Therapeutic Potential of Oxiracetam in Neurocognitive Disorders: A Narrative Review

PURPOSE: Cognitive impairment is a growing global health concern associated with aging, neurodegenerative diseases, stroke, and traumatic brain injury. Existing pharmacological treatments, including cholinesterase inhibitors and memantine, provide limited and variable benefits. This review aims to evaluate the mechanistic basis, clinical efficacy, and safety profile of oxiracetam as a potential therapeutic agent for cognitive dysfunction across a range of neurological disorders. METHODS: A narrative review was conducted by synthesizing available preclinical and clinical literature on oxiracetam. Mechanistic studies evaluating its pharmacodynamics, including effects on cholinergic and glutamatergic pathways, synaptic plasticity, neuroinflammation, and oxidative stress, were analyzed. Clinical evidence from trials involving patients with traumatic brain injury, stroke, vascular cognitive impairment, and dementia was reviewed. FINDINGS: Oxiracetam demonstrates multimodal mechanisms of action, including enhancement of cholinergic neurotransmission, modulation of AMPA receptors, and promotion of synaptic plasticity and long-term potentiation. Additionally, it exhibits antioxidant and anti-inflammatory effects contributing to neuroprotection. Clinical studies suggest potential cognitive benefits in several neurological conditions; however, results are heterogeneous, with some trials showing significant improvement and others demonstrating no superiority over placebo. CONCLUSION: Oxiracetam is a promising neurocognitive modulator with a favorable safety profile and potential therapeutic applications across multiple neurological disorders. Nevertheless, current evidence is limited by methodological constraints and inconsistent outcomes. Further large-scale, multicenter clinical trials are required to establish its definitive efficacy and clinical utility.