Decreased integrity of the monoaminergic tract is associated with a positive response to MPH in patients with vascular cognitive impairment - proof of principle study STREAM-VCI

•The STREAM-VCI is a single center, double-blind, three-way, cross-over study, in 30 VCI patients investigating the immediate effect of a single dose methylphenidate and galantamine on central nervous system functions.•In the current study we investigated differences in measures for cerebrovascular disease, structural damage to specific neurotransmitter systems, cerebral perfusion, and Alzheimer (AD) pathology, between patients with vascular cognitive impairment (VCI) who responded to either methylphenidate or galantamine and patients who did not respond.•We found that decreased integrity of the monoaminergic neurotransmitter system is associated with a positive response to MPH in patients with VCI.•In this small group of patients, we did not find an association between MRI measures and a positive response to galantamine, but we did find that responsiveness may be related to AD pathology.