Fitzpatrick-Lewis Donna, Warren Rachel, Ali Muhammad Usman, Sherifali Diana, Raina Parminder
CMAJ Open. 2015 Dec 1;3(4):E419-27. doi: 10.9778/cmajo.20150057. eCollection 2015 Oct-Dec.
The effectiveness of treatments for mild cognitive impairment is uncertain. The aim of this review was to evaluate the effectiveness and harms of treatment for mild cognitive impairment in adults 65 years of age and older.
We searched MEDLINE, Embase and Cochrane Central (December 2012-December 2014); citations from 2 systematic reviews were considered for inclusion. We included randomized controlled trials involving community-dwelling adults aged 65 years and older with a diagnosis of mild cognitive impairment. Studies reporting on cognition, function, behaviour, global status, mortality and adverse events for treatment with pharmacologic and nonpharmacologic interventions were included.
Seventeen studies were included. Cholinesterase inhibitor studies evaluating cognition (Alzheimer's Disease Assessment Scale, cognition subscale) showed no difference between intervention and control groups (mean difference [MD] -0.33, 95% CI -0.73 to 0.06]; one behavioural study showed no significant effect on cognition (Alzheimer's Disease Assessment Scale, cognition subscale) for the intervention group when compared to controls (MD -0.60, (95% CI -1.44 to 0.24), and one study on vitamin E showed no difference between intervention and control groups (MD 0.85, 95% CI -0.32 to 2.02). With the Mini-Mental State Examination, cholinesterase inhibitors showed no difference between intervention and control groups (MD 0.17, 95% CI -0.13 to 0.47); behavioural studies showed a significant difference favouring intervention (MD 1.01, 95% CI 0.25 to 1.77), and studies of dietary supplements and/or vitamins showed no difference between intervention and control groups (MD 0.20, 95% CI -0.04 to 0.43). Pharmacologic studies showed no difference in serious adverse events (risk ratio 0.98, 95% CI 0.86 to 1.10). No serious adverse events were reported for nonpharmacologic interventions.
Treatment of mild cognitive impairment with cholinesterase inhibitors showed no benefit when compared with a control group. A small cognitive benefit was observed using behavioural therapies when compared with the control group. However, the clinical significance of this small benefit remains uncertain. The current evidence does not support the use of cholinesterase inhibitors for treating mild cognitive impairment, and future high-quality research using a standardized approach is needed to affirm the finding of a small benefit on cognition that was observed for behavioural interventions.
PROSPERO no. CRD42014015431.
针对轻度认知障碍的治疗效果尚不确定。本综述的目的是评估65岁及以上成年人轻度认知障碍治疗的有效性和危害。
我们检索了MEDLINE、Embase和Cochrane Central（2012年12月至2014年12月）；纳入了2项系统评价中的参考文献。我们纳入了涉及65岁及以上社区居住成年人且诊断为轻度认知障碍的随机对照试验。纳入了报告药物和非药物干预治疗的认知、功能、行为、整体状况、死亡率和不良事件的研究。
纳入了17项研究。评估认知的胆碱酯酶抑制剂研究（阿尔茨海默病评估量表，认知子量表）显示干预组和对照组之间无差异（平均差[MD] -0.33，95%置信区间 -0.73至0.06）；一项行为研究显示，与对照组相比，干预组对认知（阿尔茨海默病评估量表，认知子量表）无显著影响（MD -0.60，95%置信区间 -1.44至0.24），一项关于维生素E的研究显示干预组和对照组之间无差异（MD 0.85，95%置信区间 -0.32至2.02）。使用简易精神状态检查表，胆碱酯酶抑制剂在干预组和对照组之间无差异（MD 0.17，95%置信区间 -0.13至0.47）；行为研究显示有利于干预的显著差异（MD 1.01，95%置信区间 0.25至1.77），膳食补充剂和/或维生素的研究显示干预组和对照组之间无差异（MD 0.20，95%置信区间 -0.04至0.43）。药物研究显示严重不良事件无差异（风险比0.98，95%置信区间 0.86至1.10）。非药物干预未报告严重不良事件。
与对照组相比，使用胆碱酯酶抑制剂治疗轻度认知障碍无益处。与对照组相比，使用行为疗法观察到了较小的认知益处。然而，这一微小益处的临床意义仍不确定。目前的证据不支持使用胆碱酯酶抑制剂治疗轻度认知障碍，需要未来采用标准化方法进行高质量研究，以证实行为干预对认知有微小益处这一发现。
PROSPERO编号CRD42014015431。
