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Subcortical Vascular Dementia: Survey of Treatment Patterns and Research Considerations

Published online by Cambridge University Press:  18 September 2015

Frank J. Molnar*
Affiliation:
Division of Geriatric Medicine, University of Ottawa and Geriatric Assessment Unit, Ottawa Civic Hospital, Ottawa, Ontario
Malcolm Man-Son-Hing
Affiliation:
Division of Geriatric Medicine, University of Ottawa and Geriatric Assessment Unit, Ottawa Civic Hospital, Ottawa, Ontario
Phil John
Affiliation:
Section of Geriatric Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba
Chris Brymer
Affiliation:
Division of Geriatric MedicineUniversity of Western Ontario, London, Ontario
Kenneth Rockwood
Affiliation:
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia
Vladimir Hachinski
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario.
*
Geriatric Assessment Unit, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada Kl Y 4E9
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Abstract:

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Background:

Since few studies have examined the effectiveness of therapies for subcortical vascular dementia, treatment guidelines are not available. Current patterns in the treatment of such dementias have not been studied.

Objective:

To determine the practice patterns of Canadian specialists for the treatment of subcortical vascular dementia, and to survey their opinions regarding issues which are important in the design of a randomized controlled trial (RCT) in this field.

Design:

National survey of all specialists certified in Neurology or Geriatric Medicine.

Results:

Of responding physicians (78%) prescribed antithrombotic therapy for patients with vascular dementia. Most begin treatment with aspirin 325 mg daily (64%). The next three most common initial treatments were; no pharmacotherapy (12%), aspirin 650 mg daily (11%), and aspirin 1300 mg daily (11%). If the dementia continued to progress despite initial therapy, the treatment options were more varied. Most specialists (69%) believed that an RCT to assess the efficacy of aspirin in vascular dementia is warranted. The majority (69%) also felt that serial neuroimaging would be required for participants in such a trial, with magnetic resonance imaging being cited most frequently (41%). The majority of specialists considered three years as the minimum durationb for such a trial.

Conclusions:

Specialist physician practice patterns vary significantly for the treatment of patients with subcortical vascular dementia. Most physicians believe that an RCT testing the efficacy of aspirin in this condition is required. However, before such a trial can be conducted, many methodological difficulties need to be addressed.

Résumé:

RÉSUMÉ:Introduction:

Comme peu d'études ont examiné l'efficacité des traitements de la démence vasculaire sous-corticale, il n'existe pas de lignes directrices pour le traitement de cette condition. Le traitement courant de ces démences n'a pas été étudié.

Objectifs:

Nous voulons déterminer quel est le traitement prescrit par les spécialistes canadiens dans la démence vasculaire sous-corticale et enquêter sur leurs opinions au sujet d'aspects qui sont impor¬tants dans la planification d'une étude contrôlée, randomisée (ECR) dans ce domaine.

Plan de l'étude:

Il s'agit d'une enquête auprès de tous les spécialistes certifiés en neurologie ou en gériatrie

Résultats:

78% des répondants pre¬scrivent une thérapie antithrombotique chez les patients atteints d'une démence vasculaire. La plupart (64%) commen¬cent le traitement par de l'aspirine à la dose de 325 mg i.d. Les trois autres traitements initiaux les plus fréquents étaient: aucune médication (12%), de l'aspirine à la dose de 650 mg i.d. (11%) et de l'aspirine à la dose de 1300 mg i.d. (11%). Si la démence continuait à progresser malgré ce traitement, les options de traitement étaient plus variées. La plupart des spécialistes (69%) croyaient qu'une ECR pour évaluer l'efficacité de l'aspirine dans la démence vascu¬laire est justifiée. La majorité (69%) croyaient également qu'une évaluation des patients participant à une telle étude par imagerie neurologique sériée serait nécessaire. La technique la plus fréquemment (41%) citée était la résonance magnétique. La majorité des spécialistes considérait que la durée minimum d'une telle étude devait être de 3 ans.

Conclusions:

Les modes de traitement des spécialistes varient beaucoup quant au traitement des patients atteints de démence vasculaire sous-corticale. La plupart des médecins croient qu'une ECR évaluant l'efficacité de l'aspirine dans cette maladie est nécessaire. Cependant, avant d'entreprendre une telle étude, plusieurs difficultés méthodologiques doivent être résolues.

Type
Original Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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