Neuroprotection in ischemic stroke: what does the future hold?

Neurodegenerative and vascular disease processes are commonly found concurrently in the brains of elderly patients, highlighting the difficulty in determining which processes may be responsible for cognitive impairment. Therapeutically, it may be more sensible to assume that most patients have mixed dementia. Therefore, therapies with multimodal modes of action would be expected to confer neuronal protection. Ischemic stroke is also associated with a complex pathophysiology and a high incidence of post-stroke cognitive impairment, but evidence for the efficacy of neuroprotective treatments in humans is contradictory (mainly due to a failed translation from bench to bedside). Nevertheless, emerging drug therapies continue to undergo testing in prospective, randomized, controlled studies. Natural biologicals, such as Actovegin, or smaller biological molecules with multifaceted effects in the restorative phase of ischemia are likely candidates for efficacy testing. In addition, a number of non-pharmacological interventions, especially lifestyle interventions, are also the subject of current research and would eventually be expected to supplement the treatment and prevention of ischemic stroke.