Intranasal Insulin for Alzheimer's Disease and Amnestic Mild Cognitive Impairment: Systematic Review and Meta-analysis
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Background: There is recent evidence that insulin resistance is responsible for increasing the risk of developing cognitivedysfunction. To systematically review the influence of intranasal insulin treatment on the cognitive function in Alzheimer’s diseasepatients. Methods: Randomized controlled trials comparing the cognitive effects of intranasal insulin therapy in Alzheimer’s diseasepatients with controlled interventions were retrieved from Pubmed, Medline, Embase and Cochrane library. Meta-analysis wasconducted on the cognitive measurements with a subgroup analysis by dose, gender and apolipoprotein E allele 4 (ApoE ε4)status. Results: Seven randomized controlled trials were eligible for inclusion. Intranasal insulin had a positive influence on thecognitive function as compared to placebo without a statistical significance (standardized mean difference; SMD = 0.109; 95%confidence interval; CI -0.04 to 0.26; P=0.14). In subgroup analysis, a 20 IU dose of intranasal insulin induced a significantimprovement in cognitive function (SMD = 0.14; 95% CI 0.05 to 0.24; P=0.004), but 40 IU did not show this effect (SMD = -0.01; 95%CI -0.11 to 0.09; P=0.82). ApoE ε4 positive patients showed a significant decline in cognitive function as compared to ApoE ε4positive patients in the control group (SMD = -0.213; 95% CI -0.38 to -0.04; P=0.015). Such an effect was not apparent in ApoE ε4negative patients. Gender had no influence on the cognitive outcomes. Conclusion: The results indicate that intranasal insulin mayhave beneficial effect in improving the cognitive function in Alzheimer’s disease patients.
Abstract
Background: There is recent evidence that insulin resistance is responsible for increasing the risk of developing cognitivedysfunction. To systematically review the influence of intranasal insulin treatment on the cognitive function in Alzheimer’s diseasepatients. Methods: Randomized controlled trials comparing the cognitive effects of intranasal insulin therapy in Alzheimer’s diseasepatients with controlled interventions were retrieved from Pubmed, Medline, Embase and Cochrane library. Meta-analysis wasconducted on the cognitive measurements with a subgroup analysis by dose, gender and apolipoprotein E allele 4 (ApoE ε4)status. Results: Seven randomized controlled trials were eligible for inclusion. Intranasal insulin had a positive influence on thecognitive function as compared to placebo without a statistical significance (standardized mean difference; SMD = 0.109; 95%confidence interval; CI -0.04 to 0.26; P=0.14). In subgroup analysis, a 20 IU dose of intranasal insulin induced a significantimprovement in cognitive function (SMD = 0.14; 95% CI 0.05 to 0.24; P=0.004), but 40 IU did not show this effect (SMD = -0.01; 95%CI -0.11 to 0.09; P=0.82). ApoE ε4 positive patients showed a significant decline in cognitive function as compared to ApoE ε4positive patients in the control group (SMD = -0.213; 95% CI -0.38 to -0.04; P=0.015). Such an effect was not apparent in ApoE ε4negative patients. Gender had no influence on the cognitive outcomes. Conclusion: The results indicate that intranasal insulin mayhave beneficial effect in improving the cognitive function in Alzheimer’s disease patients.
참고문헌 (30)
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