Anyone with an online nursing degree will tell you that dementia is a serious health concern. With nearly 7 million Americans suffering from Alzheimer’s disease alone, and millions more with other forms, it’s well known in the medical industry — and by the families who have been affected — that dementia is a scary and serious problem in dire need of a solution.
Thankfully, there is hope. A recent study has shown that the increased blood flow caused by Viagra, a medication well-known for its use in combating erectile dysfunction, shows promising signs for delaying the onset and ameliorating the symptoms of vascular dementia. While this may not translate to benefits for Alzheimer’s patients, those with cerebral small vessel disease (aka CSVD) account for millions of patients experiencing severe symptoms of dementia that decrease their quality of life and cause distress to those who care about them. These patients and their families could potentially gain valuable time and improved quality of life, if the results of initial research are found to be replicable and produce the expected long-term benefits.
What is Vascular Dementia?
Vascular dementia is one form of dementia that is associated with strokes and blood flow issues. This is often a result of CSVD, which decreases the regularity and volume of blood flow in the small blood vessels that provide blood to the parts of the brain not served by larger vessels. This causes a loss of brain function, which, over time, can lead to dementia, causing symptoms similar to those experienced by patients suffering from advanced Alzheimer’s. CSVD patients experience fatigue, forgetfulness, difficulty thinking and communicating clearly, difficulty swallowing, walking, and maintaining balance, slurred speech, depression, and even potentially strokes. Viagra, or sildenafil as the medication is called in generic form, is used as a first-line treatment for erectile dysfunction due to its well established properties in promoting healthy blood flow in regions of the body that are experiencing reduced perfusion.
The Study
Sildenafil was tested on a group of patients experiencing early symptoms of CSVD, and results were compared to groups of a similar size who were given cilostazol, a medication used to treat vascular disease, as well as a control group taking a placebo pill. The sildenafil experiment group received 50 mg of the drug three times a day for three weeks. Compared to the control group, the sildenafil group experienced no improvement in pulsatility, or the variability of blood flow in the cerebral small blood vessels, but did demonstrate substantial improvements in blood perfusion in the cerebral small vessels. This means that, while blood flow to the small vessels that cause CSVD remained inconsistent, the overall volume was improved, hopefully leading to greater functionality of the parts of the brain receiving increased oxygen as a result. Patients receiving the sildenafil treatment also experienced some noticeable improvements in the appearance of normal white matter in CVR-transcranial ultrasound scans. These results indicate that the tissue in these parts of the brain appeared to be functioning more normally as compared to the same regions of the brain in the unmedicated control group.
"This is the first trial to show that sildenafil gets into the blood vessels in the brain in people with this condition, improving blood flow and how responsive these blood vessels are," said the study's first author, Alastair Webb, an Associate Professor at Oxford University’s Wolfson Centre for Prevention of Stroke and Dementia. Webb is a neurology researcher whose work focuses on the relationship between blood pressure and cerebrovascular physiology and events, like strokes. He is one of the lead researchers in the Oxford Vascular Study (OXVASC), the branch of Oxford University’s Nuffield Department of Clinical Neurosciences focused on studying vascular diseases.
What Happens Next?
While this study does show promise, it’s still far from a complete solution for CSVD patients. Those suffering from CSVD are at increased risk of stroke, which could be potentially fatal. While sildenafil does currently appear to improve the blood flow problems that cause strokes in CSVD patients, it’s worth noting that it can increase the risk of stroke in people who take it regularly, and other studies have shown that patients who have cerebrovascular risk factors, especially those who are stroke patients, are at risk of diminished cerebral perfusion while taking sildenafil.
None of these studies are conclusive in and of themselves, and all call for further research into the effects of sildenafil on all cerebrovascular blood flow characteristics. But it’s good to see that, despite the prevalence and severity of dementia, there is yet some hope for patients and their families who fight every day to hold on to their last cherished moments with loved ones. Even if sildenafil is not the answer, the work of Alastair Webb and other researchers like him could some day make a very real difference in the lives of people impacted by this heartbreaking condition.
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