A team from the University of Edinburgh have found two cheap and relatively abundant medicines, usually used for heart diseases, can be safely adapted to  treat dementias linked to strokes.

The Edinburgh researchers led a collaborative trial with the University of Nottingham and the UK Dementia Research Institute. Their study results, published today, suggest there may be an effective treatment for people affected by lacunar strokes.

Lacunar strokes, where blood flow deep within the brain becomes blocked, are linked to nearly half of all dementias and affect at least 35,000 people in the UK each year.

Now, for the first time people who experience this type of stroke could be treated, the researchers say, by repurposing two drugs currently used to treat heart and circulatory diseases.

The researchers say isosorbide mononitrate and cilostazol can be safely adopted to improve the ‘debilitating outcomes’ faced by people after having suffered a lacunar stroke.

Additionally, when used in combination, researchers identified that the two drugs present an even more effective treatment for lacunar strokes.

While this trial involved only 363 people who had experienced a lacunar stroke, the Edinburgh-led team say this combination treatment could be available within five years if further trials validate their findings.

When small blood vessels deep within the brain are damaged and become unable to function properly, in what is known as ‘cerebral small vessel disease’, lacunar strokes can occur which can then lead to dementia. Small vessel disease alone can also cause people to experience cognitive impairment and dementia.

With lacunar strokes, people may develop similar cognitive issues: struggling with their thinking, memory and movement – all of which can be distressing.

Currently, there are no specific effective treatments for lacunar strokes.

Halting the damage

Funded by the British Heart Foundation, the trial investigated which of these drugs alone or in combination could improve the function of the inner lining of blood vessels as this was believed to play a role in the underlying small vessel disease.

Professor Joanna Wardlaw, Chair of Applied Neuroimaging at the University of Edinburgh and Foundation Chair at the UK Dementia Research Institute said she hopes further trials will help see this research translated into clinical practice:

“Now we understand more about what is triggering these small vessel strokes to attack the brain, we’ve been able to focus our efforts on treatments that can put a halt to this damage.

“We need to confirm these results in larger trials before either drug can be recommended as a treatment. However, as these drugs are already widely available for other circulatory disorders, and inexpensive, it shouldn’t take too long to move our findings from research into everyday clinical practice.”

Participants in the study all underwent standard stroke prevention treatment and, for one year took isosorbide mononitrate or cilostazol individually, both drugs together, or neither.

The study found that those who took both drugs were nearly 20% less likely to experience cognitive concerns – measured as problems with their thinking and memory – compared to the group that did not take either drug. These participants also reported a greater degree of independence and a better quality of life.

Moreover, those participants prescribed isosorbide mononitrate were less likely to have experienced further strokes at one year than those who did not take the drug.

Taken alone, both medications revealed improvements compared to no drugs alongside standard stroke protocol.

Taking isosorbide mononitrate led to improved thinking, memory skills, and quality of life, while cilostazol saw improved mood and sense of independence among participants prescribed each drug alone.

Supported by the Alzheimer’s Society and Stroke Association, the study reported that these effects were strengthened when the two drugs were taken together, with the findings published in JAMA Neurology.

Looking forward, the Edinburgh team plans to test these drugs in a larger four-year clinical trial, which they hope to start by the end of 2023.

They also want to investigate whether the drugs may be effective for different conditions related to small vessel disease, including vascular cognitive impairment and vascular dementia.

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, said:

“These promising findings provide a long-awaited positive step towards the first treatments becoming available for lacunar strokes, offering much needed hope for thousands of people.

“Lacunar strokes are not the only way that cerebral small vessel disease can affect someone. These findings also open new avenues of research into other conditions related to small vessel disease, such as vascular dementia.”

Read more: Music’s potential to help with dementia; Blue-green prescribing for climate and public health; Edinburgh team show how Alzheimer's spreads; Redefining clinical meaningfulness

Sign up to our bulletin for key health & social care updates straight to your inbox and you can follow healthandcare.scot on Google News.