Rivastigmine for vascular cognitive impairment

  • Review
  • Intervention

Authors


Abstract

Background

Vascular dementia represents the second most common type of dementia. The classification of vascular dementia broadly follows three clinico-pathological processes: multi-infarct dementia, single strategic infarct dementia and subcortical dementia. Not all victims fulfil strict criteria for dementia and may be significantly cognitively impaired without memory loss and the term vascular cognitive impairment is more useful. Currently, no established standard treatment for vascular cognitive impairment exists. Reductions in acetylcholine and acetyltransferase activity are common to both Alzheimer's disease and vascular cognitive impairment raising the possibility that cholinesterase inhibitors like rivastigmine may be beneficial for the latter.

Objectives

To assess the efficacy of rivastigmine in the treatment of people with vascular cognitive impairment, vascular dementia or mixed dementia.

Search methods

The Cochrane Dementia and Cognitive Improvement Group Specialized Register was searched for trials on 7 June 2006 using the terms: rivastigmine, Exelon, "SDZ ENA 713", SDZ-ENA-713. All major healthcare databases and many ongoing trial databases within the scope of the Group are searched regularly to keep this register up to date.

Selection criteria

All unconfounded randomized double-blind trials comparing rivastigmine with placebo were eligible for inclusion.

Data collection and analysis

No suitable trials were identified and thus we were unable to extract appropriate data or calculate summary statistics.

Main results

We were unable to perform a meta-analysis given the absence of suitable trials. Other trials relevant to the field were identified and some indication of benefit in several cognitive and non-cognitive domains was noted.

Authors' conclusions

From existing trial data there is some evidence of benefit of rivastigmine in vascular cognitive impairment. However, this conclusion is based on studies which had small numbers of patients, which sought to compare rivastigmine to treatments other than placebo or which used data extrapolated post hoc from large studies involving patients with Alzheimer's disease and vascular risk factors of unclear significance. Large placebo-controlled, double blind and adequately randomised trials are needed before firm conclusions can be drawn. The methodology of such trials should acknowledge the biological and clinical features unique to vascular cognitive impairment and its subtypes.

Plain language summary

No evidence of benefit of rivastigmine for vascular cognitive impairment (VCI)

Although existing trial data indicated some benefit of rivastigmine in VCI, these were derived from studies which had small numbers of patients, and which compared rivastigmine to treatments other than placebo or extrapolated results post hoc from large studies involving patients with Alzheimer's disease and vascular risk factors of unclear significance. They could not be included in this review. Proper randomized placebo-controlled double-blind trials involving patients with VCI are needed before any conclusions regarding the use of rivastigmine in VCI can be drawn.