Objective To evaluate the effectiveness and safety of donepezil in the treatment of senile vascular dementia. Methods The databases such as the Chinese Journal Full-text Database, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, Chinese Biomedicine Database, PubMed and The Cochrane Library were searched by computer, and the related journals and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on donepezil in the treatment of senile vascular dementia. Studies were screened according to the inclusion and exclusion criteria, data were extracted, the methodological quality of the included studies was assessed according to Jadad score criterion, and meta-analyses were performed by using RevMan 5.0 software. Results Among 25 studies (3586 patients) included, eight described the randomization methods, and three described the double blind methods. The results of meta-analyses showed, compared with the placebo group, donepezil was superior in improving vascular dementia patients’ cognition level (three studies, MD= –1.25, 95%CI –1.61 to –0.88, Plt;0.000 01), intellectual spirit level (two studies, MD=0.66, 95%CI 0.35 to 0.97, Plt;0.000 1), dementia level (three studies, MD= –0.74, 95%CI –1.16 to –0.31, P=0.004), and viability level (two studies, MD= –0.74, 95%CI –1.16 to –0.31, P=0.000 6). In improving the intellectual spirit level, donepezil was superior to piracetam (seven studies, MD=3.25, 95%CI 2.15 to 4.35, Plt;0.000 01), Xuesaitong (two studies, MD=6.12, 95%CI 4.02 to 8.22), Huperzine A (three studies, MD=2.45, 95%CI 1.14 to 3.76, P=0.000 2), and vitamin (two studies, MD=4.00, 95%CI 2.73 to 5.27, Plt;0.000 01). For improving the viability level, donepezil was superior to piracetam (five studies, MD= –3.86, 95%CI –4.83 to –2.89, Plt;0.000 01), Xuesaitong (two studies, MD= –5.49, 95%CI –7.18 to –3.80, Plt;0.000 01), Huperzine A (two studies, MD= –0.78, 95%CI –4.23 to –2.66, P=0.66), vitamin (three studies, MD= –5.88, 95%CI –8.29 to –3.48, Plt;0.000 01), and nimodipine (one study, MD= –7.09, 95%CI –10.81 to –3.37, P=0.000 2). In improving the dementia level (HDS Scale), donepezil was superior to piracetam (one study, MD=5.80, 95%CI 2.78 to 8.82, P=0.000 2), Xuesaitong (one study, MD=3.95, 95%CI 2.32 to 5.58, Plt;0.000 01), vitamin (one study, MD=3.91, 95%CI 0.94 to 6.88, P=0.010), and almitrine (one study, MD=3.37, 95%CI 1.10 to 5.64, P=0.004). Conclusion Current evidence shows that donepezil is likely to be more effective in the treatment of vascular dementia than placebo, piracetam, Xuesaitong, Huperzine A and vitamin. However, for the limited evidence and lower methodological quality of the included studies, this conclusion still needs to be verified with more high-quality RCTs.
Objective To assess the efficacy and safety of Zhiling decoction for vascular dementia. Methods The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group was searched in Feb. 2004 using the term Zhiling. In addition, we handsearched 83 traditional Chinese medicine journals （1993 to 2004 ）. We included all randomized controlled trials（RCTs）of Zhiling decoction treating people with vascular dementia. We also evaluated the internal validity of the RCTs . If all included RCTs were of high quality and homogeneity, then the meta-analysis was conducted. Results Only one RCT was identified. The outcomes were listed as the followings ： ① The Hasegawa＇ s dementia scale scoring （ HDS ） scores of the patients in Zhiling decoction group were improved significantly from baseline after 8 weeks course of treatment and there was no significant difference in the control group. The HDS scores improvement was greater than control group（P 〈0.01 ）o ② The latency of P3 was shorter in both groups after treatment, and there was a significant treatment effect in Zhiling group （t = -52. 09, 95% CI -69.79 to -34.39, P 〈0. 000 01 ）. The amplitude of 173 increased in both groups after treatment, and there was a non-sigmficant treatment effect in Zhiling group for change from baseline （t =1.40, 95% CI -0.02 to 2.82, P =0.05）. ③ Brain electrical activity monitoring （BEAM） showed that benefits in those treated by Zhiling decoction were higher than those treated by Naofukang with OR9.90 （ 95% CI 3.34 to 29.38）. ④In the Zhiling group serum cholesterol （P 〈0.01 ） , serum triglyceride （P 〈0.01 ） and LPO（P 〉0. 01 ） decreased after treatment. There was an increase in the level of high density lipoprotein （HDL） and superoxide dismutase （SOD） in red blood cells compared with baseline for Zhiling groups （P 〈0.01 ）. ⑤ The cerebral blood flow decreased in both groups after treatment, and there was a significant treatment effect in favour of Zhiling （treatment effect t = -1.03, 95% CI -1.26 to -0.80, P 〈0. 00001 ）.⑥ No side effects on heart, liver or renal function were reported in Zhiling decoction group. Conclusions The currendy available evidence is insufficient to assess the potential efficacy for Zhiling decoction in the treatment of vascular dementia. Just one RCT concerning the management of Zhifing decoction versus Naofukang suggests that Zhiling decoction may be effective in treating vascular dementia. Further randomised, double-blind, placebo-controlled trials are urgendy needed .
【摘要】 目的 探讨3分法画钟测验（clock drawing test，CDT）对阿尔茨海默病患者（Alzheimer disease，AD）与血管性痴呆患者（vascular dementia，VD）的鉴别作用。 方法 收集四川大学华西医院神经内科门诊及住院部2009年9月-2010年6月就诊的认知功能障碍患者150例，进行病史采集及神经心理测试量表，筛选出AD患者57例及VD患者43例，共计纳入100例。在两者间进行CDT，分析两者间CDT有无差别、CDT与中文版简易智能量表（Chinese version of the mini-mental state examination，MMSE）及临床痴呆评定量表（clinical dementia rating scale，CDR）的相关性。 结果 AD患者及VD患者间CDT差异无统计学意义（Pgt;0.05）；CDT与MMSE及CDR有相关性，Spearman相关系数分别为0.573和-0.542（Plt;0.001）。 结论 3分法画钟测验无法准确区分AD和VD，但对粗略判断AD及VD程度可能有一定效果。【Abstract】 Objective To investigate the differential function of the three-point scoring system for the clock drawing test (CDT) between Alzheimer’s disease (AD) and vascular dementia (VD). Methods We analyzed the clinical data of 150 patients with cognitive impairment treated in the neurology and inpatient departments of our hospital from September 2009 to July 2010. Medical history of the subjects were collected. Through the assessment by neurological and psychological rating scale, we picked out 57 patients with AD and 43 with VD and tested them with CDT. The difference of CDT results between the two groups, and the correlation of CDT with Chinese version of the mini-mental state examination (MMSE) and clinical dementia rating scale (CDR) were analyzed. Results There was no statistical difference of CDT results between AD and VD patients (Pgt;0.005). CDT had a correlations with MMSE and CDR, the Spearman correlation coefficient being 0.573 and -0.542 respectively (Plt;0.001). Conclusion The three-point scoring system for the clock drawing test cannot differentiate exactly between Alzheimer Disease and Vascular Dementia, but it can make a gross judgment of the degree of AD and VD.
ObjectivesTo systematically evaluate the efficacy and safety of butylphthalide soft capsule in the treatment of vascular dementia (VaD).MethodsDatabases including CNKI, WanFang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library were electronically searched to collect randomized controlled trials of butylphthalide soft capsule in the treatment of vascular dementia published from September 2002 to July 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 15 studies involving 1 149 patients were included. The butylphthalide soft capsule treatment group included 578 patients and the control group included 571 patients. The results of meta-analysis showed that compared with the control group (donepezil hydrochloride tablets or memantine hydrochloride tablets or EGb761 or negative control), the butylphthalide soft capsule treatment group improved the MMSE score of patients with VaD (MD=3.52, 95%CI 2.59 to 4.46, P<0.01), CDR score (MD=−0.72, 95%CI −0.80 to −0.65, P<0.01), and treatment efficiency (RR=1.31, 95%CI 1.20 to 1.43, P<0.01). However, there was no statistical difference in the number of adverse reactions between the treatment and control groups.ConclusionsButylphthalide soft capsule can be used in the treatment of patients with mild to moderate VaD. It can improve the cognitive function, raking of clinical dementia, and increase the effect rate of treatment. It can also work in conjunction with other drugs that improve cognitive function and no increase in adverse reactions has been found. However, due to the low quality of the included studies and small sample size, the actual efficacy strength is uncertain and the above conclusions are still required to be verified by more high-quality randomized controlled trials.
ObjectiveTo systematically review the data of peripheral inflammatory markers in patients with Alzheimer’s disease (AD) and vascular dementia (VaD) to further indicate pathogenesis and antidiastole.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on peripheral inflammatory markers in patients with AD and VaD from inception to July 2020. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies, and meta-analysis was performed by using Stata 15.1SE software.ResultsA total of 30 studies involving 2 377 patients were included. The results of meta-analysis showed that the IL-6 level was higher in VaD group than that in AD group (SMD=−0.477, 95%CI −0.944 to −0.009, P=0.046). However, there were no statistical difference in peripheral IL-1β (SMD=−0.034, 95%CI −0.325 to 0.257, P=0.818), TNF-α (SMD=0.409, 95%CI −0.152 to 0.970, P=0.153) or CRP (SMD=0.277, 95%CI −0.228 to 0.782, P=0.282) levels.ConclusionsThese findings suggest that IL-6 may be sensitive markers to distinguish AD from VaD. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.
Vascular dementia is one of the most common types of dementia in China. How to better prevent and treat vascular dementia is still an unresolved problem, and the risk predictor of vascular dementia may help provide clinical targeted prevention measures to intervene in the development process of vascular dementia early. This article reviews the current research status of vascular dementia predictors from four aspects: blood markers, predictors based on disease characteristics, predictors based on assessment tools and neuropsychological tests, and predictors based on activity dysfunction. It aims to provide a basis for establishing a risk prediction model for patients with vascular dementia suitable for China’s conditions in the future.