Vascular dementia
Dementia caused by cerebrovascular pathology: multiple infarcts, white matter ischemia, single strategic infarct. Diagnosis uses DSM-5 criteria and neuroimaging. No effective disease-modifying therapy exists; management focuses on vascular risk factor control.
ICD-10 F013 drugs
Also known as: VaD
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.
- DCholine alfoscerateNot recommended · Other nervous system drugs. ParasympathomimeticsAlpha-GPC is one of the few cholinergic precursors with relatively concrete evidence in vascular dementia, mostly from Italian centres. The Cochrane Fioravanti 2005 review of choline precursors (CDP-choline and alpha-GPC) in chronic cerebrovascular disorders showed moderate cognitive and behavioural scale improvement. The ASCEND-S 2021 RCT (n=210, Italian multicenter) in vascular cognitive impairment demonstrated a moderate effect on MMSE and ADAS-Cog at 1200 mg/day × 6 months. AEMPS has not registered the product; there is no centralised EU marketing authorisation. NICE dementia 2018 (NG97) lists vascular risk factor control (BP, statins, antiplatelets) first-line for vascular dementia; cholinergic therapy can be considered in mixed dementia. Gliatilin and Tsereton are registered in the Russian GRLS. Prescription requires a confirmed vascular dementia diagnosis (CT/MRI, MMSE, MoCA). If isolated vascular dementia was diagnosed without considering donepezil or rivastigmine, consider seeking a second opinion from a neurologist.
- DCiticolineNot recommended · Other psychostimulants and nootropicsCiticoline is marketed as a way to protect neurons and improve blood flow to the brain, including in vascular dementia. Clear benefit for this specific use has not been shown: there is no solid evidence that it changes cognition or the course of the disease. What actually helps in vascular dementia is managing risk factors – blood pressure, blood sugar, lipids – and working with a doctor on related conditions. Citicoline is harmless, but it should not replace treatment with proven benefit, or you may miss the care you need.
- FVinpocetineNot recommended · Psychostimulants and nootropics. Other psychostimulants and nootropicsEvidence tier F. The 2003 Cochrane review on vinpocetine in dementia (Szatmari and Whitehouse) included three RCTs and found no clinically meaningful effect on cognition, global outcome or quality of life, with insufficient evidence to support routine use. No subsequent high-quality RCT has changed this picture. The AAN 2018 practice guideline on mild cognitive impairment and international dementia guidelines (EAN 2020, NICE NG97) do not list vinpocetine. Vascular dementia management focuses on aggressive vascular risk factor control, antiplatelet therapy after non-cardioembolic stroke and structured cognitive rehabilitation.
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