Vascular care in patients with Alzheimer's disease with cerebrovascular lesions-a randomized clinical trial.
OBJECTIVE
To investigate whether vascular care slows dementia progression in patients with Alzheimer's disease with cerebrovascular lesions on neuroimaging.


METHODS
Multicenter randomized controlled clinical trial with 2-year follow-up.


METHODS
Neurological and geriatric outpatient clinics in 10 Dutch hospitals: three academic, five teaching, and two midsize community hospitals.


METHODS
One hundred thirty community-dwelling patients with mild dementia fulfilling clinical criteria for Alzheimer's disease with cerebrovascular lesions on neuroimaging.


METHODS
Patients randomized to vascular care were treated according to strict guidelines for hypercholesterolemia and hypertension. Acetylsalicylic acid, folic acid, and pyridoxine were prescribed. During visits every 3 months special attention was paid to smoking cessation, losing weight, and stimulating physical exercise.


METHODS
Primary outcome was disability, measured according to the Interview for Deterioration in Daily activities in Dementia (IDDD). Secondary outcomes were changes on the Mini-Mental State Examination (MMSE), the Revised Memory and Behavioural Problems Checklist (RMBPC), a composite measure of "poor outcome" (death, institutionalization, or severe clinical decline), and costs.


RESULTS
Patients in the vascular and standard care condition declined equally on the IDDD (13.7 vs 11.0 points; difference 2.7, 95% confidence interval = -3.1-8.6). There was no treatment effect on the MMSE or RMBPC. There were no differences in institutionalization rate, "poor outcome" (41.4% vs 35.4%, P=.50), or costs. In the intervention group, there were three intracerebral hemorrhages and one gastrointestinal hemorrhage, versus none in the control group.


CONCLUSIONS
Multicomponent vascular care, combining pharmacological and nonpharmacological interventions, does not slow decline in patients with Alzheimer's disease with cerebrovascular lesions.
Richard
Edo
E
Academic Medical Centre, University of Amsterdam, Postbus 22660, Amsterdam 1100DD, The Netherlands. e.richard@amc.uva.n
Kuiper
Roy
R
Dijkgraaf
Marcel G W
MG
Van Gool
Willem A
WA
D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001241:Aspirin / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D004038:Diet, Reducing; D018450:Disease Progression; D015444:Exercise; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D016014:Linear Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011736:Pyridoxine / Q000627:therapeutic use; D016540:Smoking Cessation; D016896:Treatment Outcome
D005492:Folic Acid; D011736:Pyridoxine; D001241:Aspirin