锂是否可以推荐用于轻度认知障碍和阿尔茨海默氏症痴呆症？缺乏关于其有效性和安全性的证据：系统回顾和荟萃分析

Q3 Medicine

Revista Colombiana de Psiquiatria Pub Date : 2024-07-01 DOI:10.1016/j.rcp.2022.04.006

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引用次数: 0

摘要

导言阿尔茨海默病是全球最普遍的神经退行性疾病。目前可用的治疗方法很少，而且效果一般。锂已被证明可减少双相情感障碍患者的认知障碍。方法我们在 2021 年 4 月 30 日至 5 月 10 日期间使用 PubMed、EMBASE、Cochrane Library、LILACS 和 Google Scholar 对文献进行了系统检索。纳入的随机对照临床试验（RCT）旨在评估锂作为阿尔茨海默氏症引起的痴呆和轻度认知障碍患者认知障碍治疗方法的有效性和安全性。主要结果是研究结束时认知功能的差异。两位作者选择了研究并提取了数据。我们计算了连续变量的标准化平均差 (SMD) 和二分变量的相对风险 (RR)。数据处理使用了 Review Manager 5.4 软件。第四份报告被纳入进行安全性分析。与安慰剂相比，接受锂治疗的轻度认知障碍或阿尔茨海默氏症所致痴呆患者的认知表现没有发现明显差异（SMD = -0.39；95%CI，-0.82 至 0.04；I2 = 53%；n = 195）。此外，锂剂与安慰剂在因任何原因停药率（RR = 0.90；95%CI，0.46-1.78；I2 = 0%）和不良反应率（RR = 1.29；95%CI，0.83-2.03；I2 = 0%）方面也未发现明显差异。有必要继续开展质量更高的研究，以证明在临床实践中对这一人群使用锂的合理性。鉴于锂的毒性，应确保对患者进行充分的预选和密切监测。

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Introduction

Alzheimer's disease is the most prevalent neurodegenerative disease worldwide. Currently available treatments are scarce and have modest effects. Lithium has been shown to decrease cognitive impairment in people with bipolar affective disorder. However, studies evaluating lithium for cognitive impairment in Alzheimer's disease remain controversial.

Methods

We conducted a systematic search of the literature using PubMed, EMBASE, the Cochrane Library, LILACS, and Google Scholar between 30 April and 10 May 2021. Randomised controlled clinical trials (RCTs) conducted to evaluate the efficacy and safety of lithium as a treatment for cognitive impairment in people with dementia and mild cognitive impairment due to Alzheimer's disease were included. The primary outcome was the difference in cognitive functioning at the end of the study. Two authors selected the studies and extracted the data. We calculated the standardised mean differences (SMD) for continuous variables and the relative risk (RR) for dichotomous variables. Review Manager 5.4 software was used for data processing.

Results

2,078 reports were identified and 3 studies with data from 248 participants were included. A fourth report was included for safety analysis. Compared to placebo, no significant difference was found in the cognitive performance of patients with mild cognitive impairment or dementia due to Alzheimer's disease receiving lithium treatment (SMD = –0.39; 95%CI, –0.82 to 0.04; I² = 53%; n = 195). Also, significant differences were not found in the rate of discontinuation for any cause (RR = 0.90; 95%CI, 0.46-1.78; I² = 0%), and the rate of adverse effects between lithium and placebo (RR = 1.29; 95%CI, 0.83-2.03; I² = 0%).

Conclusions

The current evidence is insufficient to assume any effect of lithium as a treatment for cognitive impairment in Alzheimer's disease dementia. It is necessary to continue building better quality studies to justify the use of lithium in this population in clinical practice. Given the toxicity of lithium, adequate pre-selection of patients and close monitoring should be ensured.

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来源期刊

Revista Colombiana de Psiquiatria Medicine-Psychiatry and Mental Health

CiteScore

2.50

自引率

0.00%

发文量

期刊介绍： Revista Colombiana de Psiquiatría (RCP) is a quarterly official publication of Colombian Psychiatry Association (March, June, September and December) and its purpose is to spread different the knowledge models that currently constitute the theoretical and practical body of our specialty. Psychiatrists, psychiatric residents, non psychiatric physicians, psychologists, philosophers or other health professionals or persons interested in this area can take part in the magazine. This journal publishes original works, revision or updating articles, case reports of all psychiatry and mental health areas, epistemology, mind philosophy, bioethics and also articles about methodology of investigation and critical reading.