Network meta-analysis of the efficacy of pharmacological treatments for post-stroke cognitive impairment and vascular cognitive impairment

Does your competent? doctor agree with this treatment for stroke cognitive impairment? Y/N?

with expert consensus supporting donepezil(sic) and rivastigmine for PSCI.

"Donepezil vs donepezil" essentially compares different forms, dosages, or brand names of the same medication.

Ok, I looked back at my earlier posts and you don't want to use donepezil for mild cognitive impairment.

When people experience memory loss that looks a little like Alzheimer's but isn't, doctors diagnose it as "Mild Cognitive Impairment (MCI)". Some prescribe the Alzheimer's drug donepezil (Aricept®). New research shows why it should not be prescribed for people with mild cognitive impairment (MCI) without a genetic test.
UCLA School of Nursing researchers discovered that for people who carry a specific genetic variation — the K-variant of butyrylcholinesterase, or BChE-K — donezpezil could accelerate cognitive decline. 

 Network meta-analysis of the efficacy of pharmacological treatments for post-stroke cognitive impairment and vascular cognitive impairment

Wenting LiXinyu LiuCong GaoWenbo LiXiaoling Liao^*

• Department of Neurology, Tiantan Hospital, Capital Medical University, Beijing, China

Background: Based on recent reviews, vascular cognitive impairment (VCI) encompasses a spectrum of cognitive deficits caused by cerebrovascular disease and its risk factors, ranging from mild cognitive impairment to dementia, and often coexists with neurodegenerative conditions like Alzheimer’s disease. VCI is categorized into four clinical-imaging subtypes, including post-stroke cognitive impairment (PSCI)—a common stroke complication and major VCI subtype. Current guidelines recommend cholinesterase inhibitors and NMDA receptor antagonists as first-line treatments for VCI, with expert consensus supporting donepezil and rivastigmine for PSCI. However, existing evidence primarily derives from placebo-controlled or head-to-head drug comparisons, lacking comprehensive evaluations of multiple cognitive enhancers. This study aims to systematically assess the efficacy and safety of cognitive-enhancing drugs in VCI, with a focused analysis on PSCI, to better inform clinical decision-making and improve patient outcomes.

Methods: We systematically searched four databases using predefined search strategies. Eligible studies were selected based on predetermined criteria. The included studies were analyzed with StataSE 16.0, RevMan 5.3, and Grade software to compare the efficacy and safety of cognitive-enhancing drugs to identify the optimal treatment for VCI and PSCI.

Results: Sixteen studies (5,599 participants) were included. In terms of cognitive outcomes, sailuotong was superior to placebo on the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog) (MD = −3.00, 95% CI: −4.50, −1.50) and ranked best (SUCRA 88.5%). Memantine was most effective on the Mini-Mental State Examination (MMSE) (MD = 1.23, 95% CI: 0.23–2.23; SUCRA 80.8%). For the secondary outcome, the MoCA assessment showed that Ginkgo biloba extract significantly improved Montreal Cognitive Assessment (MoCA) scores compared to placebo (MD = 1.29, 95% CI: 1.24, 1.35). Regarding safety, donepezil significantly increased the risk of overall adverse events compared to placebo (OR: 1.57; 95% CI: 1.19–2.06).

Conclusion: Our network meta-analysis suggests that memantine might have the best effect for PSCI, with sailuotong potentially serving as a secondary option. However, these estimates are based on a small randomized controlled trial and a sparse network. Therefore, the current evidence is limited, highlighting the need for more high-quality studies to robustly validate the therapeutic potential of these interventions for VCI and PSCI.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier in PROSPERO (CRD420250627957).