| 摘要: | 台灣失智症協會民國100年進行的全國失智症盛行率調查顯示隨著人口老化，失智人口明顯增加，相關照護將成為下一代沉重的負擔。退化性失智症中又以阿茲海默症最為常見。memantine是目前全民健康保險唯一給付中度至重度的阿茲海默症用藥，主要被發現可以減緩患者認知、生活等功能惡化，於失智症的治療扮演著重要的角色。嚴重的失智症所耗用掉的醫療資源也相對較多，照護者的負擔也相對較重，而藉由分析觀察並確認此藥物療效相關的研究，希望得以讓memantine得到更佳的運用與發揮。本研究首先進行文獻系統回顧(systematic review)，進入MEDLINE、PubMed等大型文獻資料庫以關鍵字memantine、Alzheimer進行系統搜尋，收錄1999.01.01 - 2014.03.31間發表，有關memantine對阿茲海默症療效相關的文章。接著將篩選後的文章用Excel建檔編碼，定義相關的變項係數。最後以R軟體做統合分析(meta-analysis)得結果，並加以討論。前後總計搜尋Ovid Medline、PubMed兩個文獻資料庫，最後合計納入分析之臨床試驗文獻共11篇。以R軟體得到療效的統合分析數據與結果後發現memantine對於阿茲海默症的認知改善在MMSE、SIB的測量值改變量具有統計意義，但是除了MMSE的部分外，其餘分析文獻的研究間皆具高度異質性。就療效而言memantine在中度至重度的阿茲海默症與過去研究一樣在統計上得到顯著的改善效果，但並不表示在臨床實證上具有顯著意義。目前的研究對於療效的評估與表現尚未有共同一致的看法，阿茲海默症目前也並無更好的替代藥物，未來仍端賴有更多的研究與數據來進行更詳細的統計分析與探討。
Conducted by Taiwan Alzheimer's Disease (AD) Associated in 2011, a nationwide research on the prevalence of dementia has indicated that the domestic people with dementia are considerably increasing in conjunction with the rapidly aging general population. Accordingly, the burden of health care for the illness is expected to be extraordinarily crippling. Currently, memantine is the only medication reimbursed by Taiwan's National Health Insurance for moderate to severe AD, the most common degenerative dementia. It is predominantly because that memantine has been demonstrated to slow the decline in cognitive and functional status and so played a vital role in the treatment for AD. Health care utilization and costs are higher for moderate to severe dementia, which represents a more onerous burden for the caregivers. The purpose of this study is to review and analyze clinical trials concerning the efficacy of memantine for AD, and then to help interpret these previous studies towards more sophisticated utilization of the medicine. Systemic review was first conducted by searching the large databases, including MEDLINE and PubMed, with the keywords "memantine" and "Alzheimer" for articles published from 01.01.1999 to 31.03.2014, regarding the efficacy of memantine for AD. Subsequently, the selected articles were filed and encoded with EXCEL, followed by defining relevant variables. Thereafter, the meta-analysis was conducted with statistical software R, and the result was interpreted and discussed in the following sections. Overall, eleven clinical trial reports, sorted out from Ovid Medline and PubMed, were considered relevant and included in this meta-analysis. Meta-analysis of the efficacy of memantine for AD showed a significant improvement in the cognitive function, determined by the significant differences from the baseline in the MMSE (mini-mental state examination) and SIB (severe impairment battery) scores. While memantine demonstrated a consistent benefit in terms of MMSE score, high heterogeneity existed in other conditions among the individual trials. The result of this meta-analysis indicated a statistically significant benefit of memantine for moderate to severe AD as previous studies concerning its efficacy. However, this does not ensure the clinical effectiveness of memantine to the same extent. So far, there is no consensus on how to evaluate or quantify the efficacy of memantine among different trials. Moreover, there is no available cure or a better alternative to memantine for AD. Therefore, to enable more detailed statistical analysis and enhanced utilization of memantine, it is crucial to carry out more researches for efficacy and cost-effectiveness of memantine in managing AD. |
