title: Transcranial Doppler assessment of cerebral vasomotor reactivity in evaluating the effects of vinpocetine in cerebral small vessel disease: a pilot study.
abstract: BACKGROUND
  There are still dilemmas about the vasodilating effect of vinpocetine, a synthetic ethyl alkaloid vincamine. The method of measuring cerebral vasomotor reactivity (VMR) by transcranial Doppler (TCD) technique before and after administration of the medication was used to estimate the degree of arterioles vasodilatation. The aim of this study was to test of the vasodilating effect of vinpocetine in patients with cerebral small vessel disease (SVD) by measuring cerebral VMR.
  
  
  METHODS
  Thirty patients with SVD were on 3-month-long oral treatment with 15 mg vinpocetine daily. Cerebral VMR was determined by breath holding test. The breath holding index (BHI) was calculated in standard manner and values > 0.69 were considered normal. At the baseline, before treatment (I), BHI, modified Rankin scale (mRS) score, Mini Mental State Examination (MMSE) score were determined. One month later (II) BHI was assessed again, while after 3 months of treatment (III) we analyzed BHI, mRS score and MMSE score.
  
  
  RESULTS
  The average age of patients was 61.4 +/- 11.5 years (range 40 to 77 years), 18 (60%) female and 12 (40%) males. Values of BHIs were increased during treatment at the right MCA (I) 1.18 +/- 0.53, (II) 1.26 +/- 0.54, (III) 1.37 +/- 0.41, with statistical significance between I and III measurement (p < 0.05). An increase was noted on the left MCA (I) 1.25 +/- 0.53, (II) 1.31 +/- 0.55 and (III) 1.32 +/- 0.42, but it did not reach statistical significance (p > 0.05). Mean MMSE score significantly increased from baseline 27.4 +/- 2.3 to 28.5 +/- 2.0 after three months of treatment (p < 0.001). Functional status showed a statistically significant improvement with mRS score increasing from 2.1 +/- 1.0 to 1.1 +/- 0.6 (p < 0.001).
  
  
  CONCLUSIONS
  This pilot study showed that 3-month-long oral treatment with vinpocetine 15 mg daily had tendency to increase BHI, indicating improvement of cerebral VMR. It is possible that higher doses of vinpocetine are needed to achieve substantial increase of VMR.
authors: Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Faculty of Medicine, Belgrade. zagorkajovanovic26@gmail.com
authors: Zagorka B
authors: ZB
authors: Jovanović
authors: Aleksandra M
authors: AM
authors: Pavlović
authors: Tatjana
authors: T
authors: Pekmezović
authors: Milija
authors: M
authors: Mijajlović
authors: Nadezda Sternić
authors: NS
authors: Covicković
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D003071:Cognition / Q000187:drug effects*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017585:Ultrasonography, Doppler, Transcranial; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014666:Vasomotor System / Q000187:drug effects; D014748:Vinca Alkaloids / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D014748:Vinca Alkaloids; C013983:vinpocetine