Vascular cognitive impairment and dementia: Prevention, treatments, mechanisms and management options for the future

Vascular Cognitive Impairment and Dementia (VCID), the second most common form of dementia, is becoming increasingly prevalent worldwide. However, currently there are no FDA-approved therapies for VCID. In this review, we explore treatments with extant supporting evidence as well as treatments in development and outline the path forward for future research. Donepezil, rivastigmine, and memantine all have some evidence as cognitive enhancers in patients with Vascular Dementia (VaD) and are approved in several non-US jurisdictions. Nutraceuticals, such as Ginkgo biloba and butylphthalide, have some supportive data and may be similarly helpful. Prevention of VCID is an important objective, and there is support for the intensive control of hypertension and treatment of hyperglycemia to prevent cognitive decline. Asymptomatic cerebral small vessel disease is commonly detected in neuropsychiatric cohorts and healthy individuals, and protocols and trials are being developed to help guide management to minimize the risk of cognitive impairment. A range of novel treatment strategies, including noninvasive neurostimulation, stimulant treatment, and neurotrophic factors, are being explored. Future research into VCID treatment needs to incorporate a range of novel technologies, including blood-based biomarkers, automation of brain image segmentation and quantification using artificial intelligence, automated remotely administered neuropsychological testing, and rational drug discovery.