Conceptos Categóricos

LA RIVASTIGMINA SERIA ADECUADA PARA EL TRATAMIENTO DE LA DEMENCIA VASCULAR

LA RIVASTIGMINA SERIA ADECUADA PARA EL TRATAMIENTO DE LA DEMENCIA VASCULAR

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La rivastigmina es un inhibidor de la colinesterasa que, debido a sus características químicas y farmacológicas, sería adecuado para el tratamiento de los pacientes con demencia vascular.
moretti9.jpg Autor:
Rita Moretti
Columnista Experto de SIIC

Institución:
Dipartimento di Medicina Clinica e Neurologia, Università degli Studi di Trieste


Artículos publicados por Rita Moretti
Coautores
Paola Torre* Rodolfo M Antonello* Nadia Koscica* Gilberto Pizzolato* 
MD, Dipartimento di Medicina Clinica e Neurologia, Università degli Studi di Trieste, Trieste, Italia*
Recepción del artículo
3 de Agosto, 2006
Aprobación
8 de Agosto, 2006
Primera edición
20 de Noviembre, 2006
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La demencia vascular representa el segundo tipo más frecuente de demencia. La clasificación de la demencia vascular sigue tres procesos clínico patológicos generales: demencia multiinfarto, demencia por infarto único ubicado en una zona estratégica y demencia subcortical. Actualmente no existen tratamientos estandarizados establecidos para los trastornos cognitivos de causa vascular. La disminución de la actividad de la acetilcolinesterasa es una estrategia habitualmente utilizada tanto para el tratamiento de los pacientes que presentan enfermedad de Alzheimer como para aquellos con trastornos cognitivos de causa vascular. En consecuencia, es posible que los inhibidores de la colinesterasa sean una opción conveniente. La presente revisión se llevó a cabo con el propósito de evaluar la eficacia de la rivastigmina para el tratamiento de los individuos que presentan trastornos cognitivos de origen vascular. De acuerdo con los datos provenientes de diferentes estudios, la rivastigmina sería útil para tratar pacientes con deterioro cognitivo de origen vascular. No obstante, esta conclusión se efectuó sobre la base de estudios en los cuales se incluyó un número reducido de pacientes, se buscó comparar la rivastigmina con agentes diferentes del placebo o se extrapolaron datos a partir de estudios de gran magnitud efectuados con pacientes que presentaban enfermedad de Alzheimer y factores de riesgo vasculares de relevancia poco clara. Desde ese punto de vista, se puede concluir que es necesario realizar estudios de gran tamaño, controlados con placebo a doble ciego y adecuadamente aleatorizados antes de poder alcanzar conclusiones sólidas. La metodología empleada en dichos estudios debería responder a las características biológicas y clínicas particulares del deterioro cognitivo vascular y sus subtipos.

Palabras clave
demencia vascular, enfermedad vascular, rivastigmina


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Abstract
Vascular dementia represents the second most common type of dementia. The classification of vascular dementia broadly follows three clinico-pathological processes: multi-infarct dementia, single strategic infarct dementia and subcortical dementia. Currently, no established standard treatment for vascular cognitive impairment exists. Reductions in acetylcholine and acetyltransferase activity are common to both Alzheimer's disease and vascular cognitive impairment raising the possibility that cholinesterase inhibitors may also be beneficial for the latter. This review has been conducted to assess the efficacy of rivastigmine in the treatment of people with vascular cognitive impairment. From existing trial data there is some evidence of benefit of rivastigmine in vascular cognitive impairment. However, this conclusion is based on studies which had small numbers of patients, which sought to compare rivastigmine to treatments other than placebo or which used data extrapolated post hoc from large studies involving patients with Alzheimer's disease and vascular risk factors of unclear significance. From these perspectives, one can conclude that large placebo-controlled, double blind and adequately randomised trials are needed before firm conclusions can and should be drawn. The methodology of such trials should acknowledge the biological and clinical features unique to vascular cognitive impairment and its subtypes.

Key words
vascular dementia, vascular disease, rivastigmine


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Clasificación en siicsalud
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Especialidades
Principal: Salud Mental
Relacionadas: Farmacología, Geriatría, Medicina Familiar, Medicina Farmacéutica, Medicina Interna, Neurología



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Rita Moretti, Dipartimento di Medicina Clinica e Neurologia, Università degli Studi di Trieste, Ospedale di Cattinara 34149, Trieste, Italia
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