The effects of memantine on behavioral disturbances in patients with Alzheimer's disease: a meta-analysis.
The effects of memantine on behavioral disturbances in patients with Alzheimer's disease: a meta-analysis.
复制标题
DOI：
10.2147/ndt.s142839
复制
发表时间：
2017
影响因子：
3.2
通讯作者：
Iwata N
中科院分区：
文献类型：
--
作者：
Kishi T;Matsunaga S;Iwata N
美金刚对治疗阿尔茨海默病患者的行为障碍有效。目前还没有完全确定哪种行为障碍对美金刚最有效。我们对美金刚与对照（安慰剂或常规护理）治疗个体行为障碍（妄想、幻觉、激越/攻击、烦躁不安、焦虑/恐怖、欣快、冷漠、去抑制、易怒/不稳定、异常运动活动/活动障碍、夜间障碍/昼夜节律障碍和进食障碍）进行了荟萃分析。本研究纳入了美金刚在阿尔茨海默病患者中的随机对照研究。为了评价这些结局，在荟萃分析中评价了基于随机效应模型的标准化平均差（SMD）及其95%置信区间（95%CI）。荟萃分析共纳入11项研究（n= 4，261;美金刚vs安慰剂：N=4，n= 1，500;美金刚+胆碱酯酶抑制剂[M + ChEI] vs ChEI：N=7，n= 2，761）。与对照组相比，美金刚在激动/攻击性方面表现出显著改善（SMD =−0.11; 95% CI =−0.20，−0.03; P=0.01; I2=47%），妄想（SMD =−0.12; 95% CI =−0.18，−0.06; P=0.0002; I2=0%），去抑制（SMD =−0.08; 95% CI =−0.15，−0.00; P=0.04; I2=0%），以及夜间紊乱/昼夜节律紊乱（SMD =−0.10; 95% CI =−0.18，−0.02; P=0.02; I2=36%）。美金刚在幻觉（SMD =−0.06; 95% CI =−0.12，0.01; P=0.07; I2=0%）和易怒/不稳定（SMD =−0.09; 95% CI =−0.19，0.01; P=0.07; I2=42%）方面也略上级对照组。美金刚在烦躁不安、焦虑/恐惧、欣快、冷漠和进食障碍方面与对照组相似。荟萃分析表明，美金刚胺对治疗阿尔茨海默病患者的大多数行为障碍都有好处。美金刚不会恶化阿尔茨海默病患者的行为障碍的阴性症状。
Memantine is effective in the treatment of behavioral disturbances in patients with Alzheimer’s disease. It has not yet been fully determined which behavioral disturbances respond best to memantine. We conducted a meta-analysis of memantine vs control (placebo or usual care) for the treatment of individual behavioral disturbances (delusion, hallucination, agitation/aggression, dysphoria, anxiety/phobia, euphoria, apathy, disinhibition, irritability/lability, aberrant motor activity/activity disturbances, nighttime disturbance/diurnal rhythm disturbances, and eating disturbances). Randomized controlled studies of memantine in patients with Alzheimer’s disease were included in this study. To evaluate these outcomes, standardized mean difference (SMD), with 95% confidence intervals (95% CIs), based upon a random-effects model was evaluated in the meta-analysis. A total of 11 studies (n=4,261; memantine vs placebo: N=4, n=1,500; memantine + cholinesterase inhibitors [M + ChEIs] vs ChEIs: N=7, n=2,761) were included in the meta-analysis. Compared to control, memantine showed significant improvement in agitation/aggression (SMD =−0.11; 95% CIs =−0.20, −0.03; P=0.01; I2=47%), delusion (SMD =−0.12; 95% CIs =−0.18, −0.06; P=0.0002; I2=0%), disinhibition (SMD =−0.08; 95% CIs =−0.15, −0.00; P=0.04; I2=0%), and nighttime disturbance/diurnal rhythm disturbances (SMD =−0.10; 95% CIs =−0.18, −0.02; P=0.02; I2=36%). Memantine was also marginally superior to control in hallucination (SMD =−0.06; 95% CIs =−0.12, 0.01; P=0.07; I2=0%) and irritability/lability (SMD =−0.09; 95% CIs =−0.19, 0.01; P=0.07; I2=42%). Memantine is similar to control in dysphoria, anxiety/phobia, euphoria, apathy, and eating disturbance. The meta-analysis suggest that memantine has benefits for the treatment of most of the behavioral disturbances in patients with Alzheimer’s disease. Memantine does not deteriorate negative symptoms as behavioral disturbances in patients with Alzheimer’s disease.