In a study from the University of Nottingham and elsewhere, scientists found two cheap and common drugs could be re-purposed as the first specific treatment for people who experience a type of stroke linked to nearly half of all dementias.
They showed that isosorbide mononitrate and cilostazol, which are already used to treat other heart and circulatory diseases, can safely and effectively improve the debilitating outcomes people experience after lacunar stroke, particularly when they’re used in combination.
Lacunar strokes affect at least 25,000 people in the UK each year. They’re thought to be caused by cerebral small vessel disease (cSVD), where small blood vessels deep within the brain become damaged and stop working properly.
Lacunar strokes can have distressing effects as people may develop problems with their thinking and memory, movement, and even dementia. There are currently no effective treatments.
The two drugs trialed could be available as a treatment for lacunar strokes within five years, if the results are confirmed in further trials.
In the study, the team examined 363 people who had experienced a lacunar stroke.
As well as their standard stroke prevention treatment, participants took either isosorbide mononitrate or cilostazol individually, both drugs together, or neither, for one year.
The researchers examined cilostazol and isosorbide mononitrate as they are thought to improve the function of the inner lining of blood vessels (the endothelium).
Problems with the endothelium are thought to play a role in CVD.
After one year, participants that took both drugs were nearly 20% less likely to have problems with their thinking and memory compared to the group that did not take either drug.
They were also more independent and reported a better quality of life.
Those who took isosorbide mononitrate were less likely to have had further strokes in one year than those who did not take the drug.
Individually isosorbide mononitrate also improved thinking and memory skills, and quality of life, while cilostazol improved independence and mood.
But these effects were strengthened when the two drugs were taken together.
The team is now planning to test these drugs in a larger four-year clinical trial, which they hope to start by the end of 2023.
They are also looking to test whether the drugs are effective in different conditions linked to cSVD, such as vascular cognitive impairment and dementia.
If you care about brain health, please read studies about how the Mediterranean diet could protect your brain health, and blueberry supplements may prevent cognitive decline.
For more information about brain health, please see recent studies about antioxidants that could help reduce dementia risk, and flavonoid-rich foods could improve survival in Parkinson’s disease.
The study was conducted by Professors Joanna Wardlaw et al and presented at the American Heart Association International Stroke Conference.
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