Chen Wen-Yin, Liu Hsing-Cheng, Cheng Ying-Chih, Li Hua, Huang Chi-Chieh, Ding Yu-Wei, Huang Ming-Chyi, Chiu Chih-Chiang, Tu Yu-Kang, Kuo Po-Hsiu
Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Clin Epidemiol. 2021 Oct 29;13:1039-1049. doi: 10.2147/CLEP.S335584. eCollection 2021.
The priority of interventions to alleviate cognitive deficits in patients with bipolar disorder (BD) is inconclusive. We systematically evaluate the efficacy of pharmacological or neurostimulation interventions for cognitive function in BD through a network meta-analysis.
The PubMed, PsycINFO, Embase, and Cochrane Library databases were searched from database inception to September 30, 2021. Following PRISMA guidelines, all eligible studies were randomized controlled trials of adult bipolar patients that provided detailed cognitive outcomes. Studies were excluded if participants limited to comorbid substance use disorder or the intervention was a psychotherapy. Network meta-analysis comparing different interventions was conducted for 8 cognitive domains. Partially ordered set with Hasse diagram was used to resolve conflicting rankings between outcomes. The study was preregistered on PROSPERO database (CRD42020152044).
Total 21 RCTs including 42 tests for assessing intervention effects on cognition were retrieved. Adjunctive erythropoietin (SMD = 0.61, 95% CI = 0.00-1.23), (SMD = 0.58, 95% CI = 0.03-1.13), and galantamine (SMD = 1.22, 95% CI = 0.10-2.35) was more beneficial for attention, working memory, and verbal learning in euthymic BD patients than treatment as usual, respectively. Hasse diagram suggested ranking of choice when multiple domains were combined.
Considerable variability in measurements of cognitive domains in BD was observed, and no intervention resulted in superior benefits across all domains. We suggested interventions priority can be tailored according to individual patients' cognitive deficits. As current findings from relatively small and heterogeneous dataset, future trials with consensus should be applied for building further evidence.
双相情感障碍（BD）患者认知缺陷干预措施的优先级尚无定论。我们通过网状Meta分析系统评价药物或神经刺激干预对BD患者认知功能的疗效。
检索PubMed、PsycINFO、Embase和Cochrane图书馆数据库，检索时间从建库至2021年9月30日。按照PRISMA指南，所有符合条件的研究均为成年双相情感障碍患者的随机对照试验，提供详细的认知结果。如果参与者仅限于合并物质使用障碍或干预措施为心理治疗，则排除这些研究。对8个认知领域进行比较不同干预措施的网状Meta分析。使用带有哈斯图的偏序集来解决结果之间相互矛盾的排名。该研究已在PROSPERO数据库（CRD42020152044）上预先注册。
共检索到21项随机对照试验，包括42项评估干预对认知影响的测试。辅助使用促红细胞生成素（标准化均数差=0.61，95%置信区间=0.00-1.23）、[此处原文缺失具体药物名称]（标准化均数差=0.58，95%置信区间=0.03-1.13）和加兰他敏（标准化均数差=1.22，95%置信区间=0.10-2.35）分别比常规治疗对心境正常的BD患者的注意力、工作记忆和言语学习更有益。哈斯图表明了多个领域合并时的选择排名。
观察到BD患者认知领域测量存在相当大的变异性，没有一种干预措施在所有领域都能带来更好的益处。我们建议可以根据个体患者的认知缺陷来调整干预措施的优先级。由于目前的研究结果来自相对较小且异质性较大的数据集，未来应进行具有共识的试验以建立更多证据。
