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Cognitive Enhancers for MCI: No Benefit, Possible Harm
Cognitive enhancers do not improve cognition in patients with mild cognitive impairment (MCI) and, in fact, may do more harm than good, new research suggests.
A systematic review of randomized trials examining the safety and efficacy of cholinesterase inhibitors and memantine in MCI patients showed no significant impact on cognition and higher risk for side effects compared with placebo.
"Our results do not support the use of cognitive enhancers for patients with mild cognitive impairment. These agents were not associated with any benefit and led to an increase in harms," the authors, with principal investigator Sharon Straus, MD, St. Michael's Hospital and the University of Toronto, Canada, write.
The study was published online September 16 in the Canadian Medical Association Journal.
Upswing in Requests for Meds
Recently recognized as a distinct condition, MCI prevalence rates are estimated to range from 3% to 42% and increase with age. It is estimated that annual conversion rates from MCI to dementia range from 3% to 17%, and this increases to between 11% and 33% 2 years after diagnosis.
Strategies to delay progression of MCI are actively being pursued, the researchers note. One potential strategy that has been proposed is the use of cognitive enhancers, agents that are often used to treat symptoms of dementia.
Although cognitive enhancers are not widely available for patients with MCI, they can often be obtained through special authorization, and the researchers note that there is an increasing trend for families of MCI patients to request these drugs, even though their safety and efficacy in this population is uncertain.
To look at the evidence, the researchers conducted a systematic review of randomized, placebo-controlled trials that examined the efficacy and safety of donepezil, rivastigmine, galantamine, or memantine on MCI. Outcomes included cognition, function, behavior, global status, and mortality and harms.
The final review was based on 8 randomized clinical trials. The researchers found no significant effects of cognitive enhancers on cognition or function. In addition, they found higher rates of nausea, diarrhea, vomiting, and headache compared with placebo.
"Patients and their families should consider this information when requesting these medications. Similarly, health care decision-makers may not wish to approve the use of these medications for mild cognitive impairment, because these drugs might not be effective and are likely associated with harm," the researchers write.
Asked by Medscape Medical News to comment on the findings, Maria Carrillo, PhD, Alzheimer's Association vice-president of medical and scientific relations, said that the findings are not surprising but added that a published meta-analysis is valuable.
The findings, she added, highlight the need for "more and better therapies and for the investment and commitment needed to make that happen."
The authors and Dr. Carrillo report no relevant financial relationships.
CMAJ. Published online September 16, 2013. Full article
Medscape Medical News © 2013 WebMD, LLC
Send comments and news tips to news@medscape.net.
Cite this article: Cognitive Enhancers for MCI: No Benefit, Possible Harm. Medscape. Sep 19, 2013.
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