背景:主观认知障碍(SCI)会大大增加痴呆的风险,并且通常被概念化为认知衰退连续性的临床前无症状阶段。由于缺乏可用于治疗SCI和降低痴呆风险的药物干预措施,以及草药和营养药物的普及,本综述的主要目的是研究中草药和营养药物(相对于对照)对有或无SCI的老年人的认知功能和安全性的疗效.次要目的是描述研究特征并评估纳入研究的方法学质量。
方法:五个数据库(Cochrane,MEDLINE,CINAHL,PsycInfo,和EMBASE)从数据库开始进行搜索,每周建立警报,直到2022年9月18日审查完成。如果文章包括以下内容,则符合资格:有和没有SCI的老年人的研究人群,草药和营养药物作为干预措施,评估认知结局,并进行随机对照试验。
结果:数据摘自21/7666合格的全文文章,并评估了方法学偏倚的风险(SCI=9/21;无SCI=12/21).大多数研究(20/21)采用平行,随机化,安慰剂对照设计,长度为12周。草药补充剂被广泛使用(17/21),即银杏(8/21)或Bacopamonnieri(6/21)的一种形式。认知的测量因研究而异,14/21报告随着时间的推移,至少一个认知功能领域有所改善,干预组(与对照组相比)。共有14/21项研究被认为具有总体上较高的方法学偏倚风险,6/21有一些担忧,只有一项研究(使用SCI人群)被评估为方法学偏倚风险较低.
结论:总体而言,这篇综述发现,对于有SCI和无SCI的老年人,草药和营养药物的认知功能疗效和安全性方面的证据质量较低,因为研究中偏倚的风险较高.此外,在未来的研究能够更准确地确定干预措施对该人群的疗效之前,还需要在SCI的分类和理解以及选择适当的试验主要结局方面做进一步的工作.
Subjective cognitive impairment (SCI) substantially increases dementia risk and is often conceptualised as the preclinical asymptomatic phase of the cognitive decline continuum. Due to the lack of pharmacological interventions available to treat SCI and reduce dementia risk, and the popularity of herbal and nutritional medicines, the primary aim of this
review was to investigate the efficacy on cognitive function and safety of herbal and nutritional medicines (relative to a control) for older adults with and without SCI. The secondary aims were to describe the study characteristics and assess the methodological quality of included studies.
Five databases (Cochrane, MEDLINE, CINAHL, PsycInfo, and EMBASE) were searched from database inception with weekly alerts established until
review finalisation on 18 September 2022. Articles were eligible if they included the following: study population of older adults with and without SCI, herbal and nutritional medicines as an intervention, evaluated cognitive outcomes and were randomised control trials.
Data were extracted from 21/7666 eligible full-text articles, and the risk of methodological bias was assessed (with SCI = 9/21; without SCI = 12/21). Most studies (20/21) employed parallel, randomised, placebo-controlled designs and were 12 weeks in length. Herbal supplements were widely used (17/21), namely a form of Ginkgo biloba (8/21) or Bacopa monnieri (6/21). Measures of cognition varied across studies, with 14/21 reporting improvements in at least one domain of cognitive functioning over time, in the intervention group (compared to control). A total of 14/21 studies were deemed as having an overall high methodological risk of bias, 6/21 had some concerns, and only one study (using an SCI population) was assessed as having a low risk of methodological bias.
Overall, this
review found that there is a low quality of evidence regarding the efficacy of cognitive function and safety of herbal and nutritional medicines for older adults with and without SCI, due to a high risk of bias across studies. Additionally, further work needs to be done in classifying and understanding SCI and selecting appropriate trial primary outcomes before future studies can more accurately determine the efficacy of interventions for this population.