Vascular Cognitive Impairment: Risk Factors, Prevention and Treatment

Background: Vascular cognitive impairment (VCI) is a major contributor to age-associated cognitive decline, both independently and as a contributor to mixed dementia syndromes. Despite many years of research, an approved therapy has not yet been identified. Methods: We reviewed preventive and therapeutic strategies tested in VCI and meta-analyzed efficacy data for eligible interventions to assess whether previously tested treatments warranted reconsideration. Results: VCI clinical trials exhibited substantial heterogeneity. Few interventions were reproducibly tested in adequately sized and designed studies. Nonetheless, some interventions showed modest effects on global cognition and functional outcomes. Conclusion: Early and effective management of cerebrovascular risk factors, particularly beginning in midlife, plays a crucial role in lowering the likelihood of developing neurodegenerative conditions such a vascular cognitive impairment and other related dementias. Ginkgo biloba extracts and acetylcholinesterase inhibitors have shown the greatest cognitive and functional benefits, though their clinical significance remains uncertain, and certainty of evidence is overall low.