Table 2 Current pharmacotherapeutic options for vascular dementia (VaD)

Angiotensin Inhibiting Enzyme (ACE) Inhibitors

Enalapril, Lisinopril, Perindopril, Ramipril

Lowers blood pressure

ACE inhibitors inhibit the production of angiotensin II, a vasoconstrictor. Blood vessels are relaxed and raise blood flow

Side effects Persistent dry cough, headaches, dizziness, rashes, hyperkalemia, fatigue, loss of taste [226]

Angiotensin-2 receptor blockers (ARBs)

Candesartan, Irbesartan, Losartan, Valsartan, Olmesartan

Lowers blood pressure

Prevents angiotensin II from binding to its receptors on muscle cells of blood vessels, thus blocking vascular smooth muscle constriction

Side effects Dizziness, headaches, cold or flu-like symptoms [22]

Calcium Channel Blockers

Amlodipine, Felodipine, Nifedipine, Diltiazem, Verapamil

Lowers blood pressure

Prevents Ca²⁺ from entering heart muscle cells and endothelial cells of blood vessels, thus reducing the heart rate and reducing depolarization-mediated contraction of the blood vessels; The combination of reduced heart rate and dilated blood vessels lowers blood pressure

Side effects Headaches, swollen ankles, constipation [244]

Diuretics

Indapamide, Bendroflumethiazide

Lowers blood pressure

Decrease blood volume and venous pressure by promoting urine production and output by the kidneys

Side effects Dizziness, headaches, dehydration, rash, muscle cramps, low blood potassium and sodium levels, gout, increased cholesterol [152]

Beta Blockers

Atenolol, Bisoprolol

Lowers blood pressure

Beta blockers interfere and block the binding of epinephrine/adrenaline on beta receptor sites found on the heart. Beta blockers slow down the heart rate and eases the contraction of the heart

Side effects Dizziness, headaches, tiredness, cold hands and feet [295]

Statins

–

Lowers cholesterol

Reduces cholesterol biosynthesis in the liver by inhibiting HMG-CoA reductase

Side effects Diarrhea, headache [291]

Low-dose Aspirin

–

Anti-platelet drug/Reduces the risk of blood clots/Blood thinning

Aspirin inhibits the production of enzyme Cox-1 which produces thromboxane A-2. Thromboxane A-2 is required for platelet aggregation

Side effects Mild indigestion, increased bleeding, allergy.[142, 182]

Clopidogrel

–

Anti-platelet drug/Reduces the risk of blood clots/Blood thinning

Inhibits the P2Y receptor, which is involved in the platelet activation and cross-linking of fibrin

Side effects Increased bleeding, diarrhea, stomach pain, indigestion, heartburn [134]

Warfarin

–

Anti-coagulant drug

Warfarin inhibits the vitamin K dependent synthesis of clotting factors in the blood

Side effects Increased bleeding, stomachache [113]

Metformin

–

Controls blood sugar

Increases body’s sensitivity to insulin and lowers blood sugar levels

Side effects Stomachache, diarrhea, nausea [129]

Antipsychotic Drugs

Haloperidol, Risperidone, Quetiapine

Treats behavioral and psychological symptoms

Dampens emotional behavior by blocking dopamine D2 receptors in the brain

Side effects Anti-cholinergic effect, sedation, weight gain, erectile dysfunction in males [261]