Clinical Evidence on Herbal Medicine for Vascular Dementia: A Systematic Review and Meta-analysis

Objective: To evaluate the efficacy and safety of herbal medicine for vascular dementia (VaD) through a systematic review and meta-analysis.Methods: Randomized controlled trials (RCTs) published between 2015 and 2025 using traditional herbal medicine were identified from PubMed, Cochrane Library, CNKI, and ScienceON. Trials with a Jadad score ≥3 were included. Outcomes assessed included cognition (MMSE, MoCA, HDS, ADAS-Cog), routine activities (ADL, BBS), serum biomarkers (Hcy, TNF-α), electroencephalography (P300), and adverse events.Results: Fifteen RCTs (n=1,327) were included. Compared to Western medicine alone, adjunctive herbal medicine significantly improved cognition [MMSE (MD=2.49; 95% CI: 2.10-2.89; p<0.00001)] and daily function [ADL (MD=-3.25; 95% CI: -4.39 to -2.10; p<0.00001)]. Biomarkers also improved: Hcy (MD=-6.33 μmol/L; 95% CI: -10.95 to -1.71; p=0.007). Adverse event rates were comparable (RR=1.00; 95% CI: 0.37-2.67; p=1.00). Chinese patent medicine also showed significant MMSE improvements versus placebo with comparable safety.Conclusion: Herbal medicine may improve cognition, daily function, and selected biomarkers in patients with VaD without increasing adverse events. However, heterogeneity and risk of bias limit certainty, highlighting the need for well-designed, blinded, standardized RCTs.