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Vascular dementia – where are the drugs?

Dr Laura PhippsKirsty MaraisClaire LucasRobin BrisbourneKaty StubbsFaye MonkEleanor Hall

With each heartbeat, blood vessels deliver around 15% of your blood up into your brain. This energy-hungry organ can only keep going thanks to the constant supply of nutrients and oxygen that are carried to it in the blood.

Hundreds of miles of arteries, veins and capillaries circulate blood around every inch of the brain. If this intricate network of blood vessels becomes damaged, or something interrupts the flow of blood, brain cells can stop functioning properly and die. This is what underlies vascular dementia, the second most common cause of dementia and a condition that affects around 150,000 people in the UK.

While there are no treatments that can stop the spread of a disease like Alzheimer’s through the brain, there are at least some drugs that can help with the symptoms. For vascular dementia, there are no such medications, and in a session at last month’s Alzheimer’s Association International Conference, researchers posed the critical question – “Where are the drugs?”

The here and now

Let’s start with the good news. There are some ways people can reduce the risk of vascular dementia and keep blood vessels in the brain healthy for longer. Stroke is a common cause of vascular dementia that can be tackled with medications or lifestyle changes to reduce the risk of blood clots, control blood pressure and keep cholesterol levels in check.

While it is important never to overlook the things that can help people with dementia in the here and now, researchers are keenly aware of the desperate need for better ways to tackle vascular dementia, and crucially, for treatments that improve the symptoms people experience.

Better drugs will need better trials

At the conference, leading international experts highlighted challenges from previous trials of vascular dementia drugs and outlined key lessons that will help future efforts.

One difficulty researchers face is that vascular dementia is not caused by a single discrete disease process. As well as strokes, it can also be caused by small vessel disease, a narrowing of small blood vessels deep inside the brain. A treatment may help people with one form of the disease but not the other, so it is important to make sure that a drug is being tested in the right group of people.

Unlike other forms of dementia, vascular dementia doesn’t tend to get steadily worse over time. Symptoms can remain stable for long stretches before progressing suddenly in a distinct step. This unpredictable development means that it can be especially difficult to measure how a drug could be affecting a person’s symptoms. Speakers at the conference pointed to the need for longer periods of testing to build a clearer picture of a drug’s impact on people’s lives.

Researchers with their fingers on the pulse

As well as these practical considerations, there are key scientific challenges in the way of better trials. But thanks to your support, Alzheimer’s Research UK is funding £4 million of pioneering research to help overcome these hurdles and pave the way to better treatments for vascular dementia.

Hitting the right targets – Prof Barry McColl

To get to grips with tackling any disease, we need to understand what is actually causing it. Some previous trials have been unsuccessful because they have not focussed on the processes that are most relevant to how nerve cells become damaged. Researchers in Edinburgh are investigating how changes in blood flow could trigger the brain’s immune response and whether this process could be contributing to nerve cell damage in vascular dementia.

Measuring change – Prof Hugh Markus

Drug trials can fall down if there isn’t a good way to measure what effect a drug is having in the brain. Biological tests that indicate how well a drug is working are critical if researchers are to develop better trials.

Prof Hugh Markus aims to identify features on MRI brain scans that can be used to evaluate new vascular dementia treatments more effectively than current methods. An MRI technique like this could be a vital boost for early stage clinical trials – reducing costs while letting researchers know which treatments should go on to final testing. This approach would allow researchers to take more new drugs into testing and help get effective treatments into the hands of patients sooner.

Pursuing the most promising drugs – Dr Jill Fowler

Before drugs are tested in people they need to undergo rigorous laboratory testing so that only the most promising potential treatments go into clinical trials. Alzheimer’s Research UK Senior Research Fellow Jill Fowler is working with mice with features of vascular dementia to see if an experimental drug could boost levels of a protein that kick-starts the brain’s cellular defence mechanism.

Developing new dementia treatments is an uphill struggle. But it’s a challenge that unites thousands of dementia researchers working in labs and clinics the world over. Just like all diseases, research into vascular dementia has its own particular set of challenges. But thanks to your support, researchers are closing in on treatments that will transform the lives of people living with vascular dementia.

If you want to be part of research that is helping us to understand dementia, you can sign up to volunteer for studies at www.joindementiaresearch.nihr.ac.uk or by calling our Dementia Research Infoline on 0300 111 5 111

5 Responses to Vascular dementia – where are the drugs?

  1. Carolyn 16 August 2017 at 7:11 pm #

    Not sure I entirely agree with this, my Dad has been on Donepezil has he has vascular dementia, and recently was taken off the medication by a medical doctor without our knowledge, those weeks were awful and my Dad declined very rapidly and ended up in hospital, the dementia team put him back on his Donepezil and although some permanent decline has taken place, he has definitely improved in the weeks he has been taking it, from someone who did not want to get out of bed, could not walk, could not feed himself to doing all those things again independently?

    • ARUK Blog Editor
      ARUK Blog Editor 21 August 2017 at 11:34 am #

      Hi Carolyn, thank you for your comments.

      Donepezil is one of the medications prescribed for Alzheimer’s disease, alluded to in the blog post, but is not licensed for the treatment of vascular dementia because this type of dementia has a very different root cause in the brain. It’s possible that your father was prescribed the drug because his diagnostic tests suggested mixed dementia; it is not unusual for people to have vascular dementia and Alzheimer’s together. You could ask his medical team if you wanted to find out more about why the drug was prescribed.

      Our point in the blog post was to stress that currently there are no drugs licensed specifically for the treatment of vascular dementia, but that there is now promising research in this area. I hope that is a bit clearer now.

  2. Marika 17 August 2017 at 8:09 am #

    Marijuana could hold the key to treating Alzheimer’s but drug laws stand in the way say some articles over the internet! How about that?

  3. lynn 25 August 2017 at 6:44 pm #

    My mother has vascular dementia and Alzheimer’s she was been on donepezil for the last five years but I have notice her symptoms getting worse over the last four months. She is eighty five years old

  4. Lynda Daniels 17 September 2017 at 11:31 am #

    My Mum was diagnosed with Vascular Dementia and was prescribed Donepezil by her Memory Clinic consultant. We were told it would slow down the progression of the disease. After several years we then learnt she also had Alzheimer’s. Sadly, her decline was quite rapid after that!

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