Difference between revisions of "Xu2019"
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| − | '''<span style="font-size:18.0pt"><span style="font-family: | + | '''<span style="font-size:18.0pt"><span style="font-family:">The addition of hyperbaric oxygen to treatment with donepezil did not importantly improve cognitive outcomes in patients with vascular dementia.</span></span>''' |
| − | <span style="font-size:large;">'''<span style="font-family: | + | <span style="font-size:large;">'''<span style="font-family:">Clinical bottom line:</span>'''</span> |
| − | #<span style="font-size:large;"><span style="font-family: | + | #<span style="font-size:large;"><span style="font-family:">Hyperbaric resulted in improved Mini Mental State Examination (MMSE) scores</span></span> |
| − | #<span style="font-size:large;"><span style="font-family: | + | #<span style="font-size:large;"><span style="font-family:">Hyperbaric also resulted in increased serum humanin levels which may have a correlation with cognitive function</span></span> |
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| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">Citation/s:</span>'''<span style="font-family:">1. Xu Y, Wang Q, Qu Z, Yang J, Zhang X, Zhao Y. Protective effect of hyperbaric oxygen therapy on cognitive function in patients with vascular dementia. Cell Transplantation 2019; 28(8):1071-1075.</span></span> |
| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">Lead author’s name and fax:</span>'''<span style="font-family:">Y. Zhao : zhao_yuwu2005@126.com</span></span> |
| − | '''<span style="font-family: | + | '''<span style="font-family:">Three-part Clinical Question:</span>'''<span style="font-size: medium; font-family:">In patients with vascular dementia, does treatment with hyperbaric oxygen and donepezil in comparison to donepezil alone result in an improvement in cognitive function?</span> |
| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">Search Terms:</span>'''<span style="font-family:">Vascular dementia; cognitive function; humanin</span></span> |
| − | '''<span style="font-family: | + | '''<span style="font-family:">The Study:</span>'''<span style="font-size: medium; font-family:">Non-blinded non-concealed randomised controlled trial with intention-to-treat.</span> |
| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">The Study Patients:</span>'''<span style="font-family:">Patients who met DSM-5 diagnostic criteria for vascular dementia. Patients with other forms of dementia, mental illness, brain trauma and severe systemic diseases were excluded.</span></span> |
| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">Control group</span>'''<span style="font-family:">(N = 79; 79 analysed): Donepezil hydrochloride 5mg daily.</span></span> |
| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">Experimental group</span>'''<span style="font-family:">(N = 79; 79 analysed): Donepezil hydrochloride 5mg daily and HBO 100% O2 at 2.0 ATA for 60 minutes 5 days per week for 12 weeks for a total of 60 sessions.</span></span> |
| − | '''<span style="font-family: | + | '''<span style="font-family:">The Evidence:</span>''' |
{| class="MsoTableGrid" style="width:450.8pt; border-collapse:collapse; border:solid windowtext 1.0pt" width="0" | {| class="MsoTableGrid" style="width:450.8pt; border-collapse:collapse; border:solid windowtext 1.0pt" width="0" | ||
|- style="height:21.55pt" | |- style="height:21.55pt" | ||
| − | | rowspan="2" style="width:63.55pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family: | + | | rowspan="2" style="width:63.55pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family:">Measure</span>'''</span></span></p> |
| − | | colspan="2" style="width:92.15pt; border:solid windowtext 1.0pt; border-left:none" width="123" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family: | + | | colspan="2" style="width:92.15pt; border:solid windowtext 1.0pt; border-left:none" width="123" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family:">Control group</span>'''</span></span></p> |
| − | | colspan="2" style="width:4.0cm; border:solid windowtext 1.0pt; border-left:none" width="151" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family: | + | | colspan="2" style="width:4.0cm; border:solid windowtext 1.0pt; border-left:none" width="151" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family:">HBOT group</span>'''</span></span></p> |
| − | | rowspan="2" style="width:77.95pt; border:solid windowtext 1.0pt; border-left:none" width="104" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family: | + | | rowspan="2" style="width:77.95pt; border:solid windowtext 1.0pt; border-left:none" width="104" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family:">Difference</span>'''</span></span></p> |
| − | | rowspan="2" style="width:103.75pt; border:solid windowtext 1.0pt; border-left:none" width="138" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family: | + | | rowspan="2" style="width:103.75pt; border:solid windowtext 1.0pt; border-left:none" width="138" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:21.55pt">'''<span style="font-family:">95% CI</span>'''</span></span></p> |
|- style="height:33.5pt" | |- style="height:33.5pt" | ||
| − | | style="width:42.55pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="57" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family: | + | | style="width:42.55pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="57" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family:">Mean value</span>'''</span></span></p> |
| − | | style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family: | + | | style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family:">SD</span>'''</span></span></p> |
| − | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family: | + | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family:">Mean value</span>'''</span></span></p> |
| − | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family: | + | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:33.5pt">'''<span style="font-family:">SD</span>'''</span></span></p> |
|- style="height:15.5pt" | |- style="height:15.5pt" | ||
| style="width:63.55pt; border:solid windowtext 1.0pt; border-top:none" width="85" | | | style="width:63.55pt; border:solid windowtext 1.0pt; border-top:none" width="85" | | ||
| − | <span style="font-size:medium;"><span style="height:15.5pt">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="height:15.5pt">'''<span style="font-family:">MMSE</span>'''</span></span> |
| − | | style="width:42.55pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="57" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:42.55pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="57" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">20.1</span></span></span></p> |
| − | | style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">2.8</span></span></span></p> |
| − | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">21.7</span></span></span></p> |
| − | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">2.4</span></span></span></p> |
| − | | style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">1.6</span></span></span></p> |
| − | | style="width:103.75pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="138" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:103.75pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="138" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">-0.4 to 3.7</span></span></span></p> |
|- style="height:15.5pt" | |- style="height:15.5pt" | ||
| style="width:63.55pt; border:solid windowtext 1.0pt; border-top:none" width="85" | | | style="width:63.55pt; border:solid windowtext 1.0pt; border-top:none" width="85" | | ||
| − | <span style="font-size:medium;"><span style="height:15.5pt">'''<span style="font-family: | + | <span style="font-size:medium;"><span style="height:15.5pt">'''<span style="font-family:">Humanin</span>'''</span></span> |
| − | | style="width:42.55pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="57" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:42.55pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="57" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">143.1</span></span></span></p> |
| − | | style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:49.6pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">8.6</span></span></span></p> |
| − | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">146.5</span></span></span></p> |
| − | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">9.4</span></span></span></p> |
| − | | style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">3.4</span></span></span></p> |
| − | | style="width:103.75pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="138" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family: | + | | style="width:103.75pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="138" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="font-size:medium;"><span style="height:15.5pt"><span style="font-family:">-22.1 to 28.9</span></span></span></p> |
|} | |} | ||
| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">Comments:</span>'''</span> |
| − | #<span style="font-size:medium;"><span style="font-family: | + | #<span style="font-size:medium;"><span style="font-family:">The authors’ treated MMSE scores as continuous and normally distributed – this is probably not appropriate. Their analysis suggests the difference between means is statistically significant (P<0.001), but we cannot confirm that on our analysis. Neither can we confirm the significant humanin analysis. The reason for the discrepancy is unclear.</span></span> |
| − | #<span style="font-size:medium;"><span style="font-family: | + | #<span style="font-size:medium;"><span style="font-family:">The authors identified a correlation between MMSE scores and humanin levels after adjusting for confounding factors. Humanin has no definitive clinical application currently.</span></span> |
| − | #<span style="font-size:medium;"><span style="font-family: | + | #<span style="font-size:medium;"><span style="font-family:">No blinding means there is a possibility of bias in this study through participation in the HBO arm.</span></span> |
| − | #<span style="font-size:medium;"><span style="font-family: | + | #<span style="font-size:medium;"><span style="font-family:">Donezepil is a cholinesterase inhibitor used to treat Alzheimer’s Disease (not vascular dementia).</span></span> |
| − | #<span style="font-size:medium;"><span style="font-family: | + | #<span style="font-size:medium;"><span style="font-family:">Outc0omes are very short-term (2 days after treatment completion.</span></span> |
| | ||
| − | <span style="font-size:medium;">'''<span style="font-family: | + | <span style="font-size:medium;">'''<span style="font-family:">Appraised by:</span>'''<span style="font-family:">Hannah Rubinstein h.rubinstein@student.unsw.edu.au; Monday, 29 November 2021</span></span> |
| − | '''<span style="font-family: | + | '''<span style="font-family:">Kill or Update By:</span>'''<span style="font-size: medium; font-family:">November 2025</span> |
| + | <p style="text-align: center;"> </p> <p style="text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</p> <p style="text-align: center;"><span style="font-size:xx-large;">[[Neuro_-_miscellaneous|BACK]]</span></p> | ||
Revision as of 00:54, 21 December 2021
The addition of hyperbaric oxygen to treatment with donepezil did not importantly improve cognitive outcomes in patients with vascular dementia.
Clinical bottom line:
- Hyperbaric resulted in improved Mini Mental State Examination (MMSE) scores
- Hyperbaric also resulted in increased serum humanin levels which may have a correlation with cognitive function
Citation/s:1. Xu Y, Wang Q, Qu Z, Yang J, Zhang X, Zhao Y. Protective effect of hyperbaric oxygen therapy on cognitive function in patients with vascular dementia. Cell Transplantation 2019; 28(8):1071-1075.
Lead author’s name and fax:Y. Zhao : zhao_yuwu2005@126.com
Three-part Clinical Question:In patients with vascular dementia, does treatment with hyperbaric oxygen and donepezil in comparison to donepezil alone result in an improvement in cognitive function?
Search Terms:Vascular dementia; cognitive function; humanin
The Study:Non-blinded non-concealed randomised controlled trial with intention-to-treat.
The Study Patients:Patients who met DSM-5 diagnostic criteria for vascular dementia. Patients with other forms of dementia, mental illness, brain trauma and severe systemic diseases were excluded.
Control group(N = 79; 79 analysed): Donepezil hydrochloride 5mg daily.
Experimental group(N = 79; 79 analysed): Donepezil hydrochloride 5mg daily and HBO 100% O2 at 2.0 ATA for 60 minutes 5 days per week for 12 weeks for a total of 60 sessions.
The Evidence:
Measure |
Control group |
HBOT group |
Difference |
95% CI | ||
Mean value |
SD |
Mean value |
SD | |||
|
MMSE |
20.1 |
2.8 |
21.7 |
2.4 |
1.6 |
-0.4 to 3.7 |
|
Humanin |
143.1 |
8.6 |
146.5 |
9.4 |
3.4 |
-22.1 to 28.9 |
Comments:
- The authors’ treated MMSE scores as continuous and normally distributed – this is probably not appropriate. Their analysis suggests the difference between means is statistically significant (P<0.001), but we cannot confirm that on our analysis. Neither can we confirm the significant humanin analysis. The reason for the discrepancy is unclear.
- The authors identified a correlation between MMSE scores and humanin levels after adjusting for confounding factors. Humanin has no definitive clinical application currently.
- No blinding means there is a possibility of bias in this study through participation in the HBO arm.
- Donezepil is a cholinesterase inhibitor used to treat Alzheimer’s Disease (not vascular dementia).
- Outc0omes are very short-term (2 days after treatment completion.
Appraised by:Hannah Rubinstein h.rubinstein@student.unsw.edu.au; Monday, 29 November 2021
Kill or Update By:November 2025
