Evidence-Based Prevention of Alzheimer's Disease: Systematic Review and Meta-Analysis of 243 Observational Prospective Studies and 153 Randomized Controlled Trials

2019 ◽  
Author(s):  
Jin-Tai Yu ◽  
Wei Xu ◽  
Chen-Chen Tan ◽  
Sandrine Andrieu ◽  
John Suckling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trials ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled

scholarly journals Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials

2020 ◽  
Vol 91 (11) ◽  
pp. 1201-1209 ◽  
Author(s):  
Jin-Tai Yu ◽  
Wei Xu ◽  
Chen-Chen Tan ◽  
Sandrine Andrieu ◽  
John Suckling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Prospective Studies ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Current Evidence ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomised Controlled

BackgroundEvidence on preventing Alzheimer’s disease (AD) is challenging to interpret due to varying study designs with heterogeneous endpoints and credibility. We completed a systematic review and meta-analysis of current evidence with prospective designs to propose evidence-based suggestions on AD prevention.MethodsElectronic databases and relevant websites were searched from inception to 1 March 2019. Both observational prospective studies (OPSs) and randomised controlled trials (RCTs) were included. The multivariable-adjusted effect estimates were pooled by random-effects models, with credibility assessment according to its risk of bias, inconsistency and imprecision. Levels of evidence and classes of suggestions were summarised.ResultsA total of 44 676 reports were identified, and 243 OPSs and 153 RCTs were eligible for analysis after exclusion based on pre-decided criteria, from which 104 modifiable factors and 11 interventions were included in the meta-analyses. Twenty-one suggestions are proposed based on the consolidated evidence, with Class I suggestions targeting 19 factors: 10 with Level A strong evidence (education, cognitive activity, high body mass index in latelife, hyperhomocysteinaemia, depression, stress, diabetes, head trauma, hypertension in midlife and orthostatic hypotension) and 9 with Level B weaker evidence (obesity in midlife, weight loss in late life, physical exercise, smoking, sleep, cerebrovascular disease, frailty, atrial fibrillation and vitamin C). In contrast, two interventions are not recommended: oestrogen replacement therapy (Level A2) and acetylcholinesterase inhibitors (Level B).InterpretationEvidence-based suggestions are proposed, offering clinicians and stakeholders current guidance for the prevention of AD.

scholarly journals Safety and efficacy of active and passive immunotherapy in mild-to-moderate Alzheimer’s disease: A systematic review and network meta-analysis

2019 ◽  
Vol 42 (1) ◽  
pp. E53-E65 ◽  
Author(s):  
Naghmeh Foroutan ◽  
Robert B. Hopkins ◽  
Jean-Eric Tarride ◽  
Ivan D. Florez ◽  
Mitchell Levine
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Safety And Efficacy ◽  
Randomized Controlled ◽  
Clinically Significant

Objective: The objective of this study was to systematically review and conduct a direct and network meta-analysis of randomized controlled trials that have examined the clinical safety and efficacy of using passive and active immunotherapies in Alzheimer’s disease (AD). Research questions: (1) Is amyloid-based immunotherapy in patients with mild-to-moderate AD associated with more efficacy benefits compared to placebo? (2) Which immunotherapy agent is associated with more comparative benefit? (3) Is passive or active immunotherapy associated with more benefits? Data sources: A systematic review of published randomized controlled trials was performed in MEDLINE, EMBASE, PubMed and Cochrane library. Review methods and meta-analysis: Two reviewers independently selected the studies, extracted the data and assessed risk of bias. Important AD cognitive scales as clinical efficacy outcomes were ADAS-cog, CDR and MMSE whereas edema, neoplasms and mortality were included as safety outcomes. A direct comparison meta-analysis using a random effect model and a network (direct and indirect) comparison was conducted to calculate mean differences in treatment effects, SUCRA and ranking probabilities for each medicine per safety and efficacy outcome. Quality of network results were assessed using GRADE methodology. Principle findings: Thirteen RCT-assessed patients with mild-to-moderate AD were included in the final analysis. The results showed that immunotherapies compared with placebo produced a statistically, but not clinically significant, improvement in ADAS-cog (MD=-0.39; 95% CI -0.42, -0.35, P=0.00) and MMSE. In terms of safety, the rate of ARIA-E was significantly higher with monoclonal antibodies. Solanezumab and AN1792 (vaccine) were the drugs of choice both from efficacy and safety perspectives. Conclusion: In terms of efficacy, the review showed a statistically, but not clinically significant, improvement in favor of immunotherapy versus placebo. Further clinical trials are required to demonstrate any cognitive benefits of immunotherapies in mild-to-moderate AD.

scholarly journals Warming Needle Moxibustion for Alzheimer’s Disease: A Systematic Review of Randomized Controlled Trials

2021 ◽  
Author(s):  
Xinming Chen ◽  
Fang Liu ◽  
Nan Lin ◽  
Qian Lin ◽  
Zecai Lv ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trials ◽  
Daily Living ◽  
Total Effective Rate ◽  
Meta Analysis ◽  
Effective Rate ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Objective: To systematically research the impact of warming needle moxibustion (WNM) for Alzheimer’s Disease (AD). Methods: Four Chinese databases and six English databases were systematically searched. Randomized controlled trials (RCTs) involving the use of WNM to intervene in AD patients were included. Data were extracted from the included studies and methodological quality was evaluated according to the Cochrane Handbook for Systematic Reviews of Intervention 5.1.0. Meta-analysis was performed using RevMan 5.4 software. Results: 8 RCTs comprising 524 patients were included. The study showed that WNM was more effective in the treatment of AD than acupuncture or pharmacotherapy. The findings were as follows: MMSE (MD=1.01, 95%CI: 0.13, 1.90, P=0.03) and CDR (MD=-0.73, 95%CI: -0.84, -0.61, P<0.00001) for global cognitive function, ADL (MD=-1.84, 95%CI: -2.47, -1.22, P<0.00001) for activities of daily living, Syndrome Differentiation Scale of Dementia (SDSD) (MD=-2.67, 95%CI: -3.62, -1.72, P<0.00001), and the total effective rate of patients (OR=3.89, 95%CI: 2.49, 6.09, P<0.00001). The differences in all indicators were statistically significant. Conclusion: WNM has a significant effect on improving cognitive function and daily living ability, reducing the symptoms of AD, and increase the total effective rate. WNM is an effective non-pharmacological therapy for patients with AD. Keywords: Warming needle moxibustion, Alzheimer’s disease, Randomized Controlled Trials, systematic review and meta-analysis

scholarly journals Efficacy And Safety of Blood Derivatives Therapy in Alzheimer’s Disease: A Systematic Review And Meta-Analysis

2021 ◽  
Author(s):  
Zhangcheng Fei ◽  
Bo Pan ◽  
Renjun Pei ◽  
Zhongsheng Chen ◽  
Xi Du ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Cognitive Improvement ◽  
Randomized Controlled

Abstract Objective: Blood derivatives therapy is a conventional clinical treatment, while the treatment for Alzheimer’s disease (AD) is relatively novel. To provide clinical references for treating AD, this meta-analysis was performed to evaluate the efficacy and safety of blood derivatives therapy on the patients with AD. Methods: A systematic articles search was performed for eligible studies published up to December 6, 2021 through the PubMed, Embase, Cochrane library, ClinicalTrials.gov, Chinese National Knowledge Infrastructure database and Wanfang databases. The included articles were screened by using rigorous inclusion and exclusion criteria. Random effects model was used for this meta-analysis when there is heterogeneity, or else fixed effects model was used. Quality of studies and risk of bias were evaluated.Results: A total of 3 plasma administrations (2 plasma exchange and 1 young plasma infusion) and 5 intravenous immunoglobulin (IVIG) randomized controlled trials with a sample size of 1148 subjects diagnosed with AD were included. There was no significant difference in cognitive improvement and all-cause discontinuation between intervention and placebo groups. In subgroup analysis, plasma administration was superior to placebo only in limited studies for individual scales. IVIG is well tolerated for AD patients even under the maximum dose (0.4g/kg), but it’s inferior to placebo in Neuropsychiatric Inventory scale in AD patients (P =0.05).Conclusions: The benefits of blood derivatives therapy for AD are limited. It’s necessary to perform well-designed randomized controlled trials with large sample sizes focusing on the appropriate blood derivatives for the specific AD sub-populations in the future. Systematic review registration: PROSPERO CRD42021233886.

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