{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:51:49Z","timestamp":1790776309568,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,9,29]],"date-time":"2017-09-29T00:00:00Z","timestamp":1506643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000190","name":"University of Alberta","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000190","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003579","name":"University of Toronto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003579","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2018,1]]},"abstract":"\n Background\/Objectives<\/jats:title>\n \n To examine the comparative effectiveness and safety of cognitive enhancers for Alzheimer's disease (\n AD<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n \n Systematic review and Bayesian network metaanalysis (\n NMA<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n \n MEDLINE<\/jats:styled-content>\n ,\n EMBASE<\/jats:styled-content>\n , Cochrane Library,\n CINAHL<\/jats:styled-content>\n , Ageline (inception\u2013March 2016).\n <\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Individuals with\n AD<\/jats:styled-content>\n in randomized controlled trials (\n RCT<\/jats:styled-content>\n s), quasi\u2010\n RCT<\/jats:styled-content>\n s, and nonrandomized studies.\n <\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Any combination of donepezil, rivastigmine, galantamine, or memantine.<\/jats:p>\n <\/jats:sec>\n \n Measurements<\/jats:title>\n Two reviewers independently screened titles, abstracts, and full\u2010texts; abstracted data; and appraised risk of bias.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Twenty thousand three hundred forty\u2010three citations were screened, and 142 studies were included (110\n RCT<\/jats:styled-content>\n s, 21 non\u2010\n RCT<\/jats:styled-content>\n s, 11 cohort studies).\n NMA<\/jats:styled-content>\n found that donepezil (Mini\u2010Mental State Examination: mean difference (\n MD<\/jats:styled-content>\n ) = 1.39, 95% credible interval (CrI) = 0.53\u20132.24), donepezil+memantine (2.59, 95% CrI = 0.12\u20134.98), and transdermal rivastigmine (2.02, 95% CrI = 0.02\u20134.08) improved cognition more than placebo.\n NMA<\/jats:styled-content>\n found that donepezil (Alzheimer's Disease Assessment Scale\u2013cognitive:\n MD<\/jats:styled-content>\n = \u22123.29, 95% CrI = \u22124.57 to \u22121.99) and galantamine (\n MD<\/jats:styled-content>\n = \u22122.13, 95% CrI = \u22123.91 to \u22120.27) improved cognition more than placebo.\n NMA<\/jats:styled-content>\n found that donepezil+memantine (\n MD<\/jats:styled-content>\n = \u22125.23, 95% CrI = \u22128.72 to \u22121.56) improved behavior more than placebo.\n NMA<\/jats:styled-content>\n found that donepezil (\n MD<\/jats:styled-content>\n = \u22120.32, 95% CrI = \u22120.46 to \u22120.19), donepezil+memantine (\n MD<\/jats:styled-content>\n = \u22120.57, 95% CrI = \u22120.95 to \u22120.21), oral rivastigmine (\n MD<\/jats:styled-content>\n = \u22120.38, 95% CrI = \u22120.56 to \u22120.17), and galantamine (\n MD<\/jats:styled-content>\n = \u22123.79, 95% CrI = \u22126.98 to \u22120.59) improved global status more than placebo.\n NMA<\/jats:styled-content>\n found that galantamine decreased the odds of mortality (odds ratio = 0.56, 95% CrI = 0.36\u20130.87). No agent increased risk of serious adverse events, falls, or bradycardia. Some increased risk of headache (oral rivastigmine), diarrhea (oral rivastigmine, donepezil), nausea (oral rivastigmine, donepezil, galantamine), and vomiting (oral rivastigmine, donepezil, galantamine).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n An exhaustive review of the literature involving 142 studies demonstrated that cognitive enhancers in general have minimal effects on cognition according to minimal clinically important difference and global ratings. The drugs appear safe, but this must be interpreted cautiously because trial participants may have less comorbidity and fewer adverse effects than those treated with these drugs in clinical practice.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.15069","type":"journal-article","created":{"date-parts":[[2018,1,22]],"date-time":"2018-01-22T10:56:58Z","timestamp":1516618618000},"page":"170-178","source":"Crossref","is-referenced-by-count":120,"title":["Comparative Effectiveness and Safety of Cognitive Enhancers for Treating Alzheimer's Disease: Systematic Review and Network Metaanalysis"],"prefix":"10.1111","volume":"66","author":[{"given":"Andrea C.","family":"Tricco","sequence":"first","affiliation":[{"name":"Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada"},{"name":"Epidemiology Division Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda 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