Assessment of cognitive functions in patients with metabolic syndrome after ischemic stroke

Post-stroke cognitive impairment (PSCI) occupies a prominent position among cognitive impairment associated with vascular brain pathology. The purpose – to assess cognitive functions in patients with the history of ischemic stroke, depending on the metabolic syndrome (MS) presence and to determine the peculiarities of cognitive functions dynamics in the early recovery period after ischemic stroke in the anterior circulation area in patients with and without metabolic syndrome depending on ischemic lesion localization. Materials and methods. There were 122 patients in the early recovery period after ischemic stroke enrolled into the study. Depending on the MS presence, patients with the history of ischemic stroke were divided into 2 groups: with MS (n = 72) and without MS (n = 50). All the patients were divided into 3 age subgroups: 45 – 59 years – middle age, 60 – 74 years – elderly, 75 – 89 years - senile age. All patients had general clinical, neuropsychological examination, laboratory tests; MRI of the brain. Results. There was no significant difference among patients of the main clinical groups on the frequency of pre-mild and mild cognitive impairment; however the incidence of post-stroke dementia was significantly higher among patients with MS comparing with those without MS. There was significant augmentation of PSCI severity with age in patients with MS and without it. According to the results of neuropsychological tests, the best cognitive functions recovery in 6 months after the stroke (in the early recovery period) was observed in patients without MS, especially in the cases of left hemisphere ischemic lesions. Conclusions. Patients with MS had significantly more pronounced PSCI than patients without MS. The increase in age had a negative effect on the PSCI severity both in patients with and without metabolic syndrome. The presence of MS worsened the process of cognitive functions restoration in patients with PSCI

Alleviating neuropsychiatric symptoms in dementia: the effects of Ginkgo biloba extract EGb 761®. Findings from a randomized controlled trial

Natalia Bachinskaya1, Robert Hoerr2, Ralf Ihl3For the GOTADAY Study Group1Institute of Gerontology, Academy of Medical Sciences, Kiev, Ukraine; 2Clinical Research Department, Dr Willmar Schwabe Pharmaceuticals, Karlsruhe, Germany; 3Geriatric Psychiatry Center, Maria-Hilf Hospital Krefeld, Krefeld, GermanyPurpose: To examine the effects of Ginkgo biloba extract EGb 761® on neuropsychiatric symptoms of dementia.Patients and methods: Randomized, controlled, double-blind, multicenter clinical trial involving 410 outpatients with mild to moderate dementia (Alzheimer’s disease with or without cerebrovascular disease, vascular dementia), scoring at least 5 on the Neuropsychiatric Inventory (NPI), with at least one item score of 3 or more. Total scores on the SKT cognitive test battery (Erzigkeit’s short syndrome test) were between 9 and 23. After random allocation, the patients took 240 mg of EGb 761® or placebo once daily for a period of 24 weeks. Changes from baseline to week 24 in the NPI composite and in the SKT total score were the primary outcomes. The NPI distress score was chosen as a secondary outcome measure to evaluate caregivers’ distress.Results: The NPI composite score improved by -3.2 (95% confidence interval -4.0 to -2.3) in patients taking EGb 761® (n = 202), but did not change (-0.9; 0.9) in those receiving placebo (n = 202), which resulted in a statistically significant difference in favor of EGb 761® (P < 0.001). Treatment with EGb 761® was significantly superior to placebo for the symptoms apathy/indifference, sleep/night-time behavior, irritability/lability, depression/dysphoria, and aberrant motor behavior. Caregivers’ distress evaluation revealed similar baseline pattern and improvements.Conclusion: Treatment with EGb 761®, at a once-daily dose of 240 mg, was safe, effectively alleviated behavioral and neuropsychiatric symptoms in patients with mild to moderate dementia, and improved the wellbeing of their caregivers.Keywords: Alzheimer's disease, vascular dementia, patients, caregivers, Ginkgo biloba, EGb 761&reg