment which has been used mainly in nursing homes. It involves playing a personalised video or audiotape recording of family members to the person with dementia when he or she is distressed or agitated.\ Study characteristics\ We looked for trials which compared SPT to usual care or to another treatment. Ideally, people with dementia should have been randomly allocated to one or other treatment, but we also included trials even if treatment allocation was not strictly random.\ We found three trials which met our inclusion criteria. The 144 participants were all living in nursing homes. The majority were women with an average age of over 80 years and severe dementia. The way SPT was administered was different in each trial. All the trials used more than one comparison treatment, which differed between trials. The trials all attempted to measure an effect on agitated behaviours, but used different approaches.\ Key findings\ Because the trials were so different from each other, we were not able to pool the results. Individually, each trial reported different methods to assess the effect of SPT on behavioural problems and the results varied depending on the method used to measure the outcome.\ None of the studies assessed quality of life, effect on daily activities, effects on caregivers, or how likely participants were to drop out of the study.\ Quality of the evidence\ The studies were small and all had problems with their methods which could have biased their results. Hence, we thought the overall quality of the evidence was very low, meaning we cannot be at all confident in the results.\ Conclusion\ Not enough high‐quality research has been done to allow us to judge whether SPT can help people with dementia who are distressed or agitated.](https://app.figure1.com/case-detail/1d560fd9-5846-457d-8714-355199caf134)

\ \ Key points\ ‐ Psychological treatments based on cognitive behavioural therapy (which focuses on changing thoughts and behaviours) probably have small positive effects on depression, quality of life and daily activities in people with dementia or mild cognitive impairment (MCI).\ ‐ There is not enough evidence to know whether any psychological treatments are helpful for anxiety in people with dementia or MCI.\ ‐ More evidence is needed about different types of psychological treatments and which treatments may be best for which people.\ We found 29 studies that included 2599 people with dementia or MCI. Most of the evidence was about treatments based on cognitive behavioural therapy (CBT, which aims to alter thoughts and behaviours) and treatments aimed at supporting well‐being, which we called counselling and supportive therapies. We also found a very small number of studies about mindfulness‐based cognitive therapy and interpersonal therapy. The majority of studies looked at the effect on depression, but very few studies had anxiety as an outcome.\ The evidence suggests:\ ‐ CBT‐based treatments probably improve symptoms of depression, quality of life and ability to manage daily activities at the end of the treatment period in people with dementia or MCI, although the effects were small. We could not be sure about any effect on anxiety. There was some evidence that the effect on depression might depend on how severe the symptoms of depression were before the start of treatment, whether people had a diagnosis of dementia or MCI and what type of treatment was used, but more research would be needed to be sure about this.\ ‐ Supportive and counselling treatments may have no effect on symptoms of depression at the end of treatment and there was not enough evidence for us to know if there was any effect on anxiety.\ ‐ We cannot be sure about the effect of mindfulness‐based therapies or interpersonal therapy because there were very few studies of these treatments.\ There was limited information about unwanted effects associated with any of the treatments.\ We could be moderately certain about the small positive effects of CBT‐based treatments on depression, quality of life and daily activities, but were less certain about other results.](https://app.figure1.com/case-detail/8c1e9e3d-e248-4d5b-adda-97e1c724af81)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)