Therapeutic strategies in vascular cognitive impairment: A systematic review of population, intervention, comparators, and outcomes

Vascular cognitive impairment (VCI) is a common and heterogeneous condition, clinically and pathophysiologically, that still lacks approved treatment.We reviewed evidence from randomized and non-randomized clinical trials in VCI to explore whether any therapeutic option warrants further investigation and to assess possible flaws in previous studies.We identified 118 studies after searching PubMed and Embase, including 19,223 participants and 5 different VCI subtypes. We found 63 different types of intervention (51 pharmacologic, 5 employing physical agent application, 7 rehabilitation approaches) compared with either placebo, best medical treatment, or other interventions. Treatment efficacy was assessed through 125 outcome measures (with a clearly pre-specified primary outcome in 50.8% of studies).Therapeutic trials in VCI have been heterogeneous in terms of populations, types of interventions, and outcomes. Overall, a lack of clear pathophysiological rationale for tested interventions seems to emerge, together with the need to homogenize trial study design.