Cognitive impairment
Reduction in cognitive function not reaching the threshold of dementia. The term 'dyscirculatory encephalopathy' is absent from international classifications.
ICD-10 F06.76 drugs
Also known as: Mild cognitive impairment, MCI
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DPiracetamNot recommended · Old «nootropics» (local classification)A 2001 Cochrane Review of piracetam in dementia and cognitive impairment reported a weak positive effect with high risk of bias and methodological problems. No independent update has been published since. International dementia guidelines (NICE NG97, AAN 2018) do not include piracetam. The drug is not registered as a medicine in the United States; FDA issued warnings to supplement manufacturers using piracetam in 2004 and 2010.
- FCortexin (bovine brain cortex polypeptides)Not recommended · Other psychostimulants and nootropics (local classification)Cortexin is not included in international guidelines for cognitive impairment and dementia (NICE NG97, AAN 2018). The drug has no independent multicentre RCTs in international journals.
- FDeproteinized hemoderivative from calf bloodNot recommended · Other metabolic agents (local classification)For cognitive impairment and 'chronic cerebral ischemia', the product is not mentioned in international guidelines (AAN, ESO).
- FEthylmethylhydroxypyridine succinateNot recommended · Other metabolic agents (local RU classification)Evidence tier F. The diagnostic entity "dyscirculatory encephalopathy" used in Russian neurology to justify long-term mexidol courses is absent from ICD-11 and from the AAN, EAN and AHA/ASA frameworks for vascular cognitive impairment. Mexidol is not listed in any international dementia or vascular cognitive impairment guideline. Evidence-based management of vascular cognitive impairment is aggressive control of vascular risk factors, physical activity, treatment of depression and sleep disorders, and structured cognitive engagement.
- FPicamilon (nicotinoyl-GABA)Not recommended · Nootropics and vasoactive agents (local classification). Russian development.For cognitive impairment, picamilon is used in Russian practice as a nootropic. Independent international RCTs with MMSE, MoCA, or ADAS-Cog endpoints do not exist. AAN and Alzheimer's Association guidelines do not list the drug. In 2015 the FDA issued an official warning about illegal picamilon sales in the US as a dietary supplement.
- FPiracetam + cinnarizineNot recommended · Combination nootropic (local classification)For cognitive impairment, international guidelines (NICE NG97, AAN 2018) list cholinesterase inhibitors and memantine for Alzheimer dementia and workup for reversible causes in mild cognitive impairment. Combination nootropics with piracetam are not included.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit