***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Vascular dementia is the second commonest form of dementia , and vascular factors contribute to the development of dementia in many patients with Alzheimer 's disease .  Galantamine amplifies the acetylcholine response by inhibiting acetylcholinesterase and modulating nicotinic receptors . It has shown broad , sustained benefits in patients with Alzheimer 's disease . We investigated the effects of galantamine in patients with a diagnosis of probable vascular dementia or Alzheimer 's disease combined with cerebrovascular disease . METHODS Eligible patients were r and omly assigned galantamine 24 mg/day ( n=396 ) or placebo ( n=196 ) in a multicentre , double-blind , 6-month trial . Primary endpoints were cognition ( Alzheimer 's disease assessment scale , cognitive subscale [ ADAS-cog ] ) and global functioning ( clinician 's interview-based impression of change plus caregiver input [ CIBIC-plus ] ) . Secondary endpoints included assessment s of activities of daily living and behavioural symptoms . Patients were monitored for adverse events . Analyses were on the basis of observed case or last observation carried forward . FINDINGS Galantamine showed greater efficacy than placebo on ADAS-cog ( galantamine change -1.7 [ SE 0.4 ] vs placebo 1.0 [ 0.5 ] ; treatment effect 2.7 points ; p<0.0001 ) and CIBIC-plus ( 213 [ 74 % ] vs 95 [ 59 % ] patients remained stable or improved , p=0.0001 ) . Activities of daily living and behavioural symptoms were also significantly improved compared with placebo ( p=0.002 and p=0.016 , respectively ) . Galantamine was well tolerated . INTERPRETATION Galantamine showed a therapeutic effect on all key areas of cognitive and non-cognitive abilities in this group of dementia patients A double-blind , placebo-controlled , parallel-group , multicentre study was conducted to evaluate the efficacy of pentoxifylline ( Trental ) in patients with multi-infa rct dementia ( MID ) according to DSM-III-R criteria . Men and women aged 45 years or older , with a Hachinski Ischemia Scale score > or = 7 and a Mini Mental State Examination ( MMSE ) score of 10 - 25 at entry , and computed tomographic evidence of vascular disease were enrolled . A total of 289 patients were r and omised to receive either oral pentoxifylline 400 mg t.i.d . or placebo for 9 months , and efficacy was assessed every 3 months . The primary outcome variable was the difference in scores between the two treatment groups , as measured on the Gottfries , Bråne , Steen ( GBS ) scale . Secondary outcome variables included the scores achieved on the S and oz Clinical Assessment Geriatric ( SCAG ) scale and MMSE , and a battery of psychological and other tests . The intention-to-treat analysis for patients completing the study ( n = 239 ) showed a statistically significant difference in the total GBS score in favour of pentoxifylline ( improvement of 3.5 points , p = 0.028 ) . A significant difference in the total GBS score in favour of pentoxifylline was even almost achieved in the intention-to-treat analysis for all evaluable patients ( n = 269 , improvement of 2.1 points , p = 0.065 ) . It is concluded that treatment with pentoxifylline is beneficial for patients with MID , the global results of the GBS and SCAG scales being reinforced by significant improvements in those subscales specific for intellectual and cognitive function The modulation of cytokine release induced by pentoxifylline ( PTX ) has recently been demonstrated not to be restricted solely to tumor necrosis factor (TNF)-α . This prompted us to study the influence of PTX on a larger spectrum of cytokines with proinflammatory actions [ TNF-α , interleukin-6 , (IL)-6 , IL-1β , IL-8 ] or with implied actions in the TH1 ( IL-2 , IFN-γ)/TH2 ( IL-10 ) balance . The IL-1RA was also explored . This work was performed using a whole-blood model in which cytokine production is measured after stimulation by lipopolysaccharide ( LPS ) ( 25 μg/ml ) and phytohemagglutinin ( PHA ) ( 5μg/ml ) in 1:10 diluted whole blood . The stimulation test was performed in blood from healthy controls and from septic patients ( without septic shock ) in the presence or absence of PTX at 10–6 , 10–5 , 10–4 , or 10–3 M. In controls and septic patients , at a 10–4 M PTX  concentration the production of IL-2 is strongly diminished ( 26–32 % of the basal level ) , followed by diminution of IFN-γ ( 30–40 % ) . As expected , of the proinflammatory cytokines TNF was the most strongly suppressed ( 50 % of baseline ) followed by IL-1 ( about 80 % of basal production ) . Finally , IL-10 was also influenced by PTX ( 65 % of baseline ) . At 10–4 M , IL-1RA and IL-6 were unaffected by PTX . Taken altogether , our data demonstrate that PTX possesses a much broader spectrum of activity on cytokine production than was initially described , and it appears to be a potential and promising immunotherapeutic agent A placebo-controlled , r and omized , double-blind study was conducted to assess the efficacy and safety of pentoxifylline in 80 patients with symptoms of vascular dementia .  Efficacy was assessed using neuropsychologic tests . With regard to the primary efficacy criteria , absolute changes in the active treatment group were more pronounced in both the protocol and endpoint analysis than in the placebo group . Compared with the placebo group , differences were statistically significant for the active treatment group . Similar changes were reported in a post-hoc defined subgroup of patients displaying " stepwise deterioration , " an essential criterion of multi-infa rct dementia ( MID ) . Medication was generally well-tolerated . The present study shows that pentoxifylline is suitable for the symptomatic treatment of vascular dementia A group of 80 elderly subjects affected with recent onset ( less than 6 mth ) slight to moderate mental deterioration was observed before and after oral drug treatment for a period of 28 wk . The study consisted of four r and omized groups of subjects homogeneous for age , sex and life habits . The first group received a placebo , the second group received piracetam ( 1600 mg 3 times a day ) , the third group received pentoxifylline ( 400 mg 3 times a day ) , and the fourth group received a combination of piracetam and pentoxifylline . At the beginning and end of each phase of the study , neuropsychological and haemorheological parameters were evaluated in all subjects . The results show that the most evident improvement in psycho-intellectual performance , associated with an increase of whole blood filtration values , was obtained in the group treated with the two-drug combination Vascular dementia is a major cause of mental and physical disability in Western countries . Treatment of vascular dementia is currently based on the recognition and control of vascular risk factors , while specific drugs have not been approved yet . The aim of the present multinational , double-blind , placebo-controlled study was to evaluate the safety and efficacy of nimodipine administered for as long as 26 weeks in improving cognition or slowing cognitive deterioration in patients defined as having multi-infa rct dementia ( DSM-III-R criteria ) . Two hundred and fifty-nine patients were included ( 128 nimodipine , 131 placebo ) , and 251 were available for the intention-to-treat analysis . No significant difference between drug-treated and placebo patients was noted on the Gottfries-Brâne-Steen scale score ( primary efficacy criterion ) , the remaining neuropsychological tests ( Zahlen-Verbindungs-Test , Fuld-Object-Memory Evaluation , Word Fluency Test , Digit Span , Mini-Mental State Examination ) , and the functional scales ( index of Activity of Daily Living , Instrumental Activity of Daily Living , Rapid Disability Scale , Clinical Dementia Rating ) , although the majority of changes were in favor of the active drug group . A lower incidence of cerebrovascular and cardiac events was observed in the nimodipine-treated patients in comparison with the placebo group . This study failed to show a significant effect of nimodipine on cognitive , social or global assessment s in patients defined as affected by multi-infa rct dementia according to the DSM-III-R criteria . A post-hoc analysis ( presented in an accompanying paper ) suggests that nimodipine may have a favorable effect in the subgroup of patients defined as affected by subcortical ( small vessel ) vascular dementia Twenty healthy volunteers were treated for 3 months with oxpenifylline ( 200 mg 3-times a day ) or a placebo in a controlled double-blind r and omized trial . The volunteers taking the oxpenifylline showed a significant increase in their fibrinolytic activity , as assessed by the dilute blood clot lysis time and fibrin plate lysis area , and a significant reduction in their plasma fibrinogen levels . No change was found in the control group . These findings suggest that oxpentifylline may be valuable in the treatment of small vessel occlusive disease associated with lowered  fibrinolytic activity  and raised fibrinogen levels Sixty elderly patients suffering from initial mental deterioration ( less than 6 months ) were divided at r and om into two groups , homogeneous for age , sex and life habits . For 28 weeks Group I was given a placebo and Group II was given 400 mg pentoxifylline ( ' Trental ' 400 ) 3-times daily for two 3-month periods interrupted by a 4-week wash-out period . Neuropsychological performance and haemorheological parameters were evaluated at the beginning and at the end of each phase of the study . The results showed that pentoxifylline medication significantly improved the psycho-intellectual performance , decreased whole blood viscosity and increased red cell filterability . The results indicate a need to concentrate further study on haemorheological factors in the clinical aspects of the ageing brain , also with a view to allowing for sufficiently long treatment periods OBJECTIVE To test the effect of pentoxifylline , a hemorheologic agent used to treat intermittent claudication , on the course of vascular dementia . DESIGN R and omized , double-blind , placebo-controlled , parallel group trial . SETTING Outpatient tertiary care center . PATIENTS 64 patients meeting DSM-III criteria for multi-infa rct dementia with modified Hachinski ischemic scores greater than or equal to 6 , 38 of whom completed the trial . INTERVENTION Pentoxifylline ( Trental ) 400 milligram tablets three times daily vs placebo for 36 weeks . MAIN OUTCOME MEASURE Alzheimer 's Disease Assessment Scale ( ADAS ) . RESULTS Baseline demographic values and psychometric variables were similar in the placebo and control groups ; endpoint statistical analysis was used to allow the use of data from all patients in this clinical ly high-risk group . For the total group , the slowing of deterioration did not reach statistical significance ( by 2-tailed t test ) , as measured by scores on the total ADAS ( P = 0.058 ) or on the cognitive ( ADAS items 1 - 11 ; P = 0.064 ) or non-cognitive subscales ( ADAS items 12 - 21 ; P = 0.234 ) , although it was significant on the cognitive subscales excluding memory ( ADAS items 2 - 6 , 8 - 10 ; P = 0.036 ) . For the subgroup of 40 patients who had CT and /or MRI evidence of stroke as well as meeting the other inclusion criteria , treatment with pentoxifylline was associated with significantly slower deterioration , as measured by the total ADAS ( P = 0.023 ) and cognitive subscores ( P = 0.020 ) but not non-cognitive subscores ( P = 0.118 ) . For the subgroup of 37 patients who had at least one discrete clinical stroke , treatment with pentoxifylline was associated with significantly less deterioration on the total ADAS ( P = 0.002 ) and both the cognitive ( P = 0.001 ) and non-cognitive ( P = 0.017 ) subscores . CONCLUSION Treatment with pentoxifylline may slow the progression of dementia in patients who meet DSM-III criteria for " multi-infa rct dementia " and who also have clinical and neuroradiological evidence of cerebrovascular disease The brains of 175 consecutive autopsy cases of dementia , clinical ly studied prospect ively , were analyzed pathoanatomically with regard to type , size and site of lesions . Pure groups of vascular dementia caused by large or small vessel disease and by hypoperfusion could be defined . The infa rcts were either complete with a more or less pronounced incomplete perifocal component or of an incomplete type only . Incomplete infa rct ion appears to be an important and yet little appreciated cause of brain dysfunction . These groups could be used as a basis for a pathoanatomical classification of vascular dementias . Vascular dementia is much more common than generally assumed The effect of oxpentifylline on mental state of patients suffering from primary degenerative dementia ( PDD ) and multi-infa rct dementia ( MID ) was investigated in a double-blind study . After an initial 2-weeks washout period , the 
    Output:
    
In conclusion , this systematic review suggested a potential therapeutic role for pentoxifylline in vascular dementia .