睾酮补充对认知健康老年男性不同认知领域的影响：当前随机临床试验的荟萃分析。
Effects of Testosterone Supplementation on Separate Cognitive Domains in Cognitively Healthy Older Men: A Meta-analysis of Current Randomized Clinical Trials.
机构信息
Australian Alzheimer's Research Foundation, Nedlands, Western Australia, Australia; School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.
Australian Alzheimer's Research Foundation, Nedlands, Western Australia, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; School of Psychiatry and Clinical Neurosciences, University of Western Australia, Nedlands, Western Australia, Australia; Department of Biomedical Sciences, Faculty of Medicine and Health Science, Macquarie University, Sydney, New South Wales, Australia.
出版信息
Am J Geriatr Psychiatry. 2019 Nov;27(11):1232-1246. doi: 10.1016/j.jagp.2019.05.008. Epub 2019 May 20.
BACKGROUND
An increasing body of literature suggests a positive, neuroprotective effect for testosterone on cognition in older men. However, randomized clinical trials (RCTs) examining the effects of testosterone supplementation (TS) on cognitive function have been inconclusive.
OBJECTIVE
To investigate the potential for TS to prevent cognitive decline in otherwise cognitively healthy older men, by examining the differential effects of TS on cognitively healthy older men in RCTs.
METHODS
Comprehensive search of electronic databases, conference proceedings, and grey literature from 1990 to 2018 was performed to identify RCTs examining the effects of TS on cognition before and after supplementation, in cognitively healthy individuals.
RESULTS
A final sample of 14 eligible RCTs met inclusion criteria. Using pooled random effects expressed as Hedge's g, comparison of placebo versus treatment groups pre- and postsupplementation showed improvements in the treatment group in executive function (g (11) = 0.14, 95% confidence interval [CI]: 0.03-0.26, z = 0.56, p = 0.011). However, it was noted that two studies in our sample did not report a significant increase in mean serum total testosterone (TT) levels in the treatment group after supplementation. Following exclusion of these studies, analysis indicated improvement in the treatment group for the overall cognitive composite (g (11) = 0.18, 95% CI: 0.02-0.33, z = 2.18), psychomotor speed (g (3) = 0.22, 95% CI: 0.01-0.43, z = 2.07) and executive function (g (9) = 0.15, 95% CI: 0.03-0.28, z = 2.35). No significant differences were noted for the global cognition, attention, verbal memory, visuospatial ability or visuospatial memory domains.
CONCLUSION
Overall, our findings support the potential for TS as a preventative measure against cognitive decline, although the effect sizes were small. These findings warrant further observational studies and clinical trials of good methodological quality, to elucidate the effect of TS on cognition.
背景
越来越多的文献表明，睾丸酮对老年男性的认知具有积极的神经保护作用。然而，关于睾丸酮补充治疗（TS）对认知功能影响的随机临床试验（RCT）结果并不一致。
目的
通过检查 TS 对认知健康的老年男性的 RCT 中认知健康的老年男性的不同影响，研究 TS 预防认知能力下降的潜力。
方法
全面检索电子数据库、会议记录和 1990 年至 2018 年的灰色文献，以确定在补充前后检查 TS 对认知健康个体认知影响的 RCT。
结果
最终纳入 14 项符合条件的 RCT。使用混合效应的 Hedge's g 表示，安慰剂与治疗组补充前后的比较显示，治疗组在执行功能方面有所改善（g（11）=0.14，95%置信区间 [CI]：0.03-0.26，z=0.56，p=0.011）。然而，我们的样本中有两项研究报告治疗组补充后血清总睾丸酮（TT）水平没有显著增加。排除这些研究后，分析表明治疗组的整体认知综合能力有所提高（g（11）=0.18，95%CI：0.02-0.33，z=2.18），精神运动速度（g（3）=0.22，95%CI：0.01-0.43，z=2.07）和执行功能（g（9）=0.15，95%CI：0.03-0.28，z=2.35）。在总体认知、注意力、言语记忆、视空间能力或视空间记忆等领域没有发现显著差异。
结论
总的来说，我们的研究结果支持 TS 作为预防认知能力下降的一种措施的潜力，尽管效果较小。这些结果需要进一步进行观察性研究和高质量的临床试验，以阐明 TS 对认知的影响。
Zotero 插件