Possibilities of drug therapy for vascular cognitive impairment: a critical view and possible compromises

To manage patients with vascular cognitive impairment (VCI) is an extremely difficult task, since drug therapy algorithms have not been elaborated, whereas the prescription of most drugs has not always been pathogenetically justified. Today, both our country and foreign countries have no uniform standards for VCI treatment, and the choice of drugs in everyday clinical practice is largely determined by a physician’s personal experience. The paper discusses main areas in the drug treatment of VCI and provides a detailed analysis of studies evaluating the efficacy and safety of basic drugs used to correct cognitive deficit. The basic anti-dementia medications (akatinol memantine and acetylcholinesterase inhibitors) recommended as mandatory treatment have been identified. The remaining groups of drugs are proposed to be used in combination therapy as add-on treatment, by taking into account individual indications. It is concluded that add-on investigations are needed to select the treatment algorithm differentiated preferably for different clinical and pathogenic VCI variants, which should also consider not only the features of clinical manifestations, but also the magnitude of structural and functional changes in the cerebral vessels and brain matter.