A Meta-Analysis of the Efficacy of Donepezil, Rivastigmine, Galantamine, and Memantine in Relation to Severity of Alzheimer's Disease
A Meta-Analysis of the Efficacy of Donepezil, Rivastigmine, Galantamine, and Memantine in Relation to Severity of Alzheimer's Disease
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DOI：
10.3233/jad-122140
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发表时间：
2013-01-01
影响因子：
4
通讯作者：
Musicco, Massimo
中科院分区：
文献类型：
--
作者：
Di Santo, Simona Gabriella;Prinelli, Federica;Musicco, Massimo
背景资料：随机临床试验已经评估了乙酰胆碱酯酶抑制剂（AChE-Is）和美金刚胺在广泛的阿尔茨海默病（AD）严重程度中的疗效。然而，这些药物的处方和报销是根据精确的上限和下限截止分数的认知tests.Objectives.目的：验证药物治疗的疗效是否有任何依赖性的痴呆患者的严重程度。已发表的英文随机、安慰剂对照试验，评价任何剂量、任何时间长度的AChE-Is或美金刚的疗效，包括任何严重程度的AD所致痴呆患者。从每项研究中提取认知、行为和功能结局，并汇总同一试验的多个结局，以获得认知、功能障碍以及行为和心理障碍的独特疗效指标。使用参数和非参数相关性analysis.Results：AChE-Is和美金刚胺对认知有显着影响的治疗效果和痴呆的严重程度的大小之间的关系的存在，测量与迷你精神状态检查，被确定。功能和心理行为结果的报告频率较低，但也显示出显着的治疗效果。不同药物之间和不同药物之间存在高度异质性。除美金刚胺外，所有药物的疗效均独立于所有领域的痴呆严重程度。美金刚对功能障碍的影响更好，在更严重的patients.Conclusions：抗痴呆药物对认知的适度有益影响是独立于痴呆的严重程度。美金刚胺仅对严重患者的功能不全更有效。
Background: Randomized clinical trials have evaluated the efficacy of acetylcholinesterase inhibitors (AChE-Is) and memantine across a wide range of Alzheimer's disease (AD) severity. However, these drugs are prescribed and reimbursed according to precise upper and lower cut off scores of cognitive tests.Objectives: To verify whether the efficacy of pharmacological treatment had any dependence on the severity of dementia in AD patients.Methods: Published English-language randomized, placebo-controlled trials evaluating the efficacy of AChE-Is or memantine at any dose, over any length of time, in patients with any severity of dementia due to AD were included. Cognitive, behavioral, and functional outcomes were extracted from each study and multiple outcomes from the same trial were pooled to obtain a unique indicator of efficacy for cognition, functional impairment, and behavioral and psychological disturbances. The existence of a relationship between size of the treatment effect and severity of dementia, measured with the Mini-Mental State Examination, was determined using parametric and non-parametric correlation analyses.Results: Both AChE-Is and memantine had significant effects on cognition. Functional and psycho-behavioral outcomes were reported less frequently but also showed significant efficacy of treatment. High heterogeneity among studies was found within and between the different drugs. The efficacy of all drugs except memantine was independent from dementia severity in all domains. Memantine effect on functional impairment was better in more severe patients.Conclusions: The modest beneficial effects of anti-dementia drugs on cognition are independent from dementia severity. Memantine is more effective on functional incompetence only in severe patients.