Methylphenidate shows early promise in vascular cognitive impairment

Jackey Suen
26 Nov 2018
Dr Jolien Leijenaar

Methylphenidate was found to improve executive functioning in patients with vascular cognitive impairment (VCI) in the STREAM-VCI study.

“Executive dysfunction and memory impairment are the most common symptoms in patients with VCI,” noted investigator Dr Jolien Leijenaar of the Amsterdam University Medical Center, the Netherlands. “Executive functioning is modulated by the monoaminergic neurotransmitter system, while memory is modulated by the cholinergic neurotransmitter system. Drugs that can modulate these two systems may therefore represent potential treatment options for VCI symptoms.”

STREAM-VCI is a proof-of-concept, single-centre, double-blind study that investigated the efficacy of methylphenidate, a monoaminergic neurotransmitter, and galantamine, a cholinergic neurotransmitter, in 30 patients with VCI. The patients received treatment with methylphenidate 10 mg, galantamine 16 mg and placebo in a randomized sequence in three follow-up visits.

Results showed significant improvement in executive functioning after methylphenidate administration (p=0.0021 vs galantamine; p=0.0016 vs placebo).

“No serious adverse events [AEs] occurred in any of the patients,” reported Leijenaar. “More patients experienced blood pressure increase, dizziness, nausea, vomiting, fatigue, diarrhoea and hyperhidrosis after administration of galantamine. Methylphenidate’s AE profile was generally comparable to that of placebo, except for a higher incidence of hypervigilance [14 percent vs 0 percent].”

“We also found that patients’ performance in delayed word recall worsened after the administration of galantamine, which may be due to AEs,” noted Leijenaar.

“Our next step is to correlate the response to methylphenidate and galantamine with structural and functional MRI,” she added.

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