HRB-Clinical Research Facility, University of Galway, Galway, Ireland.
Wellcome Trust - HRB, Irish Clinical Academic Training, Galway, Ireland.
Age Ageing. 2023 Oct 2;52(10). doi: 10.1093/ageing/afad197.
The benefit of antiplatelet therapy in preventing cognitive impairment or dementia is uncertain. We investigated the association between antiplatelet therapy and incident cognitive impairment or dementia in randomised clinical trials.
We searched PubMed, EMBASE and CENTRAL for randomised clinical trials published from database inception through 1 February 2023. Trials that evaluated the association of antiplatelet therapy with incident cognitive impairment or dementia were included. For single-agent antiplatelet, the control group was placebo. For dual agent antiplatelet therapy, the control group was single-agent monotherapy. A random-effects meta-analysis model was used to report pooled treatment effects and 95% confidence intervals (CIs). The primary outcome was incident cognitive impairment or dementia. Secondary outcomes included change in cognitive test scores.
A total of 11 randomised clinical trials were included (109,860 participants). All reported the incidence of cognitive impairment or dementia on follow-up. The mean (SD) age of trial participants was 66.2 (7.9) years. Antiplatelet therapy was not significantly associated with a reduced risk of cognitive impairment or dementia (11 trials; 109,860 participants) (3.49% versus 4.18% of patients over a mean trial follow-up of 5.8 years; odds ratio [OR], 0.94 [95% CI, 0.88-1.00]; absolute risk reduction, 0.2% [95% CI, -0.4% to 0.009%]; I2 = 0.0%). Antiplatelet therapy was not significantly associated with mean change in cognitive test scores.
In this meta-analysis, antiplatelet therapy was not significantly associated with a lower risk of incident cognitive impairment or dementia, but the CIs around this outcome do not exclude a modest preventative effect.
抗血小板治疗预防认知障碍或痴呆的益处尚不确定。我们研究了随机临床试验中抗血小板治疗与新发认知障碍或痴呆之间的关联。
我们检索了 PubMed、EMBASE 和 CENTRAL，以获取从数据库建立到 2023 年 2 月 1 日发表的随机临床试验。纳入评估抗血小板治疗与新发认知障碍或痴呆关联的试验。对于单一抗血小板药物，对照组为安慰剂。对于双联抗血小板治疗，对照组为单药单药治疗。采用随机效应荟萃分析模型报告汇总治疗效果和 95%置信区间（CI）。主要结局为新发认知障碍或痴呆。次要结局包括认知测试评分的变化。
共纳入 11 项随机临床试验（109860 名参与者）。所有研究均报告了随访期间认知障碍或痴呆的发生率。试验参与者的平均（SD）年龄为 66.2（7.9）岁。抗血小板治疗与认知障碍或痴呆风险降低无关（11 项试验；109860 名参与者）（平均试验随访 5.8 年时，患者的发生率分别为 3.49%和 4.18%；优势比[OR]，0.94[95%CI，0.88-1.00]；绝对风险降低，0.2%[95%CI，-0.4%至 0.009%]；I2=0.0）。抗血小板治疗与认知测试评分的平均变化无关。
在这项荟萃分析中，抗血小板治疗与新发认知障碍或痴呆的风险降低无显著相关性，但该结局的 CI 并未排除适度的预防作用。
