Efficacy of galantamine in probable vascular dementia and Alzheimerʹs disease combined with cerebrovascular disease: a randomised trial

Background Vascular dementia is the second commonest form of dementia, and vascular factors contribute to the development of dementia in many patients with Alzheimerʹs disease. Galantamine amplifies the acetylcholine response by inhibiting acetylcholinesterase and modulating nicotinic receptors. It has shown broad, sustained benefits in patients with Alzheimerʹs disease. We investigated the effects of galantamine in patients with a diagnosis of probable vascular dementia or Alzheimerʹs disease combined with cerebrovascular disease. Methods Eligible patients were randomly assigned galantamine 24 mg/day (n=396) or placebo (n=196) in a multicentre, double-blind, 6-month trial. Primary endpoints were cognition (Alzheimerʹs disease assessment scale, cognitive subscale [ADAS-cog]) and global functioning (clinicianʹs interview-based impression of change plus caregiver input [CIBIC-plus]). Secondary endpoints included assessments of activities of daily living and behavioural symptoms. Patients were monitored for adverse events. Analyses were on the basis of observed case or last observation carried forward. Findings Galantamine showed greater efficacy than placebo on ADAS-cog (galantamine change −1•7 [SE 0•4] vs placebo 1•0 [0•5]; treatment effect 2•7 points; p<0•0001) and CIBIC-plus (213 [74%] vs 95 [59%] patients remained stable or improved, p=0•001). Activities of daily living and behavioural symptoms were also significantly improved compared with placebo (p=0•002 and p=0•016, respectively). Galantamine was well tolerated. Interpretation Galantamine showed a therapeutic effect on all key areas of cognitive and non-cognitive abilities in this group of dementia patients.