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.

Dementia is a progressive and irreversible deterioration of cognition which has a significant impact on the person's activities of daily living and quality of life. Currently, there is no curative treatment of dementia and the treatment options currently used in clinical practice has limited therapeutic reach. Although there are ongoing clinical trials, this review article begins with the question of why statins are no longer clinically indicated in mild cognitive impairment or mild to moderate dementia? This review will explore the evidence in support and against the neuroprotective effects of statins in cognitive impairment. Whilst exploring the evidence around statins, there emerged a possibility of another molecule called cyclodextrin which could potentially not only be a more effective neuroprotective alternative to statins, but possibly an agent which could potentially improve the early or mild cognitive deficits. This literature review will hopefully support in formulating a potential research question for future clinical trials in the treatment of dementia.