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Other drugs in the class include Cialis and Levitra, all of which work by inhibiting the action of an enzyme called PDE-5. With less PDE-5 action, the smooth muscle lining the walls of blood vessels are able to relax, which facilitates better blood flow.
It’s easy to understand why this would help men who have erection problems. And scientists have hypothesized that the action of PDE-5 inhibitors could help with a number of other health problems having to do with impaired blood flow. For example, animal and human trials have been started to learn whether the drugs can facilitate improved growth in fetuses with severely restricted growth.
Naturally, medical researchers have wondered whether a PDE-5 inhibitor like Viagra or one of its competitors could be of benefit to people who have problems related to blood flow in the brain. Would such a drug help those blood vessels to relax enough so that more blood could flow through? A couple of small trials have been done, and so far, the results have been encouraging, particularly with a form of dementia known as vascular dementia.
What Is Vascular Dementia?
Vascular dementia is also sometimes called multi-infarct dementia, or vascular cognitive impairment, and it is caused by a problem with blood supply to the brain. Often, vascular dementia is caused by a series of mini-strokes, and the result can be progressively worsening cognitive function.
Vascular dementia isn’t a specific disease that can be tested for, like flu, but is an umbrella term referring to a complex of risk factors and cerebrovascular problems that eventually lead to changes in brain structures. Cognition eventually suffers. Diagnosis of vascular dementia is partly made based on the amount of time that passes between someone suffering a stroke (or mini-stroke) and the presentation of cognitive defects.
Signs and symptoms of vascular dementia may be cognitive, behavioral, and motor, and they can occur over a period of several years. Cognitive testing of people with suspected vascular dementia often reveals “patchy” deficits that present differently from the cognitive traits of people with other types of dementia, like Alzheimer’s disease.
The Key Is Blood Flow to the Brain
A study at St. George’s University of London is currently testing whether tadalafil, the active ingredient in popular erectile dysfunction drug Cialis (which is a PDE-5 inhibitor, like Viagra) may increase blood flow to the brain. If the researchers’ hypotheses is borne out, this or a similar drug may eventually be used to help retard or prevent onset of vascular dementia. Various forms of dementia are present in nearly 27 cases per 1,000 in African Americans, 22.2 cases per 1,000 in Native Americans, while affecting white and Latino people at rates of around 19 cases per 1,000.
Trials in London have already been done on 24 people, and another 30 people are scheduled to take part in similar trials in the near future. Blood flow to the brain is measured using high-tech medical scanners. If the drug indeed enables better blood flow to the brain, researchers will then do a second trial to determine whether it improves cognition as well.
Doctors are encouraged by the well-known safety profile of drugs like tadalafil and sildenafil citrate, the active ingredient in Viagra, which are often taken by people in age groups similar to those that are at higher risk of developing vascular dementia (i.e., older people).
What About Alzheimer’s Dementia?
Any benefit from PDE-5 inhibitors in people who are in the process of developing Alzheimer’s disease would be less clear-cut. In people with Alzheimer’s disease, rogue “plaques” made of certain types of proteins invade the brain and ultimately causes the cerebral cortex (which is involved with thinking, remembering, and planning) to shrivel. Other parts of the brain, notably the hippocampus, which is involved in the formation of new memories, also shrinks severely in people with Alzheimer’s disease. While the healthy brain is an amazingly complex “circuit board” that orchestrates all bodily functions, the brain with Alzheimer’s builds up with a harmful protein called “tau,” which eventually causes brain cells to die and the brain to atrophy.
In a sense, vascular dementia is more straightforward, because it results from impaired blood flow to the brain. Blood flow has been shown to improve in other regions of the body with treatment by PDE-5 inhibitors, so it makes sense to test these drugs on people who have dementia due to vascular problems. Though the drugs may make no difference in other types of dementia like Lewy body dementia (which also causes protein deposits in the brain) and Alzheimer’s, vascular dementia is widespread enough that a treatment for it could potentially change millions of lives for the better.
Boston University researcher Karin Schon is currently studying the possibility of regular cardiovascular exercise helping prevent or slow the development of dementia, including Alzheimer’s disease. Regular exercise is a lifestyle change that benefits countless bodily systems and disease processes, and Schon’s team wants to find out if it benefits the brains of people at risk for or already developing dementia.
Trials are also being developed to learn the effects of other existing drugs to prevent or slow dementia. One such compound being tested is oxytocin, a drug used to induce labor in pregnant women. Oxytocin is also known to create feelings of contentment, reduce anxiety, and impose a sense of calm and security, and may be beneficial to dementia patients who experience psychological disturbances due to their condition. Other treatments being studied for vascular dementia include a drug called amlodipine (a blood pressure medication), and a combination of ginseng, ginkgo, and saffron.
Vascular dementia is far from the only condition for which PDE-5 inhibitors are being tested. They’re also being considered for conditions are far-ranging as altitude sickness and menstrual cramps. And to think, had the people in the original clinical trials for sildenafil citrate (Viagra) not brought to the attention of researchers the side effect of better erections, the drug and others like it might have been lost to the dustbin of history.
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