Naseri Amirreza, Sadigh-Eteghad Saeed, Seyedi-Sahebari Sepideh, Hosseini Mohammad-Salar, Hajebrahimi Sakineh, Salehi-Pourmehr Hanieh
Tabriz University of Medical Sciences, Student Research Committee, Tabriz, Iran.
Tabriz University of Medical Sciences, Neurosciences Research Center, Tabriz, Iran.
Dement Neuropsychol. 2023 May 29;17:e20220053. doi: 10.1590/1980-5764-DN-2022-0053. eCollection 2023.
Anticholinergics (ACs) are among the most prescribed drugs. Investigating the impaired cognitive domains due to individual ACs usage is associated with controversial findings.
The objective of this study was to investigate the effects of individual ACs on different aspects of cognitive function based on clinical trial studies.
This systematic review was conducted following the PRISMA statement. A systematic search was performed in Embase, PubMed, Cochrane Library, Scopus, and Web of Science databases. Risk of bias (RoB) was assessed by the Joanna Briggs Institute checklists and the meta-analysis was performed using the CMA software.
Out of 3,026 results of searching, 138 studies were included. A total of 38 studies that assess the cognitive impacts of scopolamine were included in the meta-analysis. Included studies reported cognitive effects of scopolamine, mecamylamine, atropine, biperiden, oxybutynin, trihexyphenidyl, benzhexol, and dicyclomine; however, glycopyrrolate, trospium, tolterodine, darifenacin, fesoterodine, tiotropium, and ipratropium were not associated with cognitive decline. Based on the meta-analyses, scopolamine was associated with reduced recognition (SDM -1.84; 95%CI -2.48 to -1.21; p<0.01), immediate recall (SDM -1.82; 95%CI -2.35 to -1.30; p<0.01), matching to sample (SDM -1.76; 95%CI -2.57 to -0.96; p<0.01), delayed recall (SDM -1.54; 95%CI -1.97 to -1.10; p<0.01), complex memory tasks (SDM -1.31; 95%CI -1.78 to -0.84; p<0.01), free recall (SDM -1.18; 95%CI -1.63 to -0.73; p<0.01), cognitive function (SDM -0.95; 95%CI -1.46 to -0.44; p<0.01), attention (SDM -0.85; 95%CI -1.38 to -0.33; p<0.01), and digit span (SDM -0.65; 95%CI -1.21 to -0.10; p=0.02). There was a high RoB in our included study, especially in terms of dealing with possible cofounders.
The limitations of this study suggest a need for more well-designed studies with a longer duration of follow-up on this topic to reach more reliable evidence.
抗胆碱能药物（ACs）是最常被处方的药物之一。研究因个体使用ACs导致的认知领域受损存在有争议的结果。
本研究的目的是基于临床试验研究调查个体ACs对认知功能不同方面的影响。
本系统评价按照PRISMA声明进行。在Embase、PubMed、Cochrane图书馆、Scopus和Web of Science数据库中进行系统检索。采用乔安娜·布里格斯研究所清单评估偏倚风险，并使用CMA软件进行荟萃分析。
在3026条检索结果中，纳入了138项研究。共有38项评估东莨菪碱认知影响的研究纳入荟萃分析。纳入研究报告了东莨菪碱、美加明、阿托品、比哌立登、奥昔布宁、苯海索、苄托品和双环维林的认知效应；然而，格隆溴铵、曲司氯铵、托特罗定、达非那新、非索罗定、噻托溴铵和异丙托溴铵与认知衰退无关。基于荟萃分析，东莨菪碱与识别能力下降（标准化均差 -1.84；95%置信区间 -2.48至 -1.21；p<0.01）、即时回忆（标准化均差 -1.82；95%置信区间 -2.35至 -1.30；p<0.01）、匹配样本（标准化均差 -1.76；95%置信区间 -2.57至 -0.96；p<0.01）、延迟回忆（标准化均差 -1.54；95%置信区间 -1.97至 -1.10；p<0.01）、复杂记忆任务（标准化均差 -1.31；95%置信区间 -1.78至 -0.84；p<0.01）、自由回忆（标准化均差 -1.18；95%置信区间 -1.63至 -0.73；p<0.01）、认知功能（标准化均差 -0.95；95%置信区间 -1.46至 -0.44；p<0.01）、注意力（标准化均差 -0.85；95%置信区间 -1.38至 -0.33；p<0.01）和数字广度（标准化均差 -0.65；95%置信区间 -1.21至 -0.10；p = 0.02）相关。我们纳入的研究存在较高的偏倚风险，尤其是在处理可能的混杂因素方面。
本研究的局限性表明需要对此主题进行更多设计良好、随访时间更长的研究，以获得更可靠的证据。
