Clinical Observation Of Memantine And Memantine Combined With Nimodipine On Cognitive Function And Daily Life Ability In Patients With Vascular Cognitive Impairment

Background:Vascular cognitive impaiiment(VCI) encompasses all the cognitive disorders associated with cerebrovascular disease (cerebral infarct, intracerebral hemorrhage and leukoencephalopathy) or cerebro-vascular risk factors (hypertension, diabetes and hyperlipidemia), from frank dementia to mild cognitive deficits, and the most severe form of VCI is vascular dementia (VaD). It is second most common cause of dementia. The prevalence of VCI is likely to increase as the population ages and cardiovascular disease survival improves, which not only seriously affects the quality of patients’live, but also brings heavy mental and economic burden to the family and society. Prevention and treatment of VCI become an important problem in clinical work, which cause the attention of many scholars. Because vascular risk factors are treatable, it should be possible to prevent, postpone, or mitigate VCI. While the precise mechanisms are still not fully understanding, but during the past decade, we have gained a more progress of VCI (eg, the importance of toxicity of excitatory amino acids, inflammation, cholinergic nerve dysfunction and so on). Memantine is noncompetitive N-methyl -D-aspartate(NMDA) receptor antagonists, with neuroprotective effect. Based on evidence-based medicine, memantine is approved for the treatment of medium and severe AD, and received more attention to the treatment for VCI in recent years. Nimodipine is dihydropyridine calcium antagonist, which blocks L-type calcium channel and affects the automatic adjustment of cerebral blood flow and the expansion of cerebrovascular, so it has the potential effect for neuroprotective. So, in theory, nimodipine could be used for prevention and treatment of VCI. VCI is a heterogeneous disease, and the pathogenesis is complex, so there are some inevitable defects with a single treatment. At present, how to combined use of drug to improve cognitive function in patients with VCI has become a research hotspot in the field of cognition.Purpose:To observe and compare the therapeutic effect of memantine and memantine combined with nimodipine on cognitive function and daily life ability in patients with vascular cognitive impairment.Methods:1. Objects of study:Choose the mild and moderate vascular cognitive impairment patients from department of neurology in Sichuan Province People’s Hospital. A total of60patients with vascular cognitive impairment were randomly divided into the treatment group A and group B.2. Therapy:Patients in the group A were treated with memantine20 mg/day. In order to reduce the occurrence of side effects, the initial dose of memantine was5mg per day, at the next three weeks, it gradually increased5mg every week to achieve maintenance dose. The other patients in the group B were treated with memantine combined with nimodipine. The use of memantine was same as group A. And nimodipine was30mg for each administration,3times a day.3. The outcome indicators:The treatment course was26weeks for both groups. The scores of clinical efficiency, Mini-Mental State Exami-nation (MMSE), Montreal Cognitive Assessment (MoCA) and Activity of Daily Living Scale (ADL) were analyzed.Results:1. Before treatment, in the two groups, the baseline data of each index showed no significant difference (p>0.05).2. After treatment, in the two groups, MMSE and MoCA scores improved, the ADL score decreased. After26weeks treatment, MMSE, ADL and MoCA scores were significant difference, compared with the baseline data (p<0.05).3. After26weeks treatment, in group B, MMSE, MoCA added value were more obvious than group A, and there were significant difference (p<0.05); compared with group A, ADL decreased value went down even more, but no significant difference (p>0.05). Conclusion:Memantine combined with nimodipine to treat patients with mild-to-moderate VCI may be improve cognitive function better than Memantine single use, meanwhile, have some improvement in daily life ability. During the period of treatment, combined treatment group’s adverse reactions do not increase. A better curative effect in combined treatment group, it may be rely on the different pharmacological mechanisms existing complementary action and synergistic effect.