Ströhle Andreas, Schmidt Dietlinde K, Schultz Florian, Fricke Nina, Staden Theresa, Hellweg Rainer, Priller Josef, Rapp Michael A, Rieckmann Nina
Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany.
Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany.
Am J Geriatr Psychiatry. 2015 Dec;23(12):1234-1249. doi: 10.1016/j.jagp.2015.07.007. Epub 2015 Jul 21.
Demographic changes are increasing the pressure to improve therapeutic strategies against cognitive decline in Alzheimer disease (AD) and mild cognitive impairment (MCI). Besides drug treatment, physical activity seems to be a promising intervention target as epidemiological and clinical studies suggest beneficial effects of exercise training on cognition. Using comparable inclusion and exclusion criteria, we analyzed the efficacy of drug therapy (cholinesterase inhibitors, memantine, and Ginkgo biloba) and exercise interventions for improving cognition in AD and MCI populations.
We searched The Cochrane Library, EBSCO, OVID, Web of Science, and U.S Food and Drug Administration data from inception through October 30, 2013. Randomized controlled trials in which at least one treatment arm consisted of an exercise or a pharmacological intervention for AD or MCI patients, and which had either a non-exposed control condition or a control condition that received another intervention. Treatment discontinuation rates and Standardized Mean Change score using Raw score standardization (SMCR) of cognitive performance were calculated.
Discontinuation rates varied substantially and ranged between 0% and 49% with a median of 18%. Significantly increased discontinuation rates were found for galantamine and rivastigmine as compared to placebo in AD studies. Drug treatments resulted in a small pooled effect on cognition (SMCR: 0.23, 95% CI: 0.20 to 0.25) in AD studies (N = 45, 18,434 patients) and no effect in any of the MCI studies (N = 5, 3,693 patients; SMCR: 0.03, 95% CI: 0.00 to 0.005). Exercise interventions had a moderate to strong pooled effect size (SMCR: 0.83, 95% CI: 0.59 to 1.07) in AD studies (N = 4, 119 patients), and a small effect size (SMCR: 0.20, 95% CI: 0.11 to 0.28) in MCI (N = 6, 443 patients).
Drug treatments have a small but significant impact on cognitive functioning in AD and exercise has the potential to improve cognition in AD and MCI. Head-to-head trials with sufficient statistical power are necessary to directly compare efficacy, safety, and acceptability. Combining these two approaches might further increase the efficacy of each individual intervention.
PROSPERO (2013:CRD42013003910).
人口结构的变化增加了改进针对阿尔茨海默病（AD）和轻度认知障碍（MCI）认知功能衰退治疗策略的压力。除药物治疗外，体育活动似乎是一个有前景的干预靶点，因为流行病学和临床研究表明运动训练对认知功能有益。我们使用可比的纳入和排除标准，分析了药物治疗（胆碱酯酶抑制剂、美金刚和银杏叶提取物）和运动干预对AD和MCI人群认知功能改善的疗效。
我们检索了考克兰图书馆、EBSCO、OVID、科学网以及美国食品药品监督管理局自创建至2013年10月30日的数据。纳入至少一个治疗组为针对AD或MCI患者的运动或药物干预，且有未暴露对照组或接受其他干预对照组随机对照试验。计算治疗中断率以及使用认知表现原始评分标准化（SMCR）的标准化均数变化得分。
中断率差异很大，介于0%至49%之间，中位数为18%。在AD研究中，与安慰剂相比，加兰他敏和卡巴拉汀的中断率显著增加。在AD研究（N = 45, 18434例患者）中，药物治疗对认知功能有小的合并效应（SMCR：0.23，95%CI：0.20至0.25），而在任何MCI研究（N = 5, 3693例患者；SMCR：0.03，95%CI：0.00至0.005）中均无效应。在AD研究（N = 4, 119例患者）中，运动干预有中度至强的合并效应量（SMCR：0.83，95%CI：0.59至1.07），在MCI（N = 6, 443例患者）中有小的效应量（SMCR：0.20，95%CI：0.11至0.28）。
药物治疗对AD的认知功能有小但显著的影响，运动有改善AD和MCI认知功能的潜力。需要有足够统计学效能的直接比较疗效、安全性和可接受性的头对头试验。将这两种方法结合可能会进一步提高每种干预措施的疗效。
PROSPERO（2013：CRD42013003910）
