Kessler Foundation, East Hanover, NJ, USA.
Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
CNS Drugs. 2020 Jun;34(6):599-628. doi: 10.1007/s40263-020-00734-4.
Cognitive impairment is prevalent and debilitating among persons with multiple sclerosis (MS). While many pharmacologic treatments have shown good efficacy in reducing clinical relapses, brain lesions, and improving certain physical symptoms, their efficacy for improving cognitive function is not well understood.
The current systematic review aimed to evaluate the efficacy of pharmacologic treatments for improving cognitive function among persons with MS.
A literature search was conducted through the PubMed and PsycINFO databases. Two independent reviewers assessed each paper, and a third reviewer weighed in if the two reviewers could not reach a consensus. Classification of evidence was determined using the 2017 American Academy of Neurology (AAN) criteria for therapeutic trials. Standardized effect sizes (Cohen's d) were calculated to compare across studies.
Eighty-seven journal articles published between 1990 and January 2020 were included in the current review. Overall, there is insufficient evidence to support the use of pharmacologic treatments to improve cognitive function in persons with MS. There were many contradictory findings observed in this review, which may be due to possible unidentified moderating treatment response variables and/or lack of standardization in assessment procedures. There was also an overreliance on statistical significance (most papers did not provide sizes of treatment effects), which may not be clinically meaningful.
Higher-quality randomized controlled trials are needed to establish the cognitive efficacy of pharmacologic treatments for MS-related cognitive dysfunction, with cognition as the primary endpoint. Researchers are urged to use standardized criteria (such as the AAN criteria) to guide their research designs. Clinicians should consider effect sizes of studies before deciding whether to prescribe certain medications to ameliorate cognitive symptoms.
认知障碍在多发性硬化症（MS）患者中普遍存在且具有致残性。虽然许多药物治疗已显示出在减少临床复发、脑损伤和改善某些身体症状方面的良好疗效，但它们对改善认知功能的疗效尚不清楚。
本系统评价旨在评估药物治疗对改善 MS 患者认知功能的疗效。
通过 PubMed 和 PsycINFO 数据库进行文献检索。两名独立的审查员评估每篇论文，如果两名审查员无法达成共识，则由第三名审查员进行评估。使用 2017 年美国神经病学学会（AAN）治疗试验标准对证据进行分类。为了进行跨研究比较，计算了标准化效应大小（Cohen's d）。
本综述共纳入了 1990 年至 2020 年 1 月期间发表的 87 篇期刊文章。总体而言，没有足够的证据支持使用药物治疗来改善 MS 患者的认知功能。本综述观察到许多相互矛盾的发现，这可能是由于可能未识别的调节治疗反应变量和/或评估程序缺乏标准化所致。此外，人们过度依赖统计显著性（大多数论文未提供治疗效果的大小），这可能没有临床意义。
需要更高质量的随机对照试验来确定药物治疗对 MS 相关认知功能障碍的认知疗效，以认知为主要终点。研究人员应使用标准化标准（如 AAN 标准）来指导他们的研究设计。临床医生在决定是否开处方某些药物来改善认知症状之前，应考虑研究的效应大小。
