Moreta Marta Pérez-Gómez, Burgos-Alonso Natalia, Torrecilla María, Marco-Contelles José, Bruzos-Cidón Cristina
Preventive Medicine and Public Health Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain.
Pharmacology Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain.
Biomedicines. 2021 Nov 15;9(11):1689. doi: 10.3390/biomedicines9111689.
Alzheimer's disease (AD) is the most common form of dementia over the age of 65. It is estimated that 115.4 million people will be affected by AD by 2050. Acetylcholinesterase inhibitors (AChEI) are the only available and approved treatment for AD. The aim of the present study was to analyse the evidence on the efficacy of the AChEI in the treatment of cognitive symptoms of Alzheimer's disease. For that purpose, a review of review of the systematic reviews (SRs) on this topic was carried out by Web of Science, PubMed, and The Cochrane Library, among others, were searched until 24 September 2021. Thirteen of the 1773 articles evaluated the efficacy of AChEI on cognitive function and/or general condition and/or behavioural disturbances of patients with mild to moderate AD. Methodological quality and risk of bias were rated using the ROBIS scale. The quality of the identified studies was high for nine of them, unclear for two, and finally only in two of the 13 studies did we detect low quality. Overall, AChEI showed very low efficacy in improving cognition in patients with mild to moderate AD. Better results were obtained in improving global state, with donepezil being the most effective treatment. No improvements in behavioural disturbances were found. Few high-quality reviews provide clear evidence of the effects of AChEI on cognition, global change, behaviour, and mortality. The data suggest that AChEI stabilize or slow cognitive deterioration, improving global status. In addition, data indicate that the use of AChEI decreases mortality in patients with mild to moderate AD. However, there is no evidence that they improve patient behaviour. Donepezil is the best therapeutic alternative at a dose of 10 mg/day.
阿尔茨海默病（AD）是65岁以上人群中最常见的痴呆形式。据估计，到2050年将有1.154亿人受到AD影响。乙酰胆碱酯酶抑制剂（AChEI）是唯一可用且已获批准用于治疗AD的药物。本研究的目的是分析AChEI治疗阿尔茨海默病认知症状疗效的证据。为此，通过科学网、PubMed和考克兰图书馆等对该主题的系统评价（SR）的综述进行了检索，检索截至2021年9月24日。1773篇文章中有13篇评估了AChEI对轻至中度AD患者认知功能和/或一般状况和/或行为障碍的疗效。使用ROBIS量表对方法学质量和偏倚风险进行评级。其中9项已识别研究的质量较高，2项不明确，最终在13项研究中只有2项被发现质量较低。总体而言，AChEI在改善轻至中度AD患者认知方面显示出非常低的疗效。在改善整体状态方面取得了更好的结果，多奈哌齐是最有效的治疗药物。未发现行为障碍有改善。很少有高质量的综述提供AChEI对认知、整体变化、行为和死亡率影响的明确证据。数据表明，AChEI可稳定或减缓认知衰退，改善整体状况。此外，数据表明，使用AChEI可降低轻至中度AD患者的死亡率。然而，没有证据表明它们能改善患者行为。多奈哌齐以每日10毫克的剂量是最佳治疗选择。
