Park Jong Mi, Kim Yong Wook, Lee Sang Chul, Yoon Seo Yeon
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
Brain Neurorehabil. 2025 Jun 20;18(2):e4. doi: 10.12786/bn.2025.18.e4. eCollection 2025 Jul.
This systematic review and meta-analysis evaluated the efficacy and safety of methylphenidate in patients with brain disease. A comprehensive search up to November 4, 2024 identified 33 randomized controlled trials involving 1,369 participants with traumatic brain injury (TBI), stroke, Parkinson's disease (PD), Alzheimer's disease (AD), other dementias, and multiple sclerosis. Methylphenidate was administered at 10-80 mg/day or 0.1-1 mg/kg/day for durations ranging from a single dose to 6 months. Data were synthesized using a random-effects model, with study quality evaluated via the Revised Cochrane Risk of Bias Tool. Methylphenidate significantly improved attention (standardized mean difference [SMD], 0.43; 95% confidence interval [CI], 0.03 to 0.84), particularly in TBI. Motor function improved in stroke populations (mean difference [MD], 0.66; 95% CI, 0.13 to 1.18), while activities of daily living (ADL) significantly improved in stroke and AD (SMD, 0.71; 95% CI, 0.37 to 1.06). Apathy was significantly reduced in AD (SMD, -0.60; 95% CI, -0.95 to -0.26), and depression improved across patients with PD, stroke, and TBI (SMD, -0.50; 95% CI, -0.94 to -0.05). No significant effects were observed for consciousness, global cognition, executive function, fatigue, or quality of life. Side effects were mild, with a slight increase in pulse rate (MD, 0.28; 95% CI, 0.10 to 0.47). In summary, methylphenidate improves attention (TBI), motor function (stroke), ADL (stroke, AD), and mood, especially apathy (AD) and depression, with a favorable safety profile. Its effects appear condition-specific, and further research is needed to confirm long-term efficacy and establish standardized protocols.
International Prospective Register of Systematic Reviews Identifier: CRD42024563826.
本系统评价和荟萃分析评估了哌甲酯在脑部疾病患者中的疗效和安全性。截至2024年11月4日的全面检索共识别出33项随机对照试验，涉及1369名患有创伤性脑损伤（TBI）、中风、帕金森病（PD）、阿尔茨海默病（AD）、其他痴呆症和多发性硬化症的参与者。哌甲酯的给药剂量为每日10 - 80毫克或每日0.1 - 1毫克/千克，给药持续时间从单次剂量至6个月不等。使用随机效应模型对数据进行综合分析，并通过修订的Cochrane偏倚风险工具评估研究质量。哌甲酯显著改善了注意力（标准化均数差[SMD]，0.43；95%置信区间[CI]，0.03至0.84），在创伤性脑损伤患者中尤其明显。中风患者的运动功能得到改善（均数差[MD]，0.66；95% CI，0.13至1.18），而中风和阿尔茨海默病患者的日常生活活动能力（ADL）显著改善（SMD，0.71；95% CI，0.37至1.06）。阿尔茨海默病患者的冷漠症状显著减轻（SMD， - 0.60；95% CI， - 0.95至 - 0.26），帕金森病、中风和创伤性脑损伤患者的抑郁症状有所改善（SMD， - 0.50；95% CI， - 0.94至 - 0.05）。在意识、整体认知、执行功能、疲劳或生活质量方面未观察到显著影响。副作用轻微，心率略有增加（MD，0.28；95% CI，0.10至0.47）。总之，哌甲酯可改善注意力（创伤性脑损伤）、运动功能（中风）、日常生活活动能力（中风、阿尔茨海默病）和情绪，尤其是冷漠（阿尔茨海默病）和抑郁，且安全性良好。其效果似乎具有疾病特异性，需要进一步研究以确认长期疗效并建立标准化方案。
国际前瞻性系统评价注册库标识符：CRD42024563826。
