Efficacy and safety of nimodipine in subcortical vascular dementia: a subgroup analysis of the Scandinavian Multi-Infarct Dementia Trial

In Western countries, vascular dementia (VaD) is the most common form of co gnitive deterioration after Alzheimer's disease. Therapeutic trials in VaD have so far failed to yield satisfactory results. One explanation of this f ailure may be the etiological and clinical heterogeneity of the included pa tients. Patients with subcortical VaD, defined on a clinical and radiologic al basis, may constitute a more homogeneous group. Thus, we conducted a pos t-hoc subgroup analysis of the Scandinavian Multi-Infarct Dementia Trial th at evaluated the efficacy and safety of oral nimodipine administered for 6 months in 259 patients. The original patients sample was divided on the bas is of head CT in those with subcortical VaD (n=92, 45 nimodipine, 47 placeb o) and those with multi-infarct dementia (n = 167, 83 nimodipine, 84 placeb o). While in the total trial population a treatment effect could not be pro ved, in this subgroup analysis, the subcortical VaD patients treated with n imodipine performed better on the majority of neuropsychological tests and functional scales in comparison with patients on placebo. No trend could be evidenced in the multi-infarct dementia patients. Treatment efficacy was i n particular suggested for the Zahlen-Verbindungs-Test, Fuld-Object-Memory Evaluation, Word Fluency, and for the instrumental Activities of Daily Livi ng scale. The results did not reach statistical significance in this small sample. Our study preliminarily indicates that nimodipine could be effectiv e in patients with small vessel subcortical VaD and supports the rationale for a further controlled and adequately powered trial to test nimodipine in patients with subcortical VaD. (C) 2000 Elsevier Science B.V. All rights r eserved.