Centre for Clinical Brain Sciences

LACI-2 trial for stroke that can cause dementia

May 2018: Professor Joanna Wardlaw is leading a British Heart Foundation (BHF)-funded clinical trial to see if cheap, existing drugs could be used to prevent cognitive decline and dementia after stroke.

The BHF and Alzheimer’s Society are working together to test two existing treatments for heart and circulatory diseases in people who have suffered a type of stroke that occurs in the smallest blood vessels in the brain – lacunar stroke affects around 35,000 people in the UK each year.

A lacunar stroke is caused by damage to one of the small vessels deep within the brain that affects the flow of blood. It accounts for around one in four ischaemic strokes (3), where blood supply to part of the brain is interrupted, and can cause long-term disability. Researchers also believe that small vessel damage (including lacunar stroke) could contribute to at least 40 per cent of dementias, even where the main cause is Alzheimer’s disease.

There are currently no proven treatments to prevent a lacunar stroke, and existing anti-clotting treatments for stroke including aspirin may even be harmful.

Positive results from stage one of the Lacunar Intervention trial (LACI-1), funded by Alzheimer’s Society allowed the second stage (LACI-2), funded by the British Heart Foundation, to be rolled out during Dementia Awareness Week.

LACI-1 found that it was safe for people who have had a lacunar stroke to take cilostazol and isosorbide mononitrate, and at what dose, worked out the best questions to ask participants in the trial, and allowed the research team to develop a useful database for all the trial records.

Cilostazol costs around 63 pence per tablet and is currently used to treat people with peripheral arterial disease. Isosorbide mononitrate costs around 7 pence per tablet and is currently used to treat people with conditions like angina.

Due to this essential groundwork, LACI-2 can now be more quickly rolled out to include 400 people who have had lacunar strokes. Over three years, the team led by Professor Joanna Wardlaw at the University of Edinburgh will establish what effect these drugs have on reducing the risk of more lacunar strokes, and the risk of developing cognitive decline.

Research into lacunar strokes has often fallen in to the ‘gap’ between stroke research and dementia research so it hasn’t always been easy to find funding. I’m thrilled to see two charities working together to fund our research so that we can bring benefits to people who have had a lacunar stroke, and are at risk of developing cognitive decline, as soon as possible.

Professor Joanna WardlawProfessor of Applied Neuroimaging, University of Edinburgh

Related links

Brain vascular disease research at the Centre for Clinical Brain Sciences

Neurodegenerative conditions research at the Centre for Clinical Brain Sciences

Professor Joanna Wardlaw's profile

British Heart Foundation research