Efficacy and safety of nimodipine in treatment of vascular dementia: a systematic review

Abstract

Objective To systematically evaluate the clinical efficacy and safety of nimodipine in treating vascular dementia (VaD).  Methods Taking "nimodipine AND vascular dementia" as search terms, retrieve in databases such as PubMed, Cochrane Library, EMBASE/SCOPUS, Science Citation Index (SCI), China National Knowledge Infrastructure (CNKI), VIP and Wanfang Data (January 1995-March 2015). Annual searching was applied to retrieve partial periodical literatures and unpublished studies. Google Scholar was used for randomized controlled trials (RCTs) about nimodipine in treating VaD. Jadad scale was used to evaluate the quality of literature, and Meta-analyses were performed by using RevMan 5.3 software.  Results Eleven literatures met inclusion criteria, including 10 clinical studies (1333 patients). All 10 studies were RCTs, including 4 nimodipine vs placebo, 5 nimodipine vs donepezil and one nimodipne vs hydergine, but only 2 described randomization methods. The results of Meta-analysis showed: nimodipine had better Mini-Mental State Examination (MMSE) score than before treatment and placebo group (3 studies, MD = 0.270, 95%CI: 0.070—0.460, P = 0.007); one study of blank control, MD = 2.950, 95% CI: 1.670—4.200, P = 0.000). Patients treated with nimodipne had no significantly improved Activities of Daily Living (ADL) score than placebo group [one study of ADL, MD = 5.800, 95%CI: 2.480—9.120, P = 0.000; one study of ADL Index, MD = -0.040, 95%CI: -0.110—0.030, P = 0.230; one study of instrumental ADL (IADL), MD = -0.080, 95%CI: -0.110—0.000, P = 0.060]. Both nimodipine and donepezil can improve MMSE and ADL scores, but the efficacy of nimodipine was not superior to donepezil [4 studies of MMSE (12-week observation), MD = -4.400, 95% CI: -4.870— -3.920, P = 0.000; one study of MMSE (24-week observation), MD = -8.800, 95% CI: -8.970— -7.430, P = 0.000; 2 studies of ADL, MD = 1.800, 95% CI: 1.360—2.230, P = 0.000]. Compared with hydergine, nimodipine had better scores in MMSE (MD = 2.170, 95%CI: 0.890—3.450, P = 0.001) and ADL (MD = -5.160, 95%CI: -7.480— -2.840, P = 0.000) in one study. The main side effects of nimodipine were cardio-cerebrovascular diseases, neuropsychiatric symptoms, abnormal skin reaction, gastrointestinal reactions and joint edema, et al.  Conclusions Current study shows that the effect of nimodipine in the treatment of VaD may be superior to placebo and hydergine, but not better than donepezil. The results of systematic review still need more high-quality, multi-center and large-sample RCTs to further prove.

DOI: 10.3969/j.issn.1672-6731.2015.07.008