Examining the effectiveness of acetylcholinesterase inhibitors and stimulant-based medications for cognitive dysfunction in multiple sclerosis: A systematic review and meta-analysis. (March 2018)

• Record Type: Journal Article
• Authors: Cotter, Jack; Muhlert, Nils; Talwar, Anahita; Granger, Kiri
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 86(2018)
• Page Start: 99
• Page End: 107
• Publication Date: 2018-03
• Subjects: Cognition -- Multiple sclerosis -- Adjunctive pharmacotherapy -- Acetylcholinesterase inhibitors -- Stimulants -- Meta-analysis; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2018.01.006
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: Cognitive deficits are present in up to 70% of people with multiple sclerosis (MS). There are no approved treatments for these difficulties. We examined whether adjunctive pharmacotherapies can improve cognition in MS. Acetylcholinesterase inhibitors offered no significant benefits over placebo. Stimulant-based medications offered no significant benefits over placebo. Abstract: We sought to examine the effectiveness of acetylcholinesterase inhibitors (AChEIs) and stimulant-based medications for improving cognitive performance in patients with multiple sclerosis (MS). An electronic database search was conducted on 25th March 2017. Eligible studies were double-blind, randomised, placebo-controlled trials that examined the efficacy of compounds that act primarily as AChEIs or stimulants (administered daily for ≥1 week) on cognitive outcome measures in patients with MS. Where suitable data was reported, we generated effect sizes and corresponding 95% confidence intervals and performed meta-analyses using random-effects models to investigate the effectiveness of these drug types across cognitive domains. Sixteen trials were included in the systematic review, with eleven trials (N = 734 MS patients) providing sufficient data for meta-analysis. Whilst there was only a limited pool of relatively small trials and a number of different compounds, we found that collectively, both AChEIs (donepezil and rivastigmine) and stimulants (methylphenidate, modafinil, l-amphetamine sulfate and lisdexamfetamine dimesylate) offered no significant benefits over placebo on measures of processing speed, working memory, verbal fluency, verbal memory, visuospatial memory or executive functioning.