Question: In older adults diagnosed with pure vascular dementia (not Alzheimer's or mixed dementia) how effective are acetylcholinesterase inhibitors or memantine, compared to no drug treatment, in improving cognitive, global and functional symptoms of dementia?


No definite clinical implications can be made from the available evidence. There is some evidence that Acetylcholinesterase inhibitors or memantine have statistically significant positive effects on cognitive function, but there appears to be some concern regarding theirclinicalsignificance and adverse effect burden. The authors of a systematic review suggested that data are insufficient to support their widespread use in patients with vascular dementia. They also suggested that trials of 6-month duration may be too brief to assess overall effectiveness given the relative stability of placebo patient groups, and longer trials would be more likely to show meaningful data on efficacy and safety.

There is also a general consensus that future studies would benefit from outcomes that are specific to patients with vascular dementia, instead of using outcomes that are specific to Alzheimer. The authors of the systematic review stated that an individual patient meta-analysis is needed to provide more specific information on treatment responses across different types and severities of vascular dementia between groups. The authors of a RCT that evaluated reviastigmine suggested that future studies should include neuropathological or biomarker measures to evaluate the presence of concomitant Alzheimer pathology to help better comprehend the effects of treatment.

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