Pentoxifylline in cerebrovascular dementia

Objective To test the effect of pentoxifylline, a hemorheologic agent used to treat intermittent claudication, on the course of vascular dementia. Design Randomized, double-blind, placebo-controlled, parallel group trial. Setting Outpatient tertiary care center. Patients 64 patients meeting DSM-III criteria for multi-infarct dementia with modified Hachinski ischemic scores ≥6, 38 of whom completed the trial. Intervention Pentoxifylline (Trental®) 400 milligram tablets three times daily vs placebo for 36 weeks. Main Outcome Measure Alzheimer's Disease Assessment Scale (ADAS). Results Baseline demographic values and psychometric variables were similar in the placebo and control groups; endpoint statistical analysis was used to allow the use of data from all patients in this clinically high-risk group. For the total group, the slowing of deterioration did not reach statistical significance (by 2-tailed t test), as measured by scores on the total ADAS (P = 0.058) or on the cognitive (ADAS items 1–11; P = 0.064) or non-cognitive subscales (ADAS items 12–21; P = 0.234), although it was significant on the cognitive subscales excluding memory (ADAS items 2–6, 8–10; P = 0.036). For the subgroup of 40 patients who had CT and/or MRI evidence of stroke as well as meeting the other inclusion criteria, treatment with pentoxifylline was associated with significantly slower deterioration, as measured by the total ADAS (P = 0.023) and cognitive subscores (P = 0.020) but not non-cognitive subscores (P = 0.118). For the subgroup of 37 patients who had at least one discrete clinical stroke, treatment with pentoxifylline was associated with significantly less deterioration on the total ADAS (P = 0.002) and both the cognitive (P = 0.001) and non-cognitive (P = 0.017) subscores. Conclusion Treatment with pentoxifylline may slow the progression of dementia in patients who meet DSM-III criteria for “multi-infarct dementia” and who also have clinical and neuroradiological evidence of cerebrovascular disease.