Nimodipine for primary degenerative, mixed and vascular dementia

Background Dementia is an age‐associated syndrome most commonly due to Alzheimer's disease (AD) and/or cerebrovascular disease. Calcium has an important role in regulating brain functions. Calcium ions link membrane excitation to subsequent intracellular molecular responses. Age‐associated changes in calcium homoeostasis have possible repercussions on higher cortical functions. Nimodipine is an isopropyl calcium channel blocker which readily crosses the blood‐brain barrier. Its primary action is to reduce the number of open calcium channels in cell membranes, thus restricting influx of calcium ions into cells. The usefulness of nimodipine in patients with Alzheimer's disease and vascular dementia and unspecified dementia is still controversial. In spite of the uncertainties about its efficacy in dementia, nimodipine is currently frequently prescribed for cognitive impairment and dementia in several continental European countries. Objectives To assess the clinical efficacy of nimodipine for the manifestations of dementia, in unclassified disease and in the major subtypes ‐ Alzheimer's disease, cerebrovascular disease, and mixed Alzheimer's and cerebrovascular disease. Search methods We searched ALOIS ‐ the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register on 26 March 2010 using the term: nimodipine The search of August 2005 identified two studies which were excluded. The search of January 2008 identified six new studies for consideration, only one met the inclusion criteria for this meta‐analysis although the data were difficult to interpret and they were not included in this update (Pantoni 2005). The latest search of March 2010 identified no new studies for inclusion within the review. Selection criteria All unconfounded, double‐blind, randomized trials in which treatment with nimodipine was administered for more than a day and compared with placebo in patients with dementia, of unclassified type or attributable to Alzheimer's disease, cerebrovascular disease, or mixed Alzheimer's and cerebrovascular disease. Data collection and analysis Data were extracted independently by the reviewers and the odds ratio (95% CI) or the average difference (95% CI) were estimated. Both intention‐to‐treat and on‐treatment results were extracted. Main results Fifteen trials were included which tested two treatment regimes, 90 and 180 mg/day of nimodipine for 12, 24 weeks and 52 weeks. Two trials included only patients with Alzheimer's disease (AD), 1