Kingsley Ryan, Tyree Sara, Jarsania Dhairya, Edquist Christopher, Palmer Allyson, Gerberi Dana, Wilfahrt Robert, Pagali Sandeep
Division of Hospital Medicine, Mayo Clinic, Rochester, MN, USA.
Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA.
Int Neurourol J. 2024 Sep;28(3):171-180. doi: 10.5213/inj.2448266.133. Epub 2024 Sep 30.
Alpha-1 adrenergic receptor (α1-AR) antagonists are commonly used for management of benign prostatic hyperplasia or hypertension. Some studies have shown a potential link between α1-AR antagonist use and cognitive impairment. Given the conflicting data surrounding α1-AR antagonists association with cognitive dysfunction, we aim to systematically review the association of cognitive dysfunction with α1-AR antagonist use to aid clinician decision both with medication initiation and continuation. A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched Ovid Cochrane, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science on March 7, 2023, with an update run on January 22, 2024. The primary outcome was cognitive dysfunction. We used Cochrane risk of bias for randomized controlled trials (RCTs) and MINORS (Methodological Index for Non-Randomized Studies) criteria for non-RCTs to evaluate study quality. This study was registered with PROSPERO (CRD42024505751). We identified 7 studies for our systematic review (3 RCTs, 4 non-RCTs). Tamsulosin was the most studied medication (6 of 7 studies). Tamsulosin was associated with no cognitive dysfunction in 2 RCTs, increased risk for dementia in 2 non-RCTs, no change in cognition in 1 non-RCT, and decreased risk for dementia in 1 non-RCT. Among 3 non-RCTs analyzing alfuzosin, it was associated with decreased risk of or no association with dementia in 2 studies and increased risk for dementia in 1 study. Doxazosin, prazosin, and terazosin were neutral or showed a negative risk for dementia. Our systematic review did not show a convincing causal association between α1-AR antagonists, including tamsulosin, and cognitive dysfunction. Considering the existing literature, it is appropriate to use α1-AR antagonists without concern for cognitive dysfunction. Future research, through robust study designs considering the multifactorial nature of cognitive dysfunction, is required to further evaluate this association.
α1肾上腺素能受体（α1-AR）拮抗剂常用于治疗良性前列腺增生或高血压。一些研究表明，使用α1-AR拮抗剂与认知障碍之间可能存在联系。鉴于围绕α1-AR拮抗剂与认知功能障碍关联的数据相互矛盾，我们旨在系统评价认知功能障碍与使用α1-AR拮抗剂之间的关联，以协助临床医生在开始用药和持续用药时做出决策。按照PRISMA（系统评价和Meta分析优先报告项目）指南进行了一项系统评价。我们于2023年3月7日检索了Ovid Cochrane、Ovid Embase、Ovid MEDLINE、Scopus和Web of Science，并于2024年1月22日进行了更新检索。主要结局是认知功能障碍。我们使用Cochrane随机对照试验（RCT）偏倚风险评估工具和非随机对照试验的MINORS（非随机研究方法学指标）标准来评估研究质量。本研究已在PROSPERO（CRD42024505751）注册。我们为系统评价确定了7项研究（3项RCT，4项非RCT）。坦索罗辛是研究最多的药物（7项研究中的6项）。在2项RCT中，坦索罗辛与无认知功能障碍相关；在2项非RCT中，坦索罗辛与痴呆风险增加相关；在1项非RCT中，坦索罗辛对认知无影响；在1项非RCT中，坦索罗辛与痴呆风险降低相关。在分析阿夫唑嗪的3项非RCT中，在2项研究中其与痴呆风险降低或无关联，在1项研究中其与痴呆风险增加相关。多沙唑嗪、哌唑嗪和特拉唑嗪对痴呆呈中性或显示负风险。我们的系统评价未显示包括坦索罗辛在内的α1-AR拮抗剂与认知功能障碍之间存在令人信服的因果关联。考虑到现有文献，使用α1-AR拮抗剂时无需担心认知功能障碍。未来需要通过考虑认知功能障碍多因素性质的稳健研究设计进行进一步研究，以评估这种关联。
