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We conducted a VaD-focused, scale-specific systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched four databases for English-language parallel-group randomized controlled trials (1990\u20132025). Comparable placebo-controlled outcomes were pooled using random-effects meta-analysis; non-poolable outcomes were synthesized according to SWiM. Risk of bias and certainty were assessed with RoB 2 and GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen trials included 5,668 participants across trial cohorts; with one exception, all were published in 2012 or earlier. EGb 761\n                      <jats:sup>\u00ae<\/jats:sup>\n                      was evaluated in three trials; nimodipine, galantamine, memantine, and rivastigmine in two each; and pentoxifylline, citicoline, sulodexide, donepezil, and Tianzhi granule in one each. Galantamine reduced ADAS-Cog\/11 scores (2 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,332; MD\u2009\u2212\u20092.01, 95% CI\u2009\u2212\u20093.18 to \u2212\u20090.85) and ADAS-Cog\/13 scores (2 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,328; MD\u2009\u2212\u20092.51, 95% CI\u2009\u2212\u20093.87 to \u2212\u20091.15), and memantine reduced ADAS-Cog\/11 scores (2 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009752; MD\u2009\u2212\u20092.20, 95% CI\u2009\u2212\u20093.24 to \u2212\u20091.15); certainty was moderate. EGb 761\n                      <jats:sup>\u00ae<\/jats:sup>\n                      reduced SKT scores (3 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009283; MD\u2009\u2212\u20092.65, 95% CI\u2009\u2212\u20095.17 to \u2212\u20090.12), but heterogeneity was extreme (I\u00b2=92.8%; very low certainty). Galantamine showed no clear NPI benefit (2 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,310; MD\u2009\u2212\u20090.13, 95% CI\u2009\u2212\u20094.05 to 3.79), and memantine showed no clear GBS benefit (2 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009595; MD\u2009\u2212\u20091.93, 95% CI\u2009\u2212\u20094.69 to 0.84). Evidence for the other seven interventions was mainly single-trial and non-poolable; functional and global outcomes did not establish consistent benefit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Galantamine and memantine showed small short-term cognitive effects; EGb 761\n                      <jats:sup>\u00ae<\/jats:sup>\n                      suggested a fragile, very low-certainty signal; patient-important benefits remain uncertain.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00228-026-04158-9","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T03:08:33Z","timestamp":1787540913000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pharmacological interventions targeting cognition and related clinical outcomes in vascular dementia: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.1007","volume":"82","author":[{"given":"Tianyu","family":"Cheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhou","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huazheng","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gengzhen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujia","family":"Huo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"issue":"25","key":"4158_CR1","doi-asserted-by":"publisher","first-page":"3326","DOI":"10.1016\/j.jacc.2019.04.034","volume":"73","author":"C Iadecola","year":"2019","unstructured":"Iadecola C, Duering M, Hachinski V, Joutel A, Pendlebury ST, Schneider JA et al (2019) Vascular Cognitive Impairment and Dementia: JACC Scientific Expert Panel. 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