To compare the effectiveness of various pharmacotherapies in improving cognitive function in patients with vascular dementia, by conducting a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Vascular dementia is the second most common form of dementia and currently has no approved drugs for treatment. Although various pharmacotherapies, including cholinesterase inhibitors, memantine, gingko, and cerebrolysin, have shown promise in enhancing cognitive function in individuals, there is a lack of direct comparisons to determine the most effective option for cognitive improvement.

We systematically searched multiple databases, including PubMed/MEDLINE, Cochrane database, SCOPUS, Embase, and Clinicaltrials.gov, to identify RCTs focused on interventions for vascular dementia and their influence on cognitive function. The search was conducted from the earliest available date to September 2023. Utilizing the frequentist approach, pairwise and network meta-analyses (NMA) were conducted to obtain both direct and indirect comparisons of each measure, quantified as the mean difference (MD).

A total of 13 RCTs with a pooled size of 3880 patients (55.61% males) with vascular dementia were included in the analysis that used the cognitive measures MMSE (10 RCTs) and ADAS-Cog (5 RCTs). Compared to placebo, the ADAS-Cog scores improved significantly with Cerebrolysin (MD, -6.20; 95%CI, -6.39 to -6.01) and Rivastigmine (MD, -1.10; 95%CI, -1.16 to -1.04) in the overall network analysis. In a direct comparative analysis, the NMA showed Cerebrolysin (MD, -5.10; 95%CI, -5.30 to -4.90) to be more effective in improving ADAS-Cog scores than Rivastigmine. Notably, only donepezil (MD, 0.90; 95% CI, 0.70 to 1.10) and Memantine (MD, 0.60, 95% CI, 0.10 to 1.10) exhibited statistically significant, yet slight, improvements in MMSE scores compared to placebo.

Cerebrolysin demonstrates significant enhancement in cognitive function in vascular dementia, as assessed by the ADAS-Cog score. Rivastigmine also shows improvement. Additionally, Donepezil and Memantine demonstrate cognitive benefits, as measured by MMSE.