Department of Statistics and Actuarial Science, Aletheia University, New Taipei City, Taiwan, Republic of China.
Department of Mathematics, Tamkang University, New Taipei City, Taiwan.
Psychopharmacology (Berl). 2018 May;235(5):1571-1580. doi: 10.1007/s00213-018-4867-y. Epub 2018 Mar 3.
No cure is currently available for dementia; however, various treatments and interventions have been reported to be effective. The factors influencing the efficacy of dementia treatment have not been comprehensively evaluated. This study evaluated the factors influencing treatment effects on cognitive dysfunction in dementia by comparing the results obtained from a meta-analysis based on meta-regression.
We searched for articles, clinical trials, and meta-analyses on the efficacy of pharmacotherapy or psychosocial treatment for dementia published between 2000 and 2016 in the MEDLINE/PubMed, Cochrane Library, SCOPUS, and Airiti Library databases.
The 235 selected studies involved 44,854 patients with dementia (mainly vascular dementia, Alzheimer disease, and mild cognitive impairment). A preliminary random effects meta-analysis yielded a positive overall effect. The pooled standardized mean difference of the treatment effects on cognitive dysfunction was 0.439 (95% confidence interval 0.374, 0.504). The results of meta-regression showed that in young patients (β = - 0.036, p value < 0.001) with vascular dementia (β = 0.603, p value < 0.001), the efficacies of treatment 2 (symptomatic treatment for vascular dementia with piracetam, nimodipine, aniracetam, flunarizine, vinpocetine, hyperbaric oxygen, oxiracetam, or EGB761) and treatment 5 (treatment with other alternative therapies including acupuncture, premarin, statin, butylphthalide soft capsules, donepezil, huperzine A, and lithium treatment) were higher than those of other existing treatments for cognitive dysfunction (β = 0.308 and 0.321, p values = 0.010 and < 0.001, respectively).
The most effective intervention for dementia available is symptomatic treatment for vascular dementia. Antipsychotic treatment for dementia alleviates cognitive dysfunction less effectively than does symptomatic treatment. Alternative therapies are also effective at present. Further research on causes and very early diagnosis of Alzheimer disease is warranted.
目前尚无痴呆症的治愈方法，但已有多种治疗和干预措施被报道有效。影响痴呆症治疗效果的因素尚未得到全面评估。本研究通过基于元回归的荟萃分析比较结果，评估了影响痴呆认知功能障碍治疗效果的因素。
我们检索了 2000 年至 2016 年间 MEDLINE/PubMed、Cochrane 图书馆、SCOPUS 和 Airiti 图书馆数据库中关于痴呆药物治疗或心理社会治疗疗效的文章、临床试验和荟萃分析。
235 项入选研究共纳入 44854 例痴呆患者（主要为血管性痴呆、阿尔茨海默病和轻度认知障碍）。初步随机效应荟萃分析得出阳性的总体效果。认知功能障碍治疗效果的合并标准化均数差为 0.439（95%置信区间 0.374，0.504）。元回归结果显示，在年轻患者（β=-0.036，p 值<0.001）和血管性痴呆患者（β=0.603，p 值<0.001）中，治疗 2（血管性痴呆的对症治疗，用吡拉西坦、尼莫地平、茴拉西坦、氟桂利嗪、长春西汀、高压氧、奥拉西坦或 EGB761）和治疗 5（其他替代疗法，包括针灸、倍美力、他汀类药物、丁苯酞软胶囊、多奈哌齐、石杉碱甲和锂治疗）的疗效高于其他现有的认知功能障碍治疗方法（β=0.308 和 0.321，p 值=0.010 和<0.001）。
目前对痴呆症最有效的干预措施是血管性痴呆的对症治疗。抗精神病药物治疗痴呆症缓解认知功能障碍的效果不如对症治疗。替代疗法目前也有效。需要进一步研究阿尔茨海默病的病因和早期诊断。
