cognitive function: [SMD 0.19, 95% CI 0.06, 0.31, P = 0.004], 3. cerebrovascular dementia at: Data were extracted independently by the same two reviewers (JB and JLA) and crosschecked. Pharmacological and clinical properties. Comparison 2 Nimodipine vs placebo (primary degenerative dementia), Outcome 7 Withdrawals before end of treatment. There are other aspects that call for caution. Lehrl S, [8] Some subtests of the Revised Wechsler Adult Intelligence Scale (WAISR) are identical to those of the WMSR although the primary purposes of the tests are different. The mean treatment effects and the standard errors for each trial were calculated from reported information if not stated explicitly in the text. Within these groups there was a wide variety of scales. Although often used together, concurrent use of calcium-channel blockers and beta-blockers may result in additive hypotensive, negative inotropic, and/or bradycardic effects in some patients. Ban 1990 MMSE The same two reviewers (JB and JLA) assessed the methodological quality of each trial. Zamperini D, After being assessed they were excluded. Woo J. Baasch H. Mental deterioration in old age:results of two multicentre, clinical trials with nimodipine, The use of nimodipine (NimotopBayer) in patients with chronic ischaemic cerebral vasculopathies. Vera AE, Morich 1996 1996 MMSE Platt D, Morey L, Changes in calcium homoeostasis are an aspect aging that may have implications for higher cerebral functions. Thus the results and conclusions remain unchanged. Maio L, Death No efficacy measures used. Any discrepancies were solved by discussion. By pooling available data from all trials, whatever the diagnosis of the patients included, this review found benefit associated with nimodipine (90 mg/day at 12 weeks) compared with placebo on the SCAG scale (WMD 7.59, 95% CI 9.87 to 5.31, P<0.00001), on clinical global impression (WMD 0.87, 95% CI 1.07 to 0.67, P<0.00001) and cognitive function (SMD 0.61, 95% CI 0.42 to 0.81, P<0.00001) but not on scales assessing activities of daily living. Gold L, Fischhof concluded that 'nimodipine improves clinical symptomatology and cognitive functions in dementia significantly better than placebo but is more effective in PDD than MID'. 5. Cole JO. Such studies should report results from the first treatment period separately. Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) are oral medications that reverse erectile dysfunction by enhancing the effects of nitric oxide, a . A discussion of clinical phase III studies with nimodipine as a model, Nimodipine in the treatment of chronic cerebrovascular insufficiency, Nimodipine. McNamara R, Comparison 2 Nimodipine vs placebo (primary degenerative dementia), Outcome 4 Clinical Global Impression global. Indirect comparisons as reported do not provide adequate evidence. Spadari G, Palliation of the progressive memory impairment of Alzheimer's disease by nimodipine, Calcium channel blocker nimodipine for primary degenerative dementia, Shortterm effects of the calcium channel blocker nimodipine (Baye9736) in the management of primary degenerative dementia, Effect of nimodipine on the wellbeing, symptoms and efficiency of ambulatory patients with cerebrovascular disorders, Nimodipine. Morich 1996 GERRI CGIglobal impression: [WMD 0.07, 95% CI 0.18, 0.04, P = 0.2] Wang LN, Empirical research has shown that lack of adequate allocation concealment is associated with bias. Available for Android and iOS devices. CGI severity of disease: [WMD 0.07, 95% CIs 0.22, 0.08, P = 0.4] Also, where outcome variables are continuous, authors should state the appropriateness of the assumptions used (i.e. Littschauer L, Tedeschi D, The metaanalyses compare nimodipine with placebo in three populations, patients with any type of dementia, primary degenerative dementia and vascular dementia. An example of the first type is the Clinical Global Impression of Change (CGIC) , which provides an overall categorical assessment of the patient relative to baseline. Acceptability of treatment (as measured by withdrawal rate from trial) Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 10 number of patients with at least one serious adverse event before end of treatment. The outcome measures fell within the general groupings of clinical global impression, functional performance, behavioural disturbance and psychometric scores. Such tests are the Wechsler Memory Scale (WMS) (Wechsler 1987), and the Randt Memory Test (RMT) (Randt 1980). Side effects Dosage Interactions What is avanafil? Azzarelli O, MacNamara R, Mattis dementia scale Pantoni L, Zhang XH, The studies are identified from: To view a list of all sources searched for ALOIS see About ALOIS on the ALOIS website. Soglian AG, London psychogeriatric scale All remaining cases were included in the multiinfarct dementia group. It appears to be well tolerated with few side effects. Palin AN, The data of the two trials with randomized treatment period of 26 weeks were pooled with data from the 24 weektrials. The metaanalyses are based on data from participants who completed the studies. Pantoni L, et al. A zero score indicates the most severe cognitive impairment. A nimodipine interventional study of patients with mild cognitive impairment, Zhonghua Nei Ke Za Zhi [Chinese Journal of Internal Medicine]. Severity of illness is rated from 1 (normal) to 7 (extremely ill). Villavicencio de Ojeda A, Women who take it might also have increased blood flow to the genitals. SCAG: [WMD 11.75, 95% CI 15.64, 7.85, P < 0.00001] All unconfounded, doubleblind, randomized trials in which treatment with nimodipine was administered for more than a day and compared with placebo in patients with dementia, of unclassified type or attributable to Alzheimer's disease, cerebrovascular disease, or mixed Alzheimer's and cerebrovascular disease. The most common side-effects include feeling dizzy or faint, and feeling sick (nausea). Premature ejaculation that relates to erectile dysfunction may resolve if the erectile dysfunction is treated successfully. Patients with cognitive impairment can complete only a small section of these standard tests and therefore specific cognitive tests have been developed for them: MMSE is in widespread use for evaluating cognitive function. Quality of life An additional report of Pantoni 2000 examined the response to nimodipine of two subgroups of cerebrovascular dementia, those diagnosed as subcortical vascular dementia due to small vessel disease and the remainder which were regarded as multiinfarct dementia. *CGIC Clinical global impression of change (Guy 1976) It is possible to get rid of unwanted symptoms by halving the dosage. As can be seen from the table, side effects that appear related to nimodipine use based on increased incidence with higher dose or a higher rate compared to . The studies were all described as randomized, but no further details were given about the methods used. In spite of the uncertainties about its efficacy in dementia, nimodipine is currently frequently prescribed for cognitive impairment and dementia in several continental European countries. The power of this review would have been greatly strengthened by more complete reporting of data. Photo: Andreas Neumann. Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 16 number of patients with at least one adverse event of a gastrointestinal problem during treatment. *Wechsler memory scale (Wechsler 1945) It is sometimes necessary to change the sign on the treatment means in these metaanalyses so that improvement is indicated in the same direction for all scales. Ferrario 1993 Randt memory Index Dementia is an ageassociated condition and Alzheimer's disease (AD) and cerebrovascular disease are its commonest causes. Given the modest beneficial effect that can be hoped for, the size of studies has generally been inadequate to provide reliable results on the efficacy of nimodipine. *SCAG Sandoz Clinical assessmentGeriatric (Shader 1974), There are two types of global assessment. If you have erectile dysfunction (ED), your doctor may recommend that you take Viagra. The improvement may not last beyond 26 weeks of treatment. ), 1) Scores of global function: You may report them to the FDA. Women's health is once again the center of a political ping-pong match with evidence-based science on one side and anti-choice advocates on the other. Revised Wechsler Adult Intelligence Scale (WAISR) (Wechsler 1987), comprises a series of brief subtests, some taken from the WMS, each measuring a different facet of memory, which are summarised into 5 composite scores and finally 2 major scores using weights prescribed by Wechsler. One author (Morich 1996) reported two trials, carried out using an identical protocol and with very similar baseline characteristics. All trials were randomized, placebocontrolled and doubleblind; 12 trials were of parallel group design, and two were of crossover design. Inzitari D, Hernandez RE, Dose (90 and 180 mg/day) In particular, the reporting of intentiontotreat analyses is essential for unbiased assessment. activities of daily living: [SMD 0.12, 95% CIs 0.23, 0.0, P = 0.04], 180 mg/day dose at 24 weeks for measures on: An update search of January 2008 identified six studies for consideration by the authors. Comparison 3 Nimodipine vs placebo (vascular dementia), Outcome 5 Clinical Global Impression Severity of disease. Roselli A, The mean treatment effect and the standard errors for each trial were calculated from reported information if not stated explicitly in the text. Wallin A. Efficacy and safety of nimodipine in subcortical vascular dementia: a subgroup analysis of the scandinavian MultiInfarct Dementia Trial. activities on daily living, ADL: [SMD 0.16, 95% CI 0.65, 0.32, P = 0.5] Two trials included only patients with Alzheimer's disease (AD), 10 trials included only patients with cerebrovascular dementia (CVD), and three trials included patients with AD, CVD and mixed disease. Available outcome data from nine trials (2492 patients) cover the domains of cognitive function, activities of daily living, global clinical state, safety and tolerability. This second population excludes those with poor compliance, protocol violations or use or health problems. Comparison 2 Nimodipine vs placebo (primary degenerative dementia), Outcome 10 number of patients with at least one serious adverse event before end of treatment. Erkinjuntti T. The Scandinavian MultiInfarct Dementia Trial: A doubleblind, placebocontrolled trial on nimodipine in multiinfarct dementia. The diversity of the outcome measures, and the unclear and incomplete reporting of several of the trials, greatly constrained the pooling of results. This will only be possible if the company who sponsored most of the nimodipine clinical trials allows us access to their data. Along with its needed effects, nimodipine (the active ingredient contained in Nimotop) may cause some unwanted effects. From the data reviewed here, nimodipine can be an option for the treatment of patients with manifestations of dementia, due to unclassified disease or to the major subtypes of Alzheimer's disease, vascular disease, or mixed Alzheimer's and vascular dementia. Fitting a general linear model to the CGI score, and with the treatment group and diagnostic group in the model, there is no effect attributable to diagnostic group (F 1,127 = 0.10, P = 0.75), when corrected for treatment group. The .gov means its official. An update search was performed for this review on 26 March 2010. Pantoni L, Global improvement is rated from 1 (very much improved) to 7 (very much worse), with baseline at 4 for everybody. It can also modulate other calciumdependent processes such as acetylcholine release, potentially of benefit in improving memory functions in Alzheimer's disease. Calcium has an important role in regulating brain functions. Comparison 3 Nimodipine vs placebo (vascular dementia), Outcome 7 Withdrawals before end of treatment. 4. et al. In addition to gastrointestinal symptoms, many of the adverse effects were attributable to vasodilatation and hypotension, for example dizziness and headache. Below, check out the tour dates, as well as a weird tour . Calcium antagonists and multiinfarct dementia: A trial involving sequential NMR and psychometric assessment, International Journal of Geriatric Psychiatry. Besson JA, Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 6 Activities of Daily Living. In total the eligible studies contain over 1000 patients. Adan GO, He armed himself with a balaclava, latex gloves, condoms and Viagra pills and posed as a cab driver in a Mercedes to roam the streets of Brighton, East Sussex. Smith H Jr. [4] [8] It is unclear if it is effective for treating sexual dysfunction in women. Cheng S, These side effects may go away during treatment as your body adjusts to the medicine. The total score is the sum of the subtest scores. 90 mg/day dose at 24 weeks for measures on: Inzitari D, Comparison 1 Nimodipine vs placebo (all types of dementia), Outcome 3 CGI Numbers improved compared with baseline. Kapoula O, The clinical usefulness of the outcome scales can be questioned. A phase I/II trial of nimodipine for HIVrelated neurologic complications, Effects of Nimodipine on vascular dementia, Nimodipine therapy in patients with mental disturbances, Nimodipine in brain dysfunction is effective and well tolerated also in general practice. 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