Pentoxifylline in cerebrovascular dementia.

Abstract

OBJECTIVE:

To test the effect of pentoxifylline, a hemorheologic agent used to treat intermittent claudication, on the course of vascular dementia.

DESIGN:

Randomized, double-blind, placebo-controlled, parallel group trial.

SETTING:

Outpatient tertiary care center.

PATIENTS:

64 patients meeting DSM-III criteria for multi-infarct dementia with modified Hachinski ischemic scores greater than or equal to 6, 38 of whom completed the trial.

INTERVENTION:

Pentoxifylline (Trental) 400 milligram tablets three times daily vs placebo for 36 weeks.

MAIN OUTCOME MEASURE:

Alzheimer's Disease Assessment Scale (ADAS).

RESULTS:

Baseline demographic values and psychometric variables were similar in the placebo and control groups; endpoint statistical analysis was used to allow the use of data from all patients in this clinically high-risk group. For the total group, the slowing of deterioration did not reach statistical significance (by 2-tailed t test), as measured by scores on the total ADAS (P = 0.058) or on the cognitive (ADAS items 1-11; P = 0.064) or non-cognitive subscales (ADAS items 12-21; P = 0.234), although it was significant on the cognitive subscales excluding memory (ADAS items 2-6, 8-10; P = 0.036). For the subgroup of 40 patients who had CT and/or MRI evidence of stroke as well as meeting the other inclusion criteria, treatment with pentoxifylline was associated with significantly slower deterioration, as measured by the total ADAS (P = 0.023) and cognitive subscores (P = 0.020) but not non-cognitive subscores (P = 0.118). For the subgroup of 37 patients who had at least one discrete clinical stroke, treatment with pentoxifylline was associated with significantly less deterioration on the total ADAS (P = 0.002) and both the cognitive (P = 0.001) and non-cognitive (P = 0.017) subscores.

CONCLUSION:

Treatment with pentoxifylline may slow the progression of dementia in patients who meet DSM-III criteria for "multi-infarct dementia" and who also have clinical and neuroradiological evidence of cerebrovascular disease.

• Authors: R S Black, L L Barclay, K A Nolan, H T Thaler, S T Hardiman, J P Blass
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 40 Issue 3 Pg. 237-44 (Mar 1992) ISSN: 0002-8614 [Print] United States
• PMID: 1538042 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Pentoxifylline

Topics

• Academic Medical Centers
• Administration, Oral
• Aged
• Aged, 80 and over
• Cognition
• Dementia, Multi-Infarct (diagnosis, drug therapy, etiology)
• Double-Blind Method
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neuropsychological Tests
• New York
• Outpatient Clinics, Hospital
• Pentoxifylline (administration & dosage, pharmacology, therapeutic use)
• Rehabilitation Centers
• Severity of Illness Index
• Tomography, X-Ray Computed