| ObjectivesTo evaluate the therapeutic effects and safety of the Chinese Medicine in treatment with Alzheimer's Disease and Vascular Dementia by systematic reviews.MethodsWe searched the database of VIP, CNKI and CBMDisc for clinical studies of TCM in treating Alzheimer's Disease and Vascular Dementia from 1989 to 2009, established the form of information collection and quality evaluation about the clinical studies of TCM in treating AD and VD according to the principle and method of clinical epidemiology and DME, filtrated qualified researches, and evaluated the quality of the qualified researches by using the Jadad scale which is the standard of quality evaluation of randomized controlled trials, then performed meta-analysis by RevMan4.2 software after extract information data.Result396 randomised controlled trials were identified meeting the criteria. There were 61 studies which are the clinical studies of TCM in treatment with AD. Among which, only 9 trials were appraised as high quality by the Jadad scale. No RCT performed allocation concealment; 6 RCTs adopted double blinding,2 RCTs adopted single blinding;7 described the withdrawals and dropouts. In addition,there were 335 studies which are the clinical studies of TCM in treatment with VD. Among which, there were 38 trials were appraised as high quality by the Jadad scale. Only 2 RCTs performed allocation concealment;32 RCTs adopted double blinding,16 RCTs adopted single blinding;20 described the withdrawals and dropouts and 8 studies which described no withdrawals.The results of meta-analysis of AD showed that in the comparison with Cholinesterase Inhibitors, the TCM is not better than the Cholinesterase Inhibitors in the standards of the MMSE's increased score [OR(fixed)=0.78,95%CI (0.53,1.13), P=0.19], the percentage of MMSE's increased score [OR(fixed)=1.41,95%CI(0.80,2.48),P=0.24] and the difference of MMSE's scores before and after treatment [WMD(fixed)=-0.17,95%CI为(-1.76,0.56), P= 0.55]. In the comparison with the drugs of Metabolic enhanced, the TCM is better than the drugs of Metabolic enhanced in the standard of the effectiveness of traditional Chinese medical syndrome [OR(fixed)=2.60,95%CI(1.35,5.00), P= 0.004], but in the standard of the difference of MMSE's scores before and after treatment [WMD(ramdom)=1.97,95%CI为(-0.39,4.33), P=0.10], the TCM is not better than the drugs of Metabolic enhanced.The results of meta-analysis of VD showed that the TCM is better than the drugs of Metabolic enhanced in the standards of the difference of MMSE's scores before and after treatment [WMD(random)=0.96,95%CI(0.13,1.78), P= 0.02], the therapeutic indices which is couted by the scores of TCM symptoms[OR(fixed)=1.68,95%CI为(1.25,2.26), P=0.0006]and the effectiveness of traditional Chinese medical syndrome; but in the standards of the percentage of MMSE's increased score [OR(random)=1.32,95%CI(0.98,1.77), P=0.06], the difference of BBS's scores before and after treatment[WMD(fixed)=0.21,95 %CI(-0.17,0.59), P=0.28] and the difference of ADL's scores before and after treatment[WMD(fixed)=0.28,95%CI(-0.55,1.11),P=0.51], the TCM is not better than the drugs of Metabolic enhanced.ConclusionThe results of systematic reviews show that there are less number of high quality clinical literature of Chinese Medicine in treatment with AD, only 9 trials which scores are more than three points by the Jadad scale, while the number of high quality clinical literature of Chinese Medicine in treatment with VD is 38. Generally speaking, the quality of clinical research literature of Chinese Medicine in treatment with AD and VD is not satisfactory, which need to be enhanced further. The results of meta-analysis show that the curative effect of Chinese Medicine in treatment with AD is not better than the Cholinesterase Inhibitors, but the Cholinesterase Inhibitors which is the effective medicine for cure Alzheimer's Disease. Therefore the Chinese Medicine is considered to have certain effect in treatment with AD, and the curative effect of Chinese Medicine is better than the drugs of Metabolic enhanced in treatment with Alzheimer's Disease and Vascular Dementia.
|
PDF Full Text Request