Mauer Sivan, Vergne Derick, Ghaemi S Nassir
Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, USA.
Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, USA Tufts University School of Medicine, Boston, MA, USA.
Aust N Z J Psychiatry. 2014 Sep;48(9):809-18. doi: 10.1177/0004867414536932. Epub 2014 Jun 11.
Dementia is a major public health issue, with notably high rates in persons with mood illnesses. Lithium has been shown to have considerable neuroprotective effects, even in trace or low doses. The aim of this review is to summarize the current understanding of lithium benefits in trace or low doses in dementia prevention and for other behavioral or medical benefits.
A systematic review identified 24 clinical, epidemiological, and biological reports that met inclusion criteria of assessing lithium in standard or low doses for dementia or other behavioral or medical benefits.
Five out of seven epidemiological studies found an association between standard-dose lithium and low dementia rates. Nine out of 11 epidemiological studies, usually of drinking water sources, found an association between trace-dose lithium and low suicide/homicide/mortality and crime rates. All four small randomized clinical trials of lithium for Alzheimer's dementia have found at least some clinical or biological benefits versus placebo. Only one small randomized clinical trial (RCT) of trace lithium has been conducted, assessing mood symptoms in former substance abusers, and found benefit with lithium versus placebo.
Lithium, in both standard and trace doses, appears to have biological benefits for dementia, suicide, and other behavioral outcomes. Further RCT research of trace lithium in dementia is warranted.
痴呆是一个重大的公共卫生问题，在患有情绪疾病的人群中发病率尤其高。锂已被证明具有相当大的神经保护作用，即使是微量或低剂量。本综述的目的是总结目前对微量或低剂量锂在预防痴呆以及其他行为或医学益处方面的认识。
一项系统综述确定了24份临床、流行病学和生物学报告，这些报告符合评估标准剂量或低剂量锂对痴呆或其他行为或医学益处的纳入标准。
七项流行病学研究中有五项发现标准剂量锂与低痴呆率之间存在关联。11项流行病学研究（通常针对饮用水源）中有九项发现微量剂量锂与低自杀/杀人/死亡率及犯罪率之间存在关联。所有四项关于锂治疗阿尔茨海默病痴呆的小型随机临床试验均发现，与安慰剂相比，锂至少有一些临床或生物学益处。仅进行了一项关于微量锂的小型随机临床试验（RCT），评估了既往药物滥用者的情绪症状，发现锂与安慰剂相比有疗效。
标准剂量和微量剂量的锂似乎对痴呆、自杀及其他行为结果均具有生物学益处。有必要对微量锂在痴呆方面进行进一步的随机对照试验研究。
