Title: Efficacy and safety of cholinesterase inhibitors and memantine in cognitive impairment in Parkinson's disease, Parkinson's disease dementia, and dementia with Lewy bodies: systematic review with meta-analysis and trial sequential analysis Wang HF, Yu JT, Tang SW, Jiang T, Tan CC, Meng XF, Wang C, Tan MS, Tan L Ref: Journal of Neurology Neurosurg Psychiatry, 86:135, 2015 : PubMed
OBJECTIVE: Recently, several large randomised controlled trials about the treatments of cognitive impairment or dementia due to Parkinson's disease (CIND-PD or PDD) and dementia with Lewy bodies (DLB) were completed. Here, we systematically reviewed the studies (including the recent reports) to provide updated evidence for the treatments of CIND-PD, PDD and DLB. METHODS: We searched Cochrane Dementia and Cognitive Improvement Group Specialised Register, Pubmed, Embase, and other sources for eligible trials. We selected global impression and cognitive function as primary efficacy outcomes, and dropouts and adverse events as safety outcomes. Furthermore, Meta-analysis and trial sequential analysis (TSA) were used here. RESULTS: Ten trials were included in this study. Cholinesterase inhibitors and memantine produced small global efficacy on clinicians' global impression of change (CGIC), from a weighted mean difference of -0.40 (95% CI -0.77 to -0.03) to -0.65 (95% CI -1.28 to -0.01); however, cholinesterase inhibitors but not memantine significantly improved cognition on Mini-Mental State Examination (MMSE), from 1.04 (95% CI 0.43 to 1.65) to 2.57 (95% CI 0.90 to 4.23). Additionally, both of them had good safety outcomes, although rivastigmine showed an increased risk on adverse events than placebo (risk ratio, RR 1.19, TSA adjusted 95% CI 1.04 to 1.36), these events were usually mild or moderate, and the risk disappeared on serious adverse events. CONCLUSIONS: Cholinesterase inhibitors and memantine slightly improve global impression; however, only cholinesterase inhibitors enhance cognitive function. Besides, all the drugs have good safety outcomes. But the limited trials precluded the generalisation of these outcomes.
        
Title: Pharmacological treatment of neuropsychiatric symptoms in Alzheimer's disease: a systematic review and meta-analysis Wang J, Yu JT, Wang HF, Meng XF, Wang C, Tan CC, Tan L Ref: Journal of Neurology Neurosurg Psychiatry, 86:101, 2015 : PubMed
BACKGROUND: A wide variety of pharmacological agents are used in the management of neuropsychiatric symptoms, which are common in Alzheimer's disease (AD), but results from randomised controlled trials (RCTs) on the efficacy and safety of these agents are conflicting. OBJECTIVES: To quantify the efficacy and safety of pharmacological treatment on neuropsychiatric symptoms in AD patients. METHODS: Systematic review and meta-analysis of RCTs comparing pharmacological agents with placebo on Neuropsychiatric Inventory (NPI) and safety outcomes in AD patients with neuropsychiatric symptoms. RESULTS: Cholinesterase inhibitors (ChEIs) and atypical antipsychotics improved NPI total scores (ChEIs: standardised mean difference (SMD) -0.12; 95% CI -0.23 to -0.02; atypical antipsychotics: SMD -0.21; 95% CI -0.29 to -0.12), but antidepressants (95% CI -0.35 to 0.37) and memantine (95% CI -0.27 to 0.03) did not. However, ChEIs and atypical antipsychotics increased risk of dropouts due to adverse events (ChEIs: risk ratio (RR) 1.64; 95% CI 1.12 to 2.42; atypical antipsychotics: RR 2.24; 95% CI 1.53 to 3.26) and on incidence of adverse events (ChEIs: RR 1.08; 95% CI 1.01 to 1.17; atypical antipsychotics: RR 1.17; 95% CI 1.05 to 1.31). For typical antipsychotics, no study was included. CONCLUSIONS: ChEIs and atypical antipsychotics could improve neuropsychiatric symptoms in AD patients, but with bad safety outcomes.
        
Title: Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis Tan CC, Yu JT, Wang HF, Tan MS, Meng XF, Wang C, Jiang T, Zhu XC, Tan L Ref: J Alzheimers Dis, 41:615, 2014 : PubMed
Background: The role of currently available drugs for Alzheimer's disease (AD) has been controversial, with some national formularies restricting their use, and health economists questioning whether the small clinical effects are economically worthwhile. Objective: To estimate the efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of AD. Methods: Double-blind, placebo-controlled, with random assignment to a cholinesterase inhibitor or memantine trials were included into the pooled studies. Results: Cognitive effects were significant for all drugs, ranging from a -1.29 points mean difference (95% CI -2.30 to -0.28) in the 20 mg daily memantine trials to -3.20 points (95% CI -3.28 to -3.12) in the 32 mg daily galantamine group. Only memantine had no effect on the Clinicians' Global Impression of Change scale. No behavioral benefits were observed, except for -2.72 (95% CI -4.92 to -0.52) in the 10 mg daily donepezil group and -1.72 (95% CI -3.12 to -0.33) for 24 mg daily galantamine trial. Only 5 mg daily donepezil had no effect on the function outcome. Compared with placebo, more dropouts and adverse events occurred with the cholinesterase inhibitors, but not with memantine. Conclusions: Cholinesterase inhibitors and memantine are able to stabilize or slow decline in cognition, function, behavior, and global change.
        
Title: [Therapeutic effects of benthiactzine against respiratory failure induced by cholinesterase inhibitor in rats] Mo C, Wang RH, Meng XF, Long CL, Wang H Ref: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, 21:652, 2009 : PubMed
OBJECTIVE: To investigate the therapeutic effects of benthiactzine against respiratory failure induced by cholinesterase inhibitor dimethyl dichloro-vinyl phosphate (DDVP) in rats. METHODS: Forty-five male Wistar rats were divided into five groups randomly: control group, model group, and benthiactzine 0.5, 1.0, 2.0 mg/kg treatment groups (each n=9). Rats were treated with DDVP by intraperitoneal injection to reproduce respiratory failure model. The symptoms, respiratory rate (RR), blood gas analysis, electrolyte and plasma superoxide dismutase (SOD), malondialdehyde (MDA) and the pathological changes were observed before poisoning, during respiratory failure, and in different periods after the treatment. RESULTS: In rats with respiratory failure induced by DDVP, cyanosis and convulsion occurred in all groups. The success rates in three benthiactzine groups were 66.7% (6/9), 77.8% (7/9) and 88.9% (8/9). The rats of benthiactzine treatment groups recovered in 1-5 minutes after treatment and returned to normal state in 30 minutes. RR also returned to normal in 30 minutes. When respiratory failure occurred, arterial oxygen partial pressure (PaO2), arterial oxygen saturation (SaO2) and plasma SOD were decreased, plasma MDA was increased, and mixed acidosis was found. Thirty minutes after the treatment of benthiactzine, all above parameters in three groups returned to normal (all P<0.01). In respiratory failure rats, pathological examination of lung tissue revealed dilatation of pulmonary vessels with aggregation of erythrocytes, widening of alveolar space with presence of red blood cells in alveoli with heavy infiltration of inflammatory cells, and pulmonary edema and hemorrhage. The lungs of rats treated with benthiactzine showed less intense pathological changes. CONCLUSION: The new medicine against poisoning benthiactzine can be a favourable drug against respiratory failure induced by organophosphorus pesticides.
A 2860-bp cDNA was isolated from a human fetal brain cDNA library by high throughput cDNA sequencing, which encodes a putative protein with 186 amino acids. The putative protein shares 90.7% identity with rat pBOG (3403163) and shares 93.4% identity with human RBBP9 (NP_006597.1). A conserved RB binding domain, L x C x E, located between residue 63 and 68 was recognized. Therefore, it was named RBBP10. Mapviewer analysis locates it on human chromosome 20q11.22. RBBP10 spans about 9.6 kb of the genome and consists of six exons and five introns. RT-PCR revealed that the gene was expressed widely in various human tissues, and the expression level is somewhat higher in tumor tissues than in normal tissues. But subsequent sequencing analysis did notfound any mutation of this in tumor tissues. The COS 7 cell transfected with the ORF of RBBP10 showed that the protein was distributed both in the cytoplasm and in the nucleus. Our results suggest that RBBP10 is the orthologue of the rat BOG gene (AF025819) and a paralogue of human RBBP9 (AF039564).