Vascular cognitive impairment and dementia drug-development pipeline 2025.

INTRODUCTION: There are currently no approved medicines for vascular cognitive impairment and dementia (VCID). METHODS: We reviewed clinical trials across nine registries and included, summarized, and evaluated trials that had not yet published peer-reviewed results by August 22, 2025. RESULTS: We found 88 clinical trials using 62 drugs. Cardiovascular disease-targeted therapies accounted for 37% (23 drugs). Synthetic and plant-based cognitive function enhancers accounted for 21% (13 drugs) each. Drugs targeting neuropsychiatric symptoms comprised 10% of the pipeline (six agents), biological disease-targeted therapies 5% (three agents), and other drugs 6% (four agents). There were 30 trials assessing 25 drugs in Phase 4, 24 trials assessing 21 drugs in Phase 3, 29 trials assessing 28 drugs in Phase 2, and five trials assessing four drugs in Phase 1. DISCUSSION: While small relative to Alzheimer's disease (138 drugs, 182 trials in 2025), the drug pipeline for VCID shows some promise and will require further investment.