Different Doses of Pharmacological Treatments for Mild to Moderate Alzheimer’s Disease: A Bayesian Network Meta-Analysis

Abstract

Background: Pharmacological treatments play a significant role in treating mild to moderate Alzheimer's disease (AD), but the optimal doses of various drugs used for these treatments are unknown. Our study compared the efficacy, acceptability, and safety of different doses of pharmacological treatments for mild to moderate AD.Methods: Randomized controlled trials (RCTs) were identified by searching the PubMed, EMBASE, and Cochrane Library databases (all RCTs published from the date of inception of the databases until September 19, 2019). Trials comparing the efficacy, acceptability, and safety of pharmacological interventions involving donepezil, galantamine, rivastigmine, memantine, huperzine A, and Ginkgo biloba extract EGb761, alone or in combination, were identified. The primary outcomes were efficacy, acceptability, and safety.Results: Our meta-analysis included 37 studies involving 14,705 participants. In terms of improving cognitive function, galantamine 32 mg, galantamine 24 mg, donepezil 5 mg, and donepezil 10 mg were more effective than other interventions, with the surface under the cumulative ranking curve (SUCRA) values of 93.2, 75.5, 73.3, and 65.6%, respectively. According to the SUCRA values, EGb761 240 mg was considered to be the optimal intervention in terms of both acceptability and safety. With regard to clinical global impression, rivastigmine 12 mg had the highest probability of being ranked first (83.7%). The rivastigmine 15 cm 2 patch (SUCRA = 93.7%) may be the best choice for daily living. However, there were no interventions that could significantly improve neuropsychiatric symptoms, compared with the placebo.Conclusions: Different doses of the tested pharmacological interventions yielded benefits with regard to cognition, acceptability, safety, function, and clinical global impressions, but not effective behaviors.

International Biological Flora:Ginkgo biloba

“…Terpenoids and flavonoids are two main pharmacological components in Ginkgo extracts (Jacobs & Browner, 2000; Juretzek, 1997). EGb761, the only well‐studied Ginkgo extract at present, has shown beneficial effects on the treatment of vascular disease and neurodegenerative disease such as Alzheimer‐type dementia and insufficient blood flow (Arenz et al, 1996; Juretzek, 1997; Luo et al, 2002; Schmid, 1997; Tu et al, 2020; Weinmann et al, 2010; Zhang, Liu, et al, 2020).…”

Effects of 6-Month Multimodal Physical Exercise Program on Bone Mineral Density, Fall Risk, Balance, and Gait in Patients with Alzheimer’s Disease: A Controlled Clinical Trial

“…Currently, both pharmacological and non-pharmacological treatments are often applied for AD, other dementias, or cognitive impairment in older people. At present, only a few symptom-targeted pharmacological treatments are available, which provide modest improvements in patients’ livelihoods, and usually with side effects that may include nausea, dizziness, and weight loss [ 36 , 37 , 38 , 39 ]. For this reason, research on non-pharmacological treatments, which can be well implemented in the daily routine of patients, has increased in recent years.…”

Repetitive Transcranial Magnetic Stimulation for Alzheimer’s Disease Based on Apolipoprotein E Genotyping: Protocol for a Randomized Controlled Study

“…At present, there is no effective drug for Alzheimer’s disease ( Lu et al, 2020 ; Zhang et al, 2020 ). Doctors or researchers in many fields are trying variable treatment methods.…”

“…The current clinical treatment of Alzheimer’s disease with medications has unsatisfactory therapeutic effect. Zhang et al (2020) reported a meta-analysis of pharmacological treatments showing that improvement of Mini-mental State Examination (MMSE) score standard mean difference (SMD) ranges from −0.29 to 0.49; Lu et al (2020) also reported another analysis of anti- Aβ agents for mild to moderate Alzheimer’s disease suggesting no effect of anti- Aβ drugs vs. the placebo group (SMD of MMSE score improvement: −0.29, 95% CI −0.76–0.17; SMD of ADAScog score improvement: MD: 0.20, 95% CI: −0.40–0.81). In contrast, Chu et al (2021) reported a promising result.…”