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(Stroke. 2003;34:584.)
© 2003 American Heart Association, Inc.

Emerging Therapies

Acetylcholinesterase Inhibitors for Vascular Dementia and Alzheimer’s Disease Combined With Cerebrovascular Disease

From the Department of Neurology, Royal Free Hospital, London, UK.

Correspondence to Dr John V. Bowler, Royal Free Hospital, Dept of Neurology, London NW3 2QG, UK. E-mail j.bowler@rfc.ucl.ac.uk

Key Words: acetylcholine • acetylcholinesterase • cognitive disorders • dementia, multi-infarct • treatment outcome

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In a recent article by Erkinjuntti et al,¹ galantamine, an acetylcholinesterase inhibitor, was shown to be effective in the treatment of probable vascular dementia (VaD) and Alzheimer’s disease (AD) combined with cerebrovascular disease (CVD).

The study was of seemingly unusual design in that 2 apparently disparate conditions were merged together, although this is not the only trial to have used this methodology.² The authors’ rationale lies partly in their statement that "differentiation between AD and VaD on clinical grounds can be difficult," and the trial is therefore using a pragmatic approach, being a trial of treatment of cognitive impairment in the presence of CVD regardless of coexistent conditions. In fact, the study population was probably, and inadvertently, more homogeneous than the title suggests. The reason for this lies in mixed dementia and the diagnostic criteria used. These were the now-outdated NINDS-AIREN³ criteria for probable VaD and the NINCDS-ADRDA⁴ criteria for possible AD, coupled with a requirement for radiological evidence of significant cerebrovascular disease. Mixed dementia—ie, the coexistence of CVD with AD—is now known to be very common and may be the single commonest form of dementia.⁵ Both the NINDS-AIREN and NINCDS-ADRDA criteria were prepared before this was recognized. When these criteria were prepared, small amounts of CVD were routinely ignored when seen in conjunction with what was otherwise thought to be AD. There is now convincing evidence for a powerful interaction between these disease processes when coexistent^6,7 and further evidence that these conditions coexist more often than would be expected . . . [Full Text of this Article]

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