Rivastigmine for dementia in people with Down syndrome

  • Review
  • Intervention

Authors


Abstract

Background

Alzheimer's dementia (AD) is the most common form of dementia in people with Down Syndrome (DS). Acetylcholine is a chemical found in the brain that has an important role in memory, attention, reason and language. Rivastigmine is a “pseudo-irreversible” inhibitor of acetylcholinesterase, which is thought to maintain levels of acetylcholine. Rivastigmine can improve cognitive function and slow the decline of AD in the general population over time. It is important to note that people with DS tend to present with AD at a much younger age than the normal population as well as having subtle differences in physiology (e.g. metabolism and heart rate) and may therefore have different requirements from the general population.

Objectives

To determine the effectiveness and safety of rivastigmine for people with DS who develop AD.

Search methods

CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS, SCI, SSCI and the NRR were searched up to October 2008. We contacted the manufacturers of rivastigmine as well as experts in the field, to ask about reports of unpublished or ongoing trials.

Selection criteria

Randomised controlled trials of participants with DS and AD in which treatment with rivastigmine was administered compared with a placebo group.

Data collection and analysis

No study was identified which met inclusion criteria for this review.

Main results

No study was identified which met inclusion criteria for this review.

Authors' conclusions

As there are no included trials, recommendations cannot be made about rivastigmine for AD in DS. Well-designed, adequately powered studies are required.

摘要

背景

Rivastigmine對於唐氏症患者之失智症的治療

阿茲海默氏失智症 (AD) 是在唐氏症 (DS) 患者身上最常見到的失智症。乙醯膽鹼是一種於腦中發現的化學物質,對於記憶力、注意力、邏輯及語言有著重要的角色。Rivastigmine是一種乙醯膽鹼的「假性不可逆」的抑制劑,被認為可以用來維持乙醯膽鹼的濃度。在一般大眾的AD患者,Rivastigmine能夠增進認知功能,減緩隨著時間而造成的退化。重要值得去注意的是,唐氏症患者比起一般大眾來說,較容易在更年輕的年紀表現出阿茲海默氏失智症,同時在生理方面也有細微的差異 (如代謝及心跳速率) ,因此和一般大眾可能有著不同的需求。

目標

本研究的目的在於評估Rivastigmine用於唐氏症併有阿茲海默氏失智症的患者身上的效果及安全性。

搜尋策略

我們搜尋了2008年10月之前的資料庫,包括CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS, SCI, SSCI及NRR。我們並和Rivastigmine的製造廠商及這個領域當中的專家學者聯絡詢問關於未發表的論文,或者正在進行當中的試驗。

選擇標準

我們選擇採用隨機控制試驗,來比較在DS又有AD的受試者身上,使用Rivastigmine或安慰劑的差別。

資料收集與分析

沒有研究符合這個回顧文獻的收案標準。

主要結論

沒有研究符合這個回顧文獻的收案標準。

作者結論

由於並沒有符合的試驗,所以無法做出關於Rivastigmine用於DS而有AD的個案身上的結論。需要的是更完善的設計並有著適當效度的研究。

翻譯人

本摘要由成功大學附設醫院謝佩君翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

Rivastigmine用於唐氏症患者的失智症:Rivastimine被使用於輕度至中度阿茲海默氏失智症而無唐氏症的患者身上是有療效的。然而和一般大眾比較起來,唐氏症患者較易在較輕的年紀便表現有阿茲海默氏失智症,同時在生理上也會有所差異,包括體型大小、代謝及心跳速率,因些有著不同的需求必須考量。這個回顧文獻顯示並沒有使用於唐氏症患者的隨機控制試驗存在。需要的是更進一步的研究來回答這個問題。

Plain language summary

Rivastigmine for dementia in people with Down syndrome

The drug rivastigmine has been reported to have benefits for people with mild to moderate Alzheimer's disease who do not have Down syndrome. However, people with DS tend to present with AD at a much younger age than the general population as well as being physically different in terms of size, metabolism and heart rate, and may therefore have different requirements. This review identified no randomised controlled trials of rivastigmine in people with Down syndrome. Further research is needed.