Cilostazol and Probucol for Cognitive Decline after Stroke: A Cognitive Outcome Substudy of the PICASSO Trial

Abstract

Previous clinical trials to prevent post-stroke cognitive impairment, such as Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) and Secondary Prevention of Small Subcortical Strokes (SPS3), failed to show clinically meaningful results.1,2 There is an evidence that cilostazol, a phosphodiesterase- 3 inhibitor, could suppress cognitive decline in patients with dementia,3 and decrease amyloid beta accumulation.4 Probucol, a cholesteryl ester transfer protein activator with lipid- lowering and anti-oxidative effects, has a beneficial effect on cognition by inhibiting amyloid beta-induced hippocampal synaptic impairment.5 Thus, we aimed to determine the efficacy of cilostazol and probucol for preventing poststroke cognitive decline in patients with multiple cerebral microbleeds(CMBs) or a history of prior intracerebral hemorrhage (ICH); a population that is expected to have a high risk for future cognitive decline.