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


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


METHODS
Outpatient tertiary care center.


METHODS
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.


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


METHODS
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.


CONCLUSIONS
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.
Black
R S
RS
Dementia Research Service, Cornell University Medical College, Burke Rehabilitation Center, White Plains, New York 10605.
Barclay
L L
LL
Nolan
K A
KA
Thaler
H T
HT
Hardiman
S T
ST
Blass
J P
JP
D000046:Academic Medical Centers; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D015161:Dementia, Multi-Infarct / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009518:New York; D010044:Outpatient Clinics, Hospital; D010431:Pentoxifylline / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D010431:Pentoxifylline