New trial to prevent dementia after a stroke gets go-ahead

23 May 2018        

Category: Research

Today, we are announcing the start of a clinical trial to see if cheap, existing drugs could be used to prevent cognitive decline and dementia after stroke.

A scan of a brain

We are working with Alzheimer’s Society to test two existing treatments for heart and circulatory diseases in people who have suffered a type of stroke that occurs in the smallest blood vessels in the brain – lacunar stroke affects around 35,000 people in the UK each year. The first stage results are being presented at the Alzheimer’s Society Annual Conference today.

A lacunar stroke is caused by damage to one of the small vessels deep within the brain that affects the flow of blood. It accounts for around one in four ischaemic strokes, where blood supply to part of the brain is interrupted, and can cause long-term disability. Researchers also believe that small vessel damage (including lacunar stroke) could contribute to at least 40 per cent of dementias, even where the main cause is Alzheimer’s disease.

New treatments urgently needed

There are currently no proven treatments to prevent a lacunar stroke, and existing anti-clotting treatments for stroke including aspirin may even be harmful.
Positive results from stage one of the Lacunar Intervention trial (LACI-1), funded by Alzheimer’s Society have allowed the second stage (LACI-2), funded by us, to be rolled out during Dementia Awareness Week.

LACI-1 found that it was safe for people who have had a lacunar stroke to take the drugs, worked out the best questions to ask participants in the trial, and allowed the research team to develop a useful database for all the trial records.

Repurposing a cheap, available drug

The drugs used in the study are both available for the treatment of other conditions. Cilostazol costs around 63 pence per tablet and is currently used to treat people with peripheral arterial disease. Isosorbide mononitrate costs around 7 pence per tablet and is currently used to treat people with conditions like angina.

Due to this essential groundwork, LACI-2 can now be more quickly rolled out to include 400 people who have had lacunar strokes. Over three years, the team led by Professor Joanna Wardlaw at the University of Edinburgh will establish what effect these drugs have on reducing the risk of more lacunar strokes, and the risk of developing cognitive decline.

In LACI-2 patients will take cilostazol, isosorbide mononitrate or both. The researchers think that these drugs may help reduce the damage to the arteries in the brain that cause the stroke and lead to cognitive decline. They will perform MRI scans on people taking part in the trial to see what effects these drugs have on the small blood vessels within the brain.

Potential to save lives

If successful, this research could lead to new ways to treat lacunar strokes and prevent some cases of dementia.

Professor Joanna Wardlaw, from the University of Edinburgh, who is leading the research, said: “Research into lacunar strokes has often fallen in to the ‘gap’ between stroke research and dementia research so it hasn’t always been easy to find funding. I’m thrilled to see two charities working together to fund our research so that we can bring benefits to people who have had a lacunar stroke, and are at risk of developing cognitive decline, as soon as possible.”

Approximately 38,000 people die from a stroke every year in the UK and the condition is a major cause of disability with over a million UK stroke survivors. The BHF currently funds around £21 million of research into preventing and treating stroke and £4.5 million of dementia research. 

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