Evidence-Based Research in Complementary and Alternative Medicine III: Treatment of Patients with Alzheimer's Disease

Abstract

This paper presents the novel domain of evidence-based research (EBR) in the treatment of patients with Alzheimer's disease (AD) from the perspective of traditional medicine and of complementary and alternative medicine. In earlier lectures we have described the process of evidence-based medicine as a methodological approach to clinical practice that is directed to aid clinical decision-making. Here, we present a practical example of this approach with respect to traditional pharmacological interventions and to complementary and alternative treatments for patients with AD.

Scheme 1

Search Process: flow diagram of included and excluded studies. A search for relevant studies was performed using the PubMed database, and subsequently filtered out based on the inclusion/exclusion described. Thirteen reports (12 acetylcholinesterase inhibitors and 1 NMDA antagonist) were included in the best-case study examining pharmacological interventions for AD, and thus evaluated individually on its quality.

Figure 1

Wong Scale-Revised. The Wong Scale-Revised consists of nine questions used to evaluate the quality of a study. Once applied, various scores are generated that determine the validity of the paper based on a scale of 1–3, with 1 = inappropriate, 2 = mediocre, 3 = appropriate. A comprehensive score falls in the range of 9–27 points. Studies whose scores sum a total of 18 or less are rejected while those scoring 19 or over are accepted [modified from (21)].

Figure 2

(A) Results from meta-analysis of ADAS-cognitive outcome (assessment of cognition) for pharmacological interventions (acetylcholinesterase inhibitors versus NMDA antagonists). A meta-analysis was carried out to evaluate the efficacy of AChI and NMDA antagonists in increasing the cognitive performance of patients with Alzheimer's disease, based on ADAS-cognitive scores. All four studies favored the active treatment over placebo. (B) Results from meta-analysis of CIBIC-Plus score (assessment of global performance) for pharmacological interventions best-case study (acetylcholinesterase inhibitors versus NMDA antagonists). A meta-analysis was carried out to evaluate the efficacy of AChI and NMDA antagonists in increasing the global performance of patients with Alzheimer's disease, based on scores obtained from CIBIC-Plus. All three studies favored the active treatment over placebo.

Scheme 2

Search Process: flow diagram of included and excluded studies. A search for relevant studies was performed using the PubMed database, and subsequently filtered out based on the inclusion/exclusion described. Eleven reports (5 Ginkgo biloba, 5 idebneone and 1 alpha-tocopherol) were included in the best-case study examining antioxidants as a treatment for AD, and thus each study was evaluated individually on its quality.

Figure 3

(A) Results from meta-Analysis of ADAS-cognitive scores (assessment of cognitive performance) for a best-case study on complementary and alternative approaches (antioxidants). A meta-analysis was carried out to evaluate the efficacy of antioxidants in increasing the global performance of patients with Alzheimer's disease, as determined by scores from the ADAS-cognitive scale. Three studies on Ginkgo biloba favored treatment, whereas one study on idebenone favored the placebo. (B) Results from meta-analysis of SKT scores (assessment of cognitive performance) for a best-case study on complementary and alternative approaches (antioxidants). Using data from the SKT, a meta-analysis was carried out to evaluate the efficacy of antioxidants in increasing the global performance of patients with AD. All three studies favored the use of antioxidants to increase cognitive ability in AD patients.