By Adrian Burton
VALENCIA, SPAIN -- May 26, 2003 -- Simvastatin may slow down the progression of severe white matter changes in the brain, and may therefore retard cognitive decline, research suggests.
White matter changes that occur during ageing are associated with cognitive impairment and may even represent a homogeneous subtype of vascular dementia. However, little is known about how these changes progress, and currently, no drug is prescribed for retarding them.
Results presented here May 23rd at the European Stroke Conference suggest, however, that simvastatin might be able to slow down white matter-associated cognitive decline.
"Recently there has been interest in the use of statins in preventing dementia," said Lawrence Wong, MD, an associate professor at Chinese University of Hong Kong. "The most common type of vascular dementia is due to the hardening of the arteries deep inside the brain which causes white matter changes... and its been shown that this can lead to executive dysfunction."
The study involved a post hoc analysis of the results from the Regression of Cerebral Artery Stenosis Study (ROCAS), a randomised, double-blind, placebo-controlled study originally designed to determine the effect of simvastatin on the progression of cerebral artery stenosis in patients determined to be stroke-free by magnetic resonance angiography.
Dr. Wong and colleagues analysed data on 220 patients who had been randomised to receive either simvastatin 20 mg/day for 2 years or a placebo. All underwent magnetic resonance imaging before and after treatment. White matter changes were recorded by computer-assisted segmentation volumetry.
White matter changes were detected in 63 of the original 220 patients. Taken as a whole, simvastatin appeared to have no significant effect on progression, with 42% change in the simvastatin group compared to 58% in the control group (P=0.32). Neither was there any difference between the two arms when mild changes were taken into account (57% change in both arms; P=0.99).
However, when patients who had severe changes were analysed alone, the differences were quite remarkable, with 22% change in the simvastatin group compared to 60% in the placebo group.
"This is only a post hoc analysis, but it does suggest that statins might be useful in delaying severe white matter changes. This is a treatment we could consider for people with white matter disease. It's widely available, it's safe, and it may work," concluded Dr. Wong.
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