背景:精神病是阿尔茨海默病(AD)的一个非常常见的特征,随着神经退行性疾病的发展而出现。5-羟色胺(5-HT2A)受体在突触后位于额叶皮层的5-羟色胺能神经元上,并介导兴奋性和抑制性神经传递。然而,5-HT2A受体负调节剂在阿尔茨海默病精神病(ADP)中的有效性和耐受性尚不确定。
目的:检测5-HT2A受体的负调节剂作为ADP的治疗方法。
方法:主要结果指标是总神经精神量表(NPI)评分。其他预后指标包括简易精神状态检查(MMSE),卡茨日常生活活动独立指数(KATZ),停药率,和不良事件。
结果:与安慰剂相比,5-HT2A反向激动剂显著降低NPI总分,KATZ和MMSE分数.合并比值比(OR)为1.64(95%置信区间(95%CI):1.01-2.65),异质性方差估计为Tau2=0.52,I2值为90%,χ2值为111.31,p=0.04,z值为2.01。5-HT2A受体负调节剂组和安慰剂组之间的风险差异(RD)为0.12(95%CI:0.00-0.24),异质性估计为Tau2=0.03,χ2值为127.23,自由度(df)值为9,I2值为93%,z值为1.92,p值为0.01(<0.05)。
结论:我们的结果表明,5-HT2A受体的负调节剂在ADP的治疗中是有益的且耐受性良好。
BACKGROUND: Psychosis is a very common feature of Alzheimer\'s disease (AD) that can emerge as the neurodegenerative disease progresses. The 5-hydroxytryptamine (5-HT2A) receptors are located postsynaptically to serotonergic neurons in the frontal cortex and mediate both excitatory and inhibitory neurotransmissions. However, the effectiveness and tolerance of negative modulators of 5-HT2A receptors in Alzheimer\'s disease psychosis (ADP) are uncertain.
OBJECTIVE: To detect the negative modulators of the 5-HT2A receptor as a cure for ADP.
METHODS: The primary outcome indicator was the total Neuropsychiatric Inventory (NPI) score. Other prognostic indicators included Mini-Mental State Examination (MMSE), the Katz Index of Independence in Activities of Daily Living (KATZ), the discontinuation rate, and adverse events.
RESULTS: Compared to placebo, 5-HT2A inverse agonists significantly reduced the NPI total score, the KATZ and the MMSE score. The pooled odds ratio (OR) was 1.64 (95% confidence interval (95% CI): 1.01-2.65) and the heterogeneity variance was estimated at Tau2 = 0.52 with an I2 value of 90%, a χ2 value of 111.31, p = 0.04, and z-value of 2.01. The risk difference (RD) between the 5-HT2A receptor negative modulators and placebo groups was 0.12 (95% CI: 0.00-0.24) and the heterogeneity was estimated at Tau2 = 0.03, χ2 value of 127.23, degrees of freedom (df) value of 9, I2 value of 93%, z-value of 1.92, and p-value of 0.01 (<0.05).
CONCLUSIONS: Our results suggest that negative modulators of 5-HT2A receptors are beneficial and well-tolerated in the treatment of ADP.