Li Dan-Dan, Zhang Ya-Hong, Zhang Wei, Zhao Pu
College of Life and Health Sciences, Northeastern University, Shenyang, China.
Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang, China.
Front Neurosci. 2019 May 15;13:472. doi: 10.3389/fnins.2019.00472. eCollection 2019.
To study the impact of donepezil, rivastigmine, galantamine, and memantine on cognitive, functional, behavioral, global changes and adverse effects in patients with mild, moderate and severe Alzheimer's disease (AD), we screened the literature published before September 2017 in the Pubmed, Embase, Cochrane library and Web of Science Electronic databases according to the inclusion criteria. Thirty-six studies were finally determined from 1560 preliminary screened articles. The AD Assessment Scale-cognitive Subscale (ADAS-cog), AD Cooperative Study-Activities of Daily Living (ADCS-ADL), Neuropsychiatric Inventory (NPI), and Clinician's Interview-Based Impression of Change Plus Caregiver Input scale (CIBIC+) were used as valid endpoints. Of the 36 trials included, meta-analyses of these placebo-control trials showed that there were significant differences between the donepezil, rivastigmine and placebo groups using ADAS-cog, ADCS-ADL, and CIBIC+. Meta-analyses of these placebo-controlled trials showed that there were significant differences between the galantamine and placebo groups using ADAS-cog, ADCS-ADL, NPI, and CIBIC+. These observations suggest that memantine is beneficial for stabilizing or slowing the decline in ADAS-cog and ADCS-ADL changes in AD patients. However, there was no significant effect according to the ADCS-ADL, NPI, and CIBIC+ tests, which indicated that memantine treatment has no significant effect on these cognitive aspects of AD patients. Different effects of donepezil, rivastigmine, galantamine, or memantine on AD were found in this study. According to the results, we conclude that galantamine is effective in treating all aspects of AD and is the first choice for the treatment of AD. However, due to limited data, we should consider additional data to obtain more stable results.
为研究多奈哌齐、卡巴拉汀、加兰他敏和美金刚对轻度、中度和重度阿尔茨海默病（AD）患者认知、功能、行为、整体变化及不良反应的影响，我们根据纳入标准筛选了2017年9月之前发表在PubMed、Embase、Cochrane图书馆和科学网电子数据库中的文献。最终从1560篇初步筛选的文章中确定了36项研究。采用AD评估量表认知分量表（ADAS-cog）、AD协作研究日常生活活动量表（ADCS-ADL）、神经精神科问卷（NPI）以及基于临床医生访谈的变化印象加照顾者意见量表（CIBIC+）作为有效终点。在纳入的36项试验中，这些安慰剂对照试验的荟萃分析表明，使用ADAS-cog、ADCS-ADL和CIBIC+时，多奈哌齐、卡巴拉汀与安慰剂组之间存在显著差异。这些安慰剂对照试验的荟萃分析表明，使用ADAS-cog、ADCS-ADL、NPI和CIBIC+时，加兰他敏与安慰剂组之间存在显著差异。这些观察结果表明，美金刚有利于稳定或减缓AD患者ADAS-cog和ADCS-ADL变化的下降。然而，根据ADCS-ADL、NPI和CIBIC+测试，未发现显著效果，这表明美金刚治疗对AD患者的这些认知方面没有显著影响。本研究发现多奈哌齐、卡巴拉汀、加兰他敏或美金刚对AD有不同影响。根据结果，我们得出结论，加兰他敏对AD的各个方面均有效，是治疗AD的首选药物。然而，由于数据有限，我们应考虑获取更多数据以获得更稳定的结果。
