Background: Behavioural and psychological symptoms of dementia (BPSD) are highly distressing manifestations that are frequently experienced in patients with vascular dementia (VaD). BPSD are difficult to manage, associated with poorer patient outcomes, and have a profound impact on caregivers. Glutamatergic neurotoxicity has been suggested to contribute to the pathogenesis of BPSD. Memantine is a moderate-affinity, uncompetitive glutamate N-methyl-D-aspartate receptor antagonist, which has been shown to have neuroprotective properties. At present, memantine is not licensed for treatment of BPSD in VaD. Objectives: Systematically analyse the data on memantine to assess its clinical efficacy and safety in the treatment of BPSD in VaD. Results: Two RCTs, comprising of 460 patients treated with memantine and 441 patients treated with placebo that met the criteria for probable VaD, were included. Memantine showed improvements in the Alzheimer’s Disease Assessment Scale, cognitive subscale (ADAS-Cog), Gottfries-Brane-Steen (GBS) Scale, Nurses’ Observation Scale for Geriatric Patients (NOSGER), Mini-Mental State Examination (MMSE), Clinical Global Impression of Change (CGIC) and adverse events, although not all findings were statistically significant. Conclusion: Memantine appeared to be beneficial in improving BPSD in VaD patients and demonstrated a good safety profile. There is currently limited literature available to support its use in clinical practice. Therefore, further studies comprising of larger sample sizes and patients with different VaD severities are required to gain better understanding of the efficacy of memantine in VaD.