Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Intranasal Insulin for Alzheimer's Disease and Amnestic Mild Cognitive Impairment: Systematic Review and Meta-analysis

알츠하이머병 및 건망증 경도 인지장애의 인슐린 비강투여: 체계적 문헌 고찰 및 메타분석

  • Alnajjar, Sarah (Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University) ;
  • Jin, Hye Kyung (College of Pharmacy, Ewha Womans University) ;
  • Kang, Ji Eun (Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University) ;
  • Park, So Hyun (Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University) ;
  • Rhie, Sandy Jeong (Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University)
  • 사라 알라자르 (이화여자대학교 대학원 생명.약학부) ;
  • 진혜경 (이화여자대학교 대학원 약학과) ;
  • 강지은 (이화여자대학교 대학원 생명.약학부) ;
  • 박소현 (이화여자대학교 대학원 생명.약학부) ;
  • 이정연 (이화여자대학교 대학원 생명.약학부)
  • Received : 2017.09.20
  • Accepted : 2017.09.24
  • Published : 2017.09.30
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Abstract

Background: There is recent evidence that insulin resistance is responsible for increasing the risk of developing cognitive dysfunction. To systematically review the influence of intranasal insulin treatment on the cognitive function in Alzheimer's disease patients. Methods: Randomized controlled trials comparing the cognitive effects of intranasal insulin therapy in Alzheimer's disease patients with controlled interventions were retrieved from Pubmed, Medline, Embase and Cochrane library. Meta-analysis was conducted on the cognitive measurements with a subgroup analysis by dose, gender and apolipoprotein E allele 4 (ApoE ${\varepsilon}4$) status. Results: Seven randomized controlled trials were eligible for inclusion. Intranasal insulin had a positive influence on the cognitive 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 significant improvement 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 ${\varepsilon}4$ positive patients showed a significant decline in cognitive function as compared to ApoE ${\varepsilon}4$ positive 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 ${\varepsilon}4$ negative patients. Gender had no influence on the cognitive outcomes. Conclusion: The results indicate that intranasal insulin may have beneficial effect in improving the cognitive function in Alzheimer's disease patients.

Keywords

References

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