STROKE-VCI (PHARMACOLOGIC) MGM

SUMMARY

DISEASE MODIFYING DRUGS
1. Aspirin: moderate evidence2. Perindopril & Indapamide: PROGRESS trial, Arch Int Med 2003; 163(9):1069-75.

SYMPTOM MANAGEMENT
3. Cholinesterase Inhibitors: may be used for vascular dementia, have been used for Alzheimer's disease.

4. Donepezil: there is strong evidence, based on 2 RCTs, donepezil taken for 24 weeks improves cognitive function in patients with probable or possible vascular dementia (Black et al. 2003; Wilkinson et al. 2003). Not recomended for Mild Cognitive Impairment.
5. Galantamine: there is moderate evidence based on a single RCT of excellent quality.
6. Memantine:(NMDA receptor antagonist) associated with stabilization or improvement of cognitive function.
7. Pentoxyfylline:(increases cerebral blood flow) associated with cognitive benefit in patients with multi-infarct dementia.
8. Milnacipran(SNRI used in Rx depression) has positive effects on cognition in stroke patients with depression.
9. Methylphenidate: recommended in adults to enhance attention and speed of cognitive processing.
10. Rivastigmine: limited evidence.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].