Efficacy Of Rivastigmine And Donepezil On Cognitive Impairment Of Vascular Dementia - Some Preliminary Observations

Background: Vascular Dementia (VaD) is common, global, disabling and a rather neglected, age related dementia. It is important to identify and treat it since cognitive impairment produces dysfunction in occupational and social life. Moreso, due to increase in geriatric population, incidence and prevalence of VaD is also increasing. Aim: We share our observations on efficacy of Rivastigmine and Donepezil (drugs advocated for improving cognition in dementia) in patients of VaD. Material and Method: This was a non-randomized study based on clinical evaluation. We selected 53 patients suffering from VaD (as per clinical and radiological criteria). Their age range was 55-78 years (mean 65.3 + 6.2 yrs). Clinical, biochemical and radiological (Cranial CT and MRI) evaluation was done to establish etiology. Cognition was measured using modified Mini Mental State Examination (MMSE) which was repeated 2 times, at interval of 3 months. We observed the role of Rivastigmine in 14 and Donepezil in 19 patients of VaD. The change in MMSE score was compared with 20 control patients of VaD. The associated risk factors like hypertension, diabetes, hyperlipidemia etc. were managed. Acetyl Salicylic Acid (ASA) in dose of 150mg/day was given as an antiplatelet agent to all 53 patients in this study. Results: At end of study, no statistically significant improvement was observed in MMSE score in any of the 53 patients. Improvement in MMSE score (though statistically insignificant) was observed with Rivastigmine in 11 and with Donepezil in 14 patients. Progressive decline in MMSE score was observed in 14 (70%) control patients of VaD who did not receive rivastigmine or donepezil. Conclusion - Rivastigmine and Donepezil are beneficial in halting deterioration of dementia in patients suffering from VaD