Piracetam is a nootropic compound that has been studied for its potential to support or treat cognitive impairment, including dementia. Its use for dementia is primarily justified by scientific investigation, though the evidence base is limited and somewhat mixed.

Piracetam was first synthesized in the 1960s and has since been used, particularly in Europe, as a cognitive enhancer and treatment for cognitive disorders. Mechanistically, piracetam is believed to modulate neurotransmission, improve neuronal plasticity, and enhance microcirculation in the brain without causing sedation or stimulation.

Multiple randomized controlled trials (RCTs) and meta-analyses have evaluated piracetam in dementia, including Alzheimer’s disease and vascular dementia. A 2001 Cochrane review concluded that there was some evidence of benefit for global impression and cognitive function in patients with dementia, but the effect size was modest and the clinical significance unclear. Subsequent reviews and regulatory agencies, such as the European Medicines Agency (EMA), have found the evidence insufficient to support its widespread use, especially given methodological limitations and inconsistent results across studies.

Piracetam is not approved for dementia in many countries, including the US and UK, due to the lack of robust evidence and concerns about clinical relevance. However, it is still prescribed in some countries based on the limited available data and historical precedent. Overall, the scientific evidence supporting piracetam’s use in dementia is weak (rated 2/5), with ongoing debate about its efficacy and routine use.