[논문]알츠하이머병 및 건망증 경도 인지장애의 인슐린 비강투여: 체계적 문헌 고찰 및 메타분석

사라 알라자르; 진혜경; 강지은; 박소현; 이정연

doi:10.24304/kjcp.2017.27.3.161

[국내논문] 알츠하이머병 및 건망증 경도 인지장애의 인슐린 비강투여: 체계적 문헌 고찰 및 메타분석
Intranasal Insulin for Alzheimer's Disease and Amnestic Mild Cognitive Impairment: Systematic Review and Meta-analysis 원문보기

한국임상약학회지 = Korean journal of clinical pharmacy, v.27 no.3, 2017년, pp.161 - 170

사라 알라자르 (이화여자대학교 대학원 생명.약학부) , 진혜경 (이화여자대학교 대학원 약학과) , 강지은 (이화여자대학교 대학원 생명.약학부) , 박소현 (이화여자대학교 대학원 생명.약학부) , 이정연 (이화여자대학교 대학원 생명.약학부)

Abstract ▼ AI-Helper

Background: There is recent evidence that insulin resistance is responsible for increasing the risk of developing cognitive dysfunction. To systematically review the influence of intranasal insulin treatment on the cognitive function in Alzheimer's disease patients. Methods: Randomized controlled trials comparing the cognitive effects of intranasal insulin therapy in Alzheimer's disease patients with controlled interventions were retrieved from Pubmed, Medline, Embase and Cochrane library. Meta-analysis was conducted on the cognitive measurements with a subgroup analysis by dose, gender and apolipoprotein E allele 4 (ApoE ${\varepsilon}4$) status. Results: Seven randomized controlled trials were eligible for inclusion. Intranasal insulin had a positive influence on the cognitive function as compared to placebo without a statistical significance (standardized mean difference; SMD = 0.109; 95% confidence interval; CI -0.04 to 0.26; P=0.14). In subgroup analysis, a 20 IU dose of intranasal insulin induced a significant improvement in cognitive function (SMD = 0.14; 95% CI 0.05 to 0.24; P=0.004), but 40 IU did not show this effect (SMD = -0.01; 95% CI -0.11 to 0.09; P=0.82). ApoE ${\varepsilon}4$ positive patients showed a significant decline in cognitive function as compared to ApoE ${\varepsilon}4$ positive patients in the control group (SMD = -0.213; 95% CI -0.38 to -0.04; P=0.015). Such an effect was not apparent in ApoE ${\varepsilon}4$ negative patients. Gender had no influence on the cognitive outcomes. Conclusion: The results indicate that intranasal insulin may have beneficial effect in improving the cognitive function in Alzheimer's disease patients.

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제안 방법

After that, full texts of the selected articles were obtained and reviewed. Finally, the selected articles were included if they were in English, employed a randomized controlled design, used intranasal/nasal insulin as an intervention and measured the cognitive function. Study, patient, intervention, and outcome characteristics for each study was extracted in an excel sheet.
This was done by calculation of the standardized mean difference in the cognitive assays. Standardized mean difference was used as the studies used different types of tests for measuring cognitive performances.

대상 데이터

After that, 18 titles were eligible for full-text screening after. Finally, seven RCTs with a total of 360 patients were found to be eligible for the final analysis (PRISMA flow diagram). Of these 360 patients, 214 were found to have MCI and 146 were diagnosed with early AD.

이론/모형

The studies were scored for 7 components of the Cochrane risk of bias tool. Overall, the studies were considered as at low risk of bias.

참고문헌 (30)

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