Hope for first treatment for strokes linked to dementia

Alzheimer’s Society supported the trial which laid the foundation for this larger trial led by Professor Joanna Wardlaw, University of Edinburgh. This phase 2 trial was supported by the British Heart Foundation.

​Stroke and vascular dementia 

Vascular dementia is a progressive decline in thinking skills due to changes in the brain’s blood supply. It affects over 150,000 people in the UK and one of the biggest risk factors for vascular dementia is stroke although not all vascular dementia involves strokes. 

A type of stroke called a lacunar stroke- which involves a blockage of the blood vessels in the deep part of the brain, can have distressing effects as people may develop problems with their thinking and memory, movement, and even dementia. There are currently no effective treatments. 

Professor Joanna Wardlaw, Chair of Applied Neuroimaging at the University of Edinburgh and Foundation Chair at the UK Dementia Research Institute, said:  

'Up until now, lacunar strokes have been treated just like other types of stroke, but lacunar stroke is clearly different. Now we understand more about what is triggering these strokes to attack the brain, we’ve been able to focus our efforts on treatments that can put a halt to this damage.'

Repurposing drugs

Finding new drug treatments that target the diseases that cause dementia can take up to 20 years and cost millions of pounds. Drug repurposing' which takes drugs that are already being used to treat other conditions and tests their potential as a treatment for others conditions, in this case stroke and vascular dementia.  

Researchers at Universities of Edinburgh and Nottingham, and the investigated whether mononitrate and cilostazol could be repurposed to treat patients after a lacunar stroke. Today these drugs are licensed to treat other heart and circulatory diseases. As they are already being used in the clinic we understand more about their safety profile and we hope this will mean we can bring these types of treatments to people affected by stroke who may experience memory and thinking problems  dementia faster. 

Breaking news  

A clinical trial led by Professor Wardlaw, Philip Bath, and the UK Dementia Research Institute which is part-funded by Alzheimer’s Society, has shown that two cheap and readily available treatments called isosorbide mononitrate and cilostazol can safely and effectively improve a person's experience after lacunar stroke, particularly when they’re used in combination. 

The trial involved 363 people who had experienced a lacunar stroke. As well as their standard stroke prevention treatment, their participants took either one of the new treatments, or both at the same time for a year.  

After one year, people who took both drugs at the same time were nearly 20 per cent less likely to have problems with their thinking and memory compared to the group that did not take either drug. This group was also more independent and reported a better quality of life. 

These are promising results; however, we will have to wait to see if these results can be confirmed in their larger 4 year clinical trial to see the effectiveness and safety of the drug before these treatments can be made available for people to use after they’ve had a lacunar stroke.  

Professor Joanna Wardlaw, said:  

“We need to confirm these results in larger trials before either drug can be recommended as a treatment. However, as these drugs are already widely available for other circulatory disorders, and inexpensive, it shouldn’t take too long to move our findings from research into everyday clinical practice."

Alzheimer’s Society and the LACI-1 trial 

Professor Wardlaw’s previous trial funded by Alzheimer’s Society laid the foundation for this research. In a smaller trial, Professor Wardlaw recruited 57 participants and increased their dose of isosorbide mononitrate and cilostazol over a 2-week period till they reached the target range. They then maintained this dose over 8-weeks to see what effects it would have on their participants after a lacunar stroke. Results from this trial showed that these drugs were well tolerated when the dose was escalated, without safety concerns in patients. 

How can you get involved in dementia research? 

Alzheimer’s Society has a Join Dementia Research helpdesk which is a great way for people to find out more about the benefits of being involved in dementia research, how the service works, and the types of exciting studies that are currently looking for volunteers including trials looking into new treatments, therapies and improving care and support.