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非药物干预治疗轻中度抑郁障碍的痴呆患者可显著改善抑郁症状
作者:小柯机器人 发布时间:2021/3/28 15:23:30

加拿大圣迈克尔医院Jennifer A Watt团队比较了各种干预措施减少痴呆患者抑郁症状的疗效。2021年3月24日,该研究发表在《英国医学杂志》上。

为了比较药物和非药物干预对减轻痴呆症和重度抑郁患者的抑郁症状的疗效,研究组针对Medline、Embase、Cochrane图书馆等大型数据库中从建库至2020年10月15日的文献,检索出比较药物或非药物干预与常规护理或针对痴呆患者抑郁症状的任何其他干预的随机试验,进行了一项系统回顾和荟萃分析。

在筛选的22138篇文献中,包括256项研究(28483名痴呆症患者)。数据缺失是审查结果的最大风险。网络荟萃分析研究包括没有被诊断为严重抑郁障碍的痴呆患者,他们正在经历抑郁症状(213项研究;25177名痴呆患者;研究间方差0.23)。与常规护理相比,七种干预措施可更大程度地减轻患者抑郁症状,分别为认知刺激、认知刺激联合胆碱酯酶抑制剂、按摩和抚触疗法、多学科护理、职业治疗、结合社交和认知刺激的锻炼和回忆治疗。

对于未诊断为重度抑郁障碍的痴呆患者,除按摩和抚触疗法、认知刺激联合胆碱酯酶抑制剂、认知刺激联合运动和社会交往比某些药物干预更有效外,药物干预和非药物干预在减轻抑郁症状方面的疗效无统计学差异。临床和方法学的异质性排除了网络荟萃分析的研究,这些研究比较了针对痴呆和重度抑郁症患者,干预措施减轻其抑郁症状的有效性(22项研究;1829名患者)。

研究结果表明,非药物干预比药物干预可更有效地减少没有严重抑郁障碍的痴呆患者的抑郁症状。

附:英文原文

Title: Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis

Author: Jennifer A Watt, Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A Khan, Marco Ghassemi, Yonda Lai, Victoria Treister, Yuan Thompson, Raphael Schneider, Andrea C Tricco, Sharon E Straus

Issue&Volume: 2021/03/24

Abstract:

Objective To describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder.

Design Systematic review and meta-analysis.

Data sources Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, and grey literature between inception and 15 October 2020.

Eligibility criteria for study selection Randomised trials comparing drug or non-drug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia.

Main outcome measures Pairs of reviewers screened studies, abstracted aggregate level data, and appraised risk of bias with the Cochrane risk of bias tool, which facilitated the derivation of standardised mean differences and back transformed mean differences (on the Cornell scale for depression in dementia) from bayesian random effects network meta-analyses and pairwise meta-analyses.

Results Of 22138 citations screened, 256 studies (28483 people with dementia) were included. Missing data posed the greatest risk to review findings. In the network meta-analysis of studies including people with dementia without a diagnosis of a major depressive disorder who were experiencing symptoms of depression (213 studies; 25177 people with dementia; between study variance 0.23), seven interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference 2.93, 95% credible interval 4.35 to 1.52), cognitive stimulation combined with a cholinesterase inhibitor (11.39, 18.38 to 3.93), massage and touch therapy (9.03, 12.28 to 5.88), multidisciplinary care (1.98, 3.80 to 0.16), occupational therapy (2.59, 4.70 to 0.40), exercise combined with social interaction and cognitive stimulation (12.37, 19.01 to 5.36), and reminiscence therapy (2.30, 3.68 to 0.93). Except for massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction, which were more efficacious than some drug interventions, no statistically significant difference was found in the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder. Clinical and methodological heterogeneity precluded network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder (22 studies; 1829 patients).

Conclusions In this systematic review, non-drug interventions were found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder.

DOI: 10.1136/bmj.n532

Source: https://www.bmj.com/content/372/bmj.n532

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj