Efficacy And Safety Of Idebenone And Nimodipine In Vascular Dementia

Objective: Vascular dementia(VD) is a cognitive impairment resultingfrom cerebrovascular disease and ischemic or hemorrhagic brain injury, is thesecond common type of dementia, only second to Alzheimer’s disease (AD).With the increasing of the incidence of Cerebrovascular diseases,the incidenceof VD increases significantly,which not only seriously affects the patient’shealth and the quality of patient’s life,but also brings huge burden to theirfamilies and the society.VD is the only dementia that can be prevented,sofar.And early treatment is reversible for VD.Idebenone is a analogue of coenzyme Q10that can not only activate themitochondrial electron transport chain,facilitate the production of ATP，improve the energy metabolism of cerebral ischemia and hypoxia,but also canbe a powerful antioxidants,scavenge a variety of free radical generated whenthe brain is ischemic and hypoxic,thereby,inhibit microsomal lipidperoxidation induced by those free radical,protect the mitochondrialmembrane and keep its normal physiological function.In addition,Idebenonecan inhibit the platelet aggregation and atherosclerosis,improve the cerebralenergy metabolism.Nimodipine， which is a1,4-dihydropyridine-derivative L-type Ca2+channel blocker，has potent vasodilatory effect on cerebral vessels，can preventthe cerebral vasospasm and reduce the resistance of cerebralcirculation,thereby increases cerebral blood flow and improve cerebralmetabolism.In addition,Nimodipine also works on neurons, specificallyCombined with learning and memory of the relevant function area in the brain,especially the hippocampus and cortex, restrain the abnormal open of Ca2+channels when the region ischemia and hypoxia, inhibit cell damage caused bycell toxic substance,which can be caused by calcium overload, thereby have nerve protection.In this randomized,controlled,open,clinical trial, Efficacy and safety ofIdebenone and Nimodipine was evaluated in vascular dementia.Methods: In this randomized, controlled, clinical trial,66patients of VDwas collected, according to Diagnostic and Statistical Manual of MentalDisorders，Fourth Edition（DSM-IV）, who were randomized to the group ofIdebenone or Nimodipine. The group of Idebenone were received Idebenone90mg per day（30mg per tablet，1tablet per time，3times a day，oral after permeal）, the group of Nimodipine were received Nimodipine120mg per day（20mg per tablet，2tablet per time，3times a day，oral after permeal）.Idebenone or Nimodipine were given for3months.In the observationperiod,foundation treatment were given conventionally,includingantihypertensive drugs、 Hypoglycemic Drugs、 AntihyperlipidemicDrugs,etc.But the drugs,which can promote the patients intellectual, wereinhibited,such as:the cholinesterase inhibitors donepezil hydrochloride andHuperzine tablet、 the N-methyl-D-aspartate receptor antagonistMemantine,Cerebral metabolic enhancer oxiracetam,etc.The patients werebeen followed up in1month and3months.Efficacy was evaluated using minimental state examination（MMSE），Montreal cognitive assessmen（tMoCA），activity of daily living（ADL）.Safety was evaluated using incidence of adverseevents, laboratory abnormalities such as abnormalities of hepar function andrenal function,recurrence of cerebrovascular disease,etcResults:66patients with VD66were enrolled, of which65completedthe study,of which35were the Idebenone group(male22,female13,mean age63.06±4.45years),of which31were the Nimodipine group(male20,female11,mean age61.39±6.43years).there are no significant difference in gender,age, illness weight degree (MMSE before treatment, MoCA, ADL score) ofthe two groups（P>0.05）. These data demonstrate that the group of Idebenoneand Nimodipine after treatment2times follow-up, mini mental stateexamination（MMSE），Montreal cognitive assessment（MoCA），activity ofdaily living（ADL）scores are higher than before treatment. the scores were rising and had significant difference and statistical significance (P <0.05).However,the Idebenone group compared with the Nimodipine group,mini mental state examination（MMSE），Montreal cognitive assessment（MoCA），activity of daily living（ADL）scores had no significant differenceand statistical significance （P>0.05）.Because of rash,one patient oftheIdebenone group exited the test and improved after withdrawal; In theNimodipine group1case of patients appears facial blushing,2cases ofpatients’ blood pressure drops,which improved after adjusting themedication;The rest of the patients did not see the obvious adverse reaction.Conclusion: Idebenone and Nimodipine can effectively improve thecognitive ability of vascular dementia patients, including executive ability, andhad higher security and well tolerated.However, compared with each other,hadthe similar curative effect,and no obvious difference.