The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China.
CNS Neurol Disord Drug Targets. 2018;17(7):509-521. doi: 10.2174/1871527317666180706143051.
Aphasia is a common complication after stroke, and traditional speech and language therapy (SLT) has a limited effect on post-stroke aphasia (PSA). While there has been an increasing number of controlled clinical trials on the efficacy of drugs in the treatment of PSA, there have been very few systematic reviews on the efficacy and safety of pharmacological treatments in people with PSA.
To evaluate the efficacy and safety of pharmacological interventions for PSA.
The Cochrane Central Register of Controlled Trials (CENTRA), PubMed, Embase, Chinese Journal Full-text Database (CJFD), China Biology Medicine disc (CBMdisc), Wanfang Data and VIP Information System were searched for randomized controlled trials about pharmacological treatments for PSA. Literature screening using the inclusion and exclusion criteria, data extraction and methodological quality assessment of the included studies were completed by two independent reviewers. Methodological quality was considered high for modified Jadad quality scale scores of 4 to 7. RevMan 5.3 software was used to conduct a meta-analysis of high-quality studies.
Fifteen studies (578 participants) satisfied the eligibility criteria for this systematic review. Five trials (277 participants) assessed donepezil, four studies (124 participants) assessed memantine, three studies (72 participants) assessed bromocriptine, one trial (45 patients) evaluated galantamine, one study (21 patients) evaluated amphetamine, and one trial (39 patients) evaluated levodopa. The systematic review showed that donepezil achieved remarkable results in terms of the aphasia quotient (AQ) (SMD 0.82, 95% CI 0.48-1.17, P < 0.00001), repetition ability (SMD 0. 81, 95% CI 0.57-1.06, P < 0.00001), naming ability (SMD 0.56, 95% CI 0.29-0. 84, P < 0.00001), auditory comprehension (SMD 0.85, 95% CI 0.58-1. 13, P< 0.00001) and oral expression (SMD 0.90, 95% CI 0.54-1.26, P < 0.00001). Memantine showed no pronounced improvement in auditory comprehension (SMD 0.35, 95% CI -0.05-0.74, P = 0.09) but did improve the AQ (SMD 0.57, 95% CI 0.09-1.06, P = 0. 02), naming ability (SMD 0.81, 95% CI 0.38-1.25, P = 0.0002), spontaneous speech (SMD 0.76, 95% CI 0. 39- 1.13, P < 0.0001), and repetition ability (SMD 0.37, 95% CI 0.01-0.73, P = 0.04). Bromocriptine showed pronounced improvement in naming ability (SMD -0.20, 95% CI- 0.67-0.26, P = 0.39), verbal fluency (SMD 0.02, 95% CI 0.53-0.56, P = 0.95), and repetition ability (SMD 0.29, 95% CI -0.23-0. 81, P = 0.28). There is limited and inconclusive evidence for galantamine, amphetamine and levodopa.
Current evidence suggests that drugs, such as donepezil and memantine, can improve the prognosis of PSA. Donepezil has a significant effect in improving the ability of auditory comprehension, naming, repetition and oral expression. Memantine has a significant effect in improving the ability of naming, spontaneous speech and repetition. Bromocriptine showed no significant improvements in the treatment of aphasia after stroke. Data regarding galantamine, amphetamine and levodopa in the treatment of aphasia after stroke are limited and inconclusive.
失语症是中风后的常见并发症，传统的言语和语言治疗（SLT）对中风后失语症（PSA）的效果有限。虽然已经有越来越多的关于药物治疗 PSA 疗效的对照临床试验，但关于 PSA 药物治疗的疗效和安全性的系统评价却很少。
评估药物干预 PSA 的疗效和安全性。
系统检索 Cochrane 中央对照试验注册库（CENTRA）、PubMed、Embase、中国期刊全文数据库（CJFD）、中国生物医学文献数据库（CBMdisc）、万方数据知识服务平台和 VIP 信息系统中关于 PSA 药物治疗的随机对照试验。使用纳入和排除标准进行文献筛选，由两名独立 reviewers 完成纳入研究的数据提取和方法学质量评估。改良 Jadad 质量量表评分为 4 至 7 分的研究被认为具有较高的方法学质量。使用 RevMan 5.3 软件对高质量研究进行荟萃分析。
共有 15 项研究（578 名参与者）符合本系统评价的纳入标准。五项试验（277 名参与者）评估了多奈哌齐，四项研究（124 名参与者）评估了美金刚，三项研究（72 名参与者）评估了溴隐亭，一项试验（45 名患者）评估了加兰他敏，一项研究（21 名患者）评估了安非他命，一项试验（39 名患者）评估了左旋多巴。系统评价显示，多奈哌齐在失语症商数（AQ）（SMD 0.82，95%CI 0.48-1.17，P<0.00001）、重复能力（SMD 0.81，95%CI 0.57-1.06，P<0.00001）、命名能力（SMD 0.56，95%CI 0.29-0.84，P<0.00001）、听觉理解能力（SMD 0.85，95%CI 0.58-1.13，P<0.00001）和口语表达能力（SMD 0.90，95%CI 0.54-1.26，P<0.00001）方面均取得显著效果。美金刚在听觉理解能力方面无显著改善（SMD 0.35，95%CI -0.05-0.74，P=0.09），但改善了 AQ（SMD 0.57，95%CI 0.09-1.06，P=0.02）、命名能力（SMD 0.81，95%CI 0.38-1.25，P=0.0002）、自发言语能力（SMD 0.76，95%CI 0.39-1.13，P<0.0001）和重复能力（SMD 0.37，95%CI 0.01-0.73，P=0.04）。溴隐亭在命名能力（SMD -0.20，95%CI-0.67-0.26，P=0.39）、言语流畅性（SMD 0.02，95%CI 0.53-0.56，P=0.95）和重复能力（SMD 0.29，95%CI -0.23-0.81，P=0.28）方面表现出显著改善。加兰他敏、安非他命和左旋多巴的证据有限且不一致。
目前的证据表明，药物如多奈哌齐和美金刚可改善 PSA 的预后。多奈哌齐在改善听觉理解、命名、重复和口语表达能力方面有显著效果。美金刚在改善命名、自发言语和重复能力方面有显著效果。溴隐亭在治疗中风后失语症方面无显著改善。加兰他敏、安非他命和左旋多巴治疗中风后失语症的数据有限且不一致。
