| Objective: rder to provide clinical reference for the clinical treatment of Alzheimer’s disease,The Network Meta-Analysis(NMA)method was used to evaluate the effect of different anti-dementia drugs on the cognitive function of patients with Alzheimer’s disease.method: A computer serch domestic and international medical database including Pubmed database,web of science,clinicaltrials,Embase,Cohranne library,Chinese knowledge network,CBM database,Wanfang database and other databases on various types of anti-dementia drug treatment of Alzheimer’s disease randomized controlled trial(Randomized Controlled trials,RCTs),According to the strict inclusion and exclusion criteria,the preliminary retrieval of the literature screening,the final inclusion of 33 articles,a total of 8039 patients.There were 4468 patients in the treatment group and 3571 patients in the placebo group.The main evaluation index was the mini-mental state examination(MMSE)scale.According to the MMSE scale,the included 33 articles were divided into mild,moderate and severe 3 subgroups.A total of 11 articles were included in the literature,including 12 drugs(including placebo),a total of 3800 patients were included,of which 1830 cases were treated and the control group of 1970 cases.AD patients with moderate cognitive decline in a total of 17 articles included,15 drugs(including placebo)included a total of 3194 patients,including treatment group 2108 cases,the control group 1086 cases.AD patients with severe cognitive dysfunction group included a total of 5 articles,including three kinds of drugs(including placebo),a total of 1045 patients,including treatment group of 530 cases,the control group of 515 cases.According to the heterogeneity of the included literature,the random effect model was used to analyze the network by R software.For the direct and indirect comparison results,the heterogeneity and node analysis of Gemtc data packet in R software were used to test the heterogeneity of the included literature.The Gemtc data packet was used to sort the therapeutic effect.Results and conclusions: The effect of MD value and its 95% confidence interval indicates that if MD >0,it proves that the drug has a positive correlation with the decrease of cognitive function in patients with Alzheimer’s disease.In AD patients with mild cognitive dysfunction subgroup,The most significant effect of the drug is donepezil,galanthamine and huperzine A.MD values were 5.2,2.5 and 2.4,respectively.Lithium、folic acid、 vitamin E and simvastatin compared with placebo,MD values were-0.62,-0.16,-0.0021 and-1.6.Consider that these four drugs have no significant effect on the improvement of mild cognitive function in patients with Alzheimer’s disease.Among the 12 therapeutic drugs,the efficacy of donepezil in the treatment of mild cognitive impairment in patients with AD was the best,and the rest of the drugs were in the order of efficacy: galanthamine> huperzine A> melatonin> memantine> estrogen > Atorvastatin> Vitamin E> folic acid> placebo> lithium> simvastatin.In AD patients with moderate cognitive dysfunction subgroup,the most significant effect is donepezil,huperzine A and rivastigmine.MD values of 3.8,2.9 and 3.0,respectively.Among them,estrogen,SB-742457 and Dimebon,simvastatin compared with placebo,MD values were-0.31,-0.39,-3.7,-0.035.Consider that these four drugs have no significant effect on the improvement of moderate cognitive function in patients with Alzheimer’s disease.Among the 15 therapeutic agents,Donepezil was the most effective in the treatment of moderate cognitive dysfunction in patients with AD.The rest of the drugs were sorted by donepezil> huperzine A> rivastigmine> galanthamine> memantine> Escitrine> N-acetylcysteine> fluvastatin> atorvastatin> aripiprazole> simvastatin> placebo> estrogen> SB-742457> Dimebon.In AD patients with severe cognitive dysfunction subgroup,donepezil to reduce AD in patients with severe cognitive dysfunction than the memantine. |
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