Efficacy and Safety of Oxiracetam in Patients with Vascular Cognitive Impairment: A Multicenter, Randomized, Double-Blinded, Placebo-Controlled, Phase IV Clinical Trial

Background: Oxiracetam may have a modest effect on preventing cognitive decline. Exercise can also enhance cognitive function. This trial aims to investigate the effect of oxiracetam on post-stroke cognitive impairment and explore whether this effect is modified by exercise. Furthermore, the mechanisms that mediate this effect will be investigated through a neural network analysis.Methods: This is a multicenter, randomized, double-blind, placebo-controlled phase IV trial. Patients who com-plained of cognitive decline 3 months after stroke and had a high risk of cognitive decline were eligible. Patients were randomly assigned to receive either 800 mg of oxiracetam or placebo twice daily for 36 weeks. After randomization, a predetermined exercise protocol was provided to each participant, and the degree of physical activity was assessed using wrist actigraphy at 4, 12, 24, and 36 weeks. Resting-state functional MRI was ob-tained in baseline and 36-week follow-up. Co-primary endpoints are changes in the Mini-Mental State Exami-nation and Clinical Dementia Rating-Sum of Boxes. Secondary endpoints include changes in the NINDS-CSN VCIHS-Neuropsychology Protocol, Euro QoL, patient's global assessment, and functional network connectivity. If there is a significant difference in physical activity between the two groups, the interaction effect between physical activity and the treatment group will be examined. A total of 500 patients were enrolled from February 2018, and the last patient's final follow-up was completed in September 2022.Conclusion: This trial is meaningful not only to prove the efficacy of oxiracetam, but also evaluate whether ex-ercise can modify the effects of medication and how cognitive function can be restored. Trial registration http://cris.nih.go.kr (KCT0005137).