美金刚对阿尔茨海默病患者行为障碍的影响：一项荟萃分析。
The effects of memantine on behavioral disturbances in patients with Alzheimer's disease: a meta-analysis.
作者信息
Kishi Taro, Matsunaga Shinji, Iwata Nakao
机构信息
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
出版信息
Neuropsychiatr Dis Treat. 2017 Jul 20;13:1909-1928. doi: 10.2147/NDT.S142839. eCollection 2017.
BACKGROUND
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.
METHODS
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.
RESULTS
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; =0.01; =47%), delusion (SMD =-0.12; 95% CIs =-0.18, -0.06; =0.0002; =0%), disinhibition (SMD =-0.08; 95% CIs =-0.15, -0.00; =0.04; =0%), and nighttime disturbance/diurnal rhythm disturbances (SMD =-0.10; 95% CIs =-0.18, -0.02; =0.02; =36%). Memantine was also marginally superior to control in hallucination (SMD =-0.06; 95% CIs =-0.12, 0.01; =0.07; =0%) and irritability/lability (SMD =-0.09; 95% CIs =-0.19, 0.01; =0.07; =42%). Memantine is similar to control in dysphoria, anxiety/phobia, euphoria, apathy, and eating disturbance.
CONCLUSION
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.
背景
美金刚在治疗阿尔茨海默病患者的行为障碍方面有效。目前尚未完全确定哪些行为障碍对美金刚反应最佳。
方法
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/攻击行为、烦躁不安、焦虑/恐惧、欣快、淡漠、脱抑制、易怒/情绪不稳定、异常运动活动/活动障碍、夜间障碍/昼夜节律障碍以及进食障碍）进行了荟萃分析。本研究纳入了美金刚治疗阿尔茨海默病患者的随机对照研究。为评估这些结果，在荟萃分析中基于随机效应模型评估了标准化均数差（SMD）及95%置信区间（95%CI）。
结果
荟萃分析共纳入11项研究（n = 4261；美金刚与安慰剂：N = 4，n = 1500；美金刚 + 胆碱酯酶抑制剂[M + ChEIs]与ChEIs：N = 7，n = 2761）。与对照相比，美金刚在激越/攻击行为（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%）、脱抑制（SMD = -0.08；95%CI = -0.15，-0.00；P = 0.04；I² = 0%）以及夜间障碍/昼夜节律障碍（SMD = -0.10；95%CI = -0.18，-0.02；P = 0.02；I² = 36%）方面显示出显著改善。美金刚在幻觉（SMD = -0.06；95%CI = -0.12，0.01；P = 0.07；I² = 0%）和易怒/情绪不稳定（SMD = -0.09；95%CI = -0.19，0.01；P = 0.07；I² = 42%）方面也略优于对照。美金刚在烦躁不安、焦虑/恐惧、欣快、淡漠和进食障碍方面与对照相似。
结论
荟萃分析表明，美金刚对治疗阿尔茨海默病患者的大多数行为障碍有益。美金刚不会使阿尔茨海默病患者的行为障碍等阴性症状恶化。
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