Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.
Laboratory of Movement Analysis, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Alzheimers Res Ther. 2018 Feb 20;10(1):21. doi: 10.1186/s13195-018-0347-1.
A growing number of pharmacological and nonpharmacological trials have been performed to test the efficacy of approved or experimental treatments in Alzheimer disease (AD) and mild cognitive impairment (MCI). In this context, functional magnetic resonance imaging (fMRI) may be a good candidate to detect brain changes after a short period of treatment.
This critical review aimed to identify and discuss the available studies that have tested the efficacy of pharmacological and nonpharmacological treatments in AD and MCI cases using task-based or resting-state fMRI measures as primary outcomes. A PubMed-based literature search was performed with the use of the three macro-areas: 'disease', 'type of MRI', and 'type of treatment'. Each contribution was individually reviewed according to the Cochrane Collaboration's tool for assessing risk of bias. Study limitations were systematically detected and critically discussed. We selected 34 pharmacological and 13 nonpharmacological articles. According to the Cochrane Collaboration's tool for assessing risk of bias, 40% of these studies were randomized but only a few described clearly the randomization procedure, 36% declared the blindness of participants and personnel, and only 21% reported the blindness of outcome assessment. In addition, 28% of the studies presented more than 20% drop-outs at short- and/or long-term assessments. Additional common shortcomings of the reviewed works were related to study design, patient selection, sample size, choice of outcome measures, management of drop-out cases, and fMRI methods.
There is an urgent need to obtain efficient treatments for AD and MCI. fMRI is powerful enough to detect even subtle changes over a short period of treatment; however, the soundness of methods should be improved to enable meaningful data interpretation.
越来越多的药理学和非药理学试验已经进行，以测试已批准或实验性治疗阿尔茨海默病（AD）和轻度认知障碍（MCI）的疗效。在这种情况下，功能磁共振成像（fMRI）可能是检测短期治疗后大脑变化的良好候选方法。
本综述旨在确定和讨论已发表的研究，这些研究使用基于任务或静息状态 fMRI 测量作为主要结果，测试 AD 和 MCI 病例中药物和非药物治疗的疗效。使用基于 PubMed 的文献检索，使用了三个宏观领域：“疾病”、“MRI 类型”和“治疗类型”。根据 Cochrane 协作组评估偏倚风险的工具，对每项研究进行了单独审查。系统地检测并批判性地讨论了研究局限性。我们选择了 34 篇药理学和 13 篇非药理学文章。根据 Cochrane 协作组评估偏倚风险的工具，这些研究中有 40%是随机的，但只有少数研究清楚地描述了随机程序，36%的研究报告了参与者和人员的盲法，只有 21%的研究报告了结果评估的盲法。此外，28%的研究在短期和/或长期评估中出现了超过 20%的脱落病例。被审查作品的其他常见缺点与研究设计、患者选择、样本量、结果测量选择、脱落病例管理和 fMRI 方法有关。
迫切需要获得针对 AD 和 MCI 的有效治疗方法。fMRI 强大到足以在短时间内检测到即使是细微的变化；然而，为了能够进行有意义的数据分析，应该改进方法的合理性。
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