About 35,000 people each year in the UK have a type of stroke, called 'lacunar' or 'small
vessel' stroke, which is different to other common types of stroke and for which there is no
proven treatment. It is thought that small vessel stroke is caused by damage to the lining of
the tiny blood vessels deep inside the brain that stops them functioning normally. This not
only causes stroke but, perhaps more importantly, causes problems with thinking and walking,
possibly causing up to 45% of all dementias either on its own, or mixed with Alzheimer's
disease (about 350,000 patients in the UK). Some drugs that are commonly used in other blood
vessel diseases may help improve small vessel function and prevent worsening of brain damage.
One drug (cilostazol) has been tested in patients with stroke in the Asia Pacific countries
but not on dementia; the other drug (isosorbide mononitrate) is widely used in the UK for
heart disease but not stroke. The investigators want to set up a clinical trial to test if
the study methods are practical so that patients and trial centres can follow the procedures,
and to confirm how many patients have more stroke-like symptoms or experience worsening of
their thinking skills. This information is needed to be sure that a very large clinical trial
to find out if these drugs can prevent worsening of small vessel disease will be possible.