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BMC Med. 2017 May 24;15(1):107. doi: 10.1186/s12916-017-0869-6.

Towards the concept of disease-modifier in post-stroke or vascular cognitive impairment: a consensus report.

Author information

1
University of Lille, Inserm, CHU, U1171 'Degenerative and vascular cognitive disorders', Lille, France. regis.bordet@univ-lille2.fr.
2
Département de Pharmacologie Médicale, Faculté de Médecine, 1 place Verdun, 59045, Lille Cedex, France. regis.bordet@univ-lille2.fr.
3
University of Duesseldorf, Alexian Research Center, Krefeld, Germany.
4
Department of Neurology, Tel Aviv University, Ramat Aviv, Israel.
5
Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
6
University Medical Centre Ljubljana, Neurologic Hospital, Neurorehabilitation Unit, Ljubljana, Slovenia.
7
Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany.
8
Department of Neurology, Neurosurgery and Genetics, Russian National Research Medical University, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.

Abstract

BACKGROUND:

Vascular cognitive impairment (VCI) is a complex spectrum encompassing post-stroke cognitive impairment (PSCI) and small vessel disease-related cognitive impairment. Despite the growing health, social, and economic burden of VCI, to date, no specific treatment is available, prompting the introduction of the concept of a disease modifier.

CONSENSUS AND SUGGESTIONS:

Within this clinical spectrum, VCI and PSCI remain advancing conditions as neurodegenerative diseases with progression of both vascular and degenerative lesions accounting for cognitive decline. Disease-modifying strategies should integrate both pharmacological and non-pharmacological multimodal approaches, with pleiotropic effects targeting (1) endothelial and brain-blood barrier dysfunction; (2) neuronal death and axonal loss; (3) cerebral plasticity and compensatory mechanisms; and (4) degenerative-related protein misfolding. Moreover, pharmacological and non-pharmacological treatment in PSCI or VCI requires valid study designs clearly stating the definition of basic methodological issues, such as the instruments that should be used to measure eventual changes, the biomarker-based stratification of participants to be investigated, and statistical tests, as well as the inclusion and exclusion criteria that should be applied.

CONCLUSION:

A consensus emerged to propose the development of a disease-modifying strategy in VCI and PSCI based on pleiotropic pharmacological and non-pharmacological approaches.

KEYWORDS:

Clinical trial; Disease-modifying therapy; Multimodal approach; Post-stroke cognitive impairment; Vascular cognitive impairment; Vascular dementia

PMID:
28539119
PMCID:
PMC5444106
DOI:
10.1186/s12916-017-0869-6
[Indexed for MEDLINE]
Free PMC Article

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