在初级中枢神经系统感染中治疗认知障碍:对药理干预措施的系统审查
Syeda T Rizvi1,2, Jhankhana S Shah1,2, Sarah Shaaya1,2
1University of Toronto, Toronto, ON.
Medicine
|July 14, 2023
概括
药物治疗对中枢神经系统 (CNS) 感染的认知障碍具有有限的有效性,如莱姆病和克鲁茨菲尔德特-雅各布病. 证据质量低,需要改进临床试验方法和结果措施.
科学领域:
- 神经科学是一个神经科学.
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 在初级中枢神经系统 (CNS) 感染中,认知障碍是一个重大问题.
- 目前正在研究药物治疗作为减轻这些障碍的潜在干预措施.
研究的目的:
- 综合关于药物治疗在减少主要中枢神经系统感染的成年人认知障碍的疗效的科学证据.
- 评估用于治疗这些疾病的各种药物类别的证据的确定性.
主要方法:
- 对2021年10月之前发表的实验研究进行了对MEDLINE,Embase和Cochrane数据库的系统搜索.
- 包括的研究是随机对照试验 (RCT) 和非随机研究 (NRS),比较药物治疗与安慰剂或其他治疗方法.
- 用GRADE准则来评估证据的确定性.
主要成果:
- 包括八个RCT和一个NRS,涉及805名患有莱姆病 (LD),简单疹病毒1型 (HSV-1) 或克鲁茨菲尔特-雅各布病 (CJD) 的患者.
- 抗生素在LD患者中显示出一些认知益处; 对于HSV-1的结果不一致; flupirtine maleate改善了CJD的认知得分.
- 纳入的RCT和NRS的质量低至非常低,表明研究结果的确定性很低.
结论:
- 关于抗微生物药物和止痛药在LD,HSV-1和CJD的认知障碍中有效性的证据有限,确定性低.
- 未来的研究应该优先考虑强大的临床试验方法,标准化的结果措施和明确的终点.
- 加强关于试验设计的报告和共识对于推进治疗策略至关重要.
相关概念视频
01:30Cognitive Enhancers: Cholinesterase Inhibitors and NMDA Receptor Antagonists
159
Cognitive enhancers, also known as "smart drugs," are substances used to enhance memory, mental alertness, and concentration. These can be natural or synthetic and improve cognition in conditions like Alzheimer's disease (AD) and other neurodegenerative diseases. Some common examples include caffeine, amphetamines, methylphenidate, modafinil, arecoline, donepezil, vortioxetine, and piracetam. These enhancers work on the principle of synaptic plasticity and altered circuit function.
159
01:22Alzheimer's Disease: Treatment
219
Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...
219
01:26Psychosis: Goals of Pharmacotherapy
170
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
170
01:26Alzheimer's Disease: Overview
525
Alzheimer's Disease (AD) is a continually advancing neurodegenerative disorder, distinguished by escalating memory loss, cognitive dysfunction, and dementia. The disease unfolds in three stages: preclinical, mild cognitive impairment (MCI), and dementia. Its onset is insidious, and the progression gradual, with the cause not well explained by other disorders.
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ...
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ...
525
01:29Drug Delivery: Parenteral Route
633
The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
633
01:28Drug Therapy
73
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
73