September 30, 2022
Stroke can cause cognitive decline. The frequency of cognitive impairment after an ischemic stroke ranges from 20 to 30%, with an increasing risk in the two years after stroke. According to recent studies, 25% of patients suffer from poststroke dementia, and the risk of poststroke patients developing dementia within the following five years is nine times higher than in the healthy population, especially for cognitive domains such as memory and attention. Prevention of secondary strokes and specific treatment for the improvement of cognitive function should be a main task of the management of cognitive impairment following cerebrovascular disease. Secondary stroke prevention includes control of risk factors such as blood pressure, cholesterol levels, and hyperhomocysteinemia. Homocysteine is an independent risk factor for stroke. Strokes caused by hyperhomocysteinemia are usually followed by cerebral microangiopathy and multiple infarction that can reduce cognitive function in various domains.
Ingestion of 0.5–5 mg folic acid, use of neuroprotective drugs, antianxiety medicine, hypnosedatives, and antidepressants has side effects and is expensive. Therefore, the use of natural medicines, especially in the more effective herbal form rather than the active component (isolation of the pure compound) is getting more and more popular in our days.
One medicinal herb commonly used is Gotu kola (Centella asiatica). The main group of components in Gotu kola is the triterpenes including asiaticoside, madecassoside, asiatic acid, and madecassic acid, which have antioxidant, antiinflammatory, and antiapoptotic properties.
Recent studies showed the effectiveness of Gotu kola (Centella asiatica) in improving cognitive function in patients with vascular cognitive impairment (VCI). This study uses a quasi-experimental design. Subjects in this study were patients with poststroke cognitive impairment who were treated at two hospitals in Yogyakarta, Indonesia. The number of subjects was 48: 17 subjects were treated with 1000 mg/day of gotu kola extract, 17 subjects treated with 750 mg/day of Gotu kola extract, and 14 subjects treated with 3 mg/day of folic acid for 6 weeks. The result showed that there was no significant difference between treatment groups for all domains tested, except for memory domain (delayed recall memory) which showed statistically more significant improvement in patients treated with Gotu kola compared with patients treated with folic acid. Thus, in this study, after 6 weeks of treatment, the result showed that Gotu kola 750 mg and 1000 mg are equally effective to folic acid 3 mg in improving all cognitive domains in patients with vascular cognitive impairment, while being superior in improving memory. Therefore, among the seven cognitive domains assessed by the MoCA-Ina test, Gotu kola treatment showed better improvement in delayed memory recall compared with folic acid treatment.