Efficacy and safety of traditional Chinese medicine kidney-tonifying and blood-activating therapy in the treatment of vascular dementia: a systematic review and meta-analysis

Abstract

This meta-analysis evaluated the efficacy and safety of Kidney-tonifying and Blood-activating Therapy (KTBAT) for vascular dementia (VaD). Eight electronic databases were systematically searched from inception to January 12, 2026, for randomized controlled trials (RCTs). Primary endpoints included clinical effectiveness and cognitive scores (MMSE, HDS, CDR). Secondary outcomes focused on neurotrophic factors (BDNF, NGF, GDNF). Study quality was assessed via RoB 1, with data synthesis performed using RevMan 5.4. Thirty-eight RCTs involving 3,357 participants were identified. KTBAT, whether administered as monotherapy or combined with Western medicine (WMT), significantly increased the clinical effectiveness rate compared to WMT (RR = 1.25, 95% CI: [1.20, 1.31]). Regarding cognition, KTBAT significantly improved MMSE (MD = 3.71, 95% CI: [2.96, 4.47]) and HDS scores (MD = 4.07, 95% CI: [2.63, 5.52]). CDR scores were also lower after intervention (SMD = −0.87, 95% CI: [−1.26, −0.47]). Additionally, KTBAT was associated with higher serum levels of BDNF (SMD = 1.02, 95% CI: [0.13, 1.90]) and NGF (SMD = 0.69, 95% CI: [0.27, 1.12]). GDNF was assessed in only one trial, and its level was also higher in the intervention group. Adverse events (AEs) rates did not differ significantly between KTBAT and WMT (RR = 0.71, 95% CI: [0.32, 1.57], p  = 0.40), with no serious AEs or deaths reported. KTBAT appears to be a potentially effective intervention for improving clinical effectiveness and cognitive function in VaD; however, its safety profile remains uncertain. While these findings support KTBAT as a promising candidate for VaD management, further high-quality, multicenter trials are warranted to strengthen the evidence base. https://www.crd.york.ac.uk/prospero/search , identifier CRD420251272344.