Division of Stroke and Vascular Neurology, Mercy Health Hauenstein Neurosciences, 200 Jefferson Street SE, Grand Rapids, MI, 49503, USA.
Department Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, 220 Cherry Street SE Room H 3037, Grand Rapids, MI, 49503, USA.
CNS Drugs. 2017 Sep;31(9):759-776. doi: 10.1007/s40263-017-0459-3.
Vascular cognitive impairment (VCI) is the second most common type of dementia after Alzheimer's disease (AD). Stroke and cardiovascular risk factors have been linked to both AD and VCI and potentially can affect cognitive function in mid and later life. Various pharmacological agents, including donepezil, galantamine, and memantine, approved for the treatment of AD have shown modest cognitive benefits in patients with vascular dementia (VaD). However, their functional and global benefits have been inconsistent. Donepezil has shown some cognitive benefit in patients with VaD only, and galantamine has shown some benefit in mixed dementia (AD/VaD). The benefits of other drugs such as rivastigmine, memantine, nimodipine, and piracetam are not clear. Some other supplements and herbal therapies, such as citicoline, actovegin, huperzine A, and vinpocetine, have also been studied in patients with VaD, but their beneficial effects are not well established. Non-drug therapies and lifestyle modifications such as diet, exercise, and vascular risk factor control are important in the management of VCI and should not be ignored. However, there is a need for more robust clinical trials focusing on executive function and other cognitive measures and incorporation of newer imaging modalities to provide additional evidence about the utility of these strategies in patients with VCI.
血管性认知障碍（VCI）是仅次于阿尔茨海默病（AD）的第二大常见痴呆症类型。中风和心血管危险因素与 AD 和 VCI 都有关联，并可能影响中年和晚年的认知功能。各种已批准用于治疗 AD 的药物，包括多奈哌齐、加兰他敏和美金刚，在血管性痴呆（VaD）患者中显示出适度的认知益处。然而，它们在功能和整体上的益处并不一致。多奈哌齐仅在 VaD 患者中显示出一些认知益处，而加兰他敏在混合性痴呆（AD/VaD）中显示出一些益处。其他药物如利斯的明、美金刚、尼莫地平、吡拉西坦的益处则不明确。其他一些补充剂和草药疗法，如胞磷胆碱、艾地苯醌、石杉碱甲和长春西汀，也在 VaD 患者中进行了研究，但它们的有益效果尚未得到充分证实。非药物治疗和生活方式改变，如饮食、运动和血管危险因素控制，在 VCI 的管理中非常重要，不应忽视。然而，需要进行更多的关注执行功能和其他认知测量的临床试验，并结合新的成像方式，以提供更多关于这些策略在 VCI 患者中的效用的证据。
