Department of Oriental Neuropsychiatry, Dongguk University Ilsan Oriental Hospital, Goyang, South Korea.
Department of Oriental Neuropsychiatry, Graduate School of Dongguk University, Seoul, South Korea.
J Integr Complement Med. 2023 Oct;29(10):605-620. doi: 10.1089/jicm.2022.0806. Epub 2023 Mar 27.
Alzheimer's disease (AD), the most common cause of dementia, has only symptomatic treatments in conventional Western medicine (WM). Disease-modifying drugs are still under development. This study evaluated the efficacy and safety of herbal medicine (HM) based on pattern identification (PI) as a whole system practice for treating AD. Thirteen databases were searched from inception to August 31, 2021. Twenty-seven randomized controlled trials (RCTs) with 2069 patients were included in the evidence synthesis. The meta-analysis showed that, compared with WM, HM prescription based on PI, either alone or in combination with WM, could significantly improve the cognitive functions of AD patients (Mini-Mental State Examination [MMSE]-HM vs. WM: mean difference [MD] = 1.96, 95% confidence intervals [CIs]: 0.28-3.64, = 981, = 96%; HM+WM vs. WM: MD = 1.33, 95% CI: 0.57-2.09, = 695, = 68%) and their ability to perform activities of daily living (ADL-HM vs. WM: standardized mean difference [SMD] = 0.71, 95% CI: 0.04-1.38, = 639, = 94%; HM+WM vs. WM: SMD = 0.60, 95% CI: 0.27-0.93, = 669, = 76%). Duration-wise, 12 weeks of HM+WM were superior to 12 weeks of WM and 24 weeks of HM were superior to 24 weeks of WM. None of the included studies found any severe safety concerns. The odds of mild-to-moderate adverse events were marginally lower in HM than in WM (odds ratio = 0.34, 95% CI: 0.11-1.02, = 689, = 55%). Hence, prescribing PI-based HM is a safe and effective therapeutic option for AD, either as first-line therapy or adjuvant treatment. However, most of the included studies have a high or uncertain risk of bias. Thus, well-designed RCTs with proper blinding and placebo controls are needed.
阿尔茨海默病（AD）是痴呆症最常见的病因，在传统的西方医学（WM）中仅有对症治疗。目前仍在开发能够改变疾病进程的药物。本研究评估了基于模式识别（PI）的草药（HM）作为一种整体系统实践治疗 AD 的疗效和安全性。从成立到 2021 年 8 月 31 日，共检索了 13 个数据库。纳入了 27 项随机对照试验（RCT），共 2069 名患者的证据进行综合评估。Meta 分析显示，与 WM 相比，基于 PI 的 HM 处方，无论是单独使用还是与 WM 联合使用，均能显著改善 AD 患者的认知功能（MMSE-HM 与 WM 相比：MD=1.96，95%置信区间：0.28-3.64，=981，=96%；HM+WM 与 WM 相比：MD=1.33，95%置信区间：0.57-2.09，=695，=68%）和日常生活活动能力（ADL-HM 与 WM 相比：SMD=0.71，95%置信区间：0.04-1.38，=639，=94%；HM+WM 与 WM 相比：SMD=0.60，95%置信区间：0.27-0.93，=669，=76%）。从持续时间上看，12 周的 HM+WM 优于 12 周的 WM，24 周的 HM 优于 24 周的 WM。纳入的研究均未发现任何严重的安全性问题。与 WM 相比，HM 发生轻度至中度不良反应的几率略有降低（比值比=0.34，95%置信区间：0.11-1.02，=689，=55%）。因此，基于 PI 的 HM 处方是 AD 的一种安全有效的治疗选择，无论是一线治疗还是辅助治疗。然而，纳入的大多数研究都存在高风险或不确定的偏倚。因此，需要进行设计良好的、采用适当盲法和安慰剂对照的 RCT。
