Abstract
Background: Vascular dementia (VD) is a common type of disease in the elderly. Numerous clinical trials have suggested that hyperbaric oxygen is an effective and safe complementary therapy for aging-related disorders. However, there is no reliable systematic evidence regarding hyperbaric oxygen therapy (HBOT) for the treatment of VD. Therefore, we performed a meta-analysis to evaluate the clinical efficacy and safety of HBOT in treating VD.Methods: We methodically retrieved the clinical studies from eight databases (PubMed, Cochrane Library, Embase, Web of Science, Sino-Med, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and WanFang) from their inception to November 2018. RevMan 5.3.5 was used for quality assessment and data analysis. Stata 15.1 was employed for publication bias detection and sensitivity analysis.Results: Twenty-five randomized clinical trials (RCTs) involving 1,954 patients met our inclusion criteria. These articles researched the HBOT + oxiracetam + conventional therapy (CT) vs. oxiracetam + CT (n = 13), HBOT + butylphthalide +CT vs. butylphthalide + CT (n = 5), HBOT + donepezil + CT vs. donepezil + CT (n = 4), HBOT + nicergoline + CT vs. nicergoline + CT (n = 2) and HBOT + CT vs. CT (n = 1). The results indicated that additional HBOT strikingly improved the Mini-Mental State Examination (MMSE) (MD = 4.00; 95% CI = 3.28–4.73; P < 0.00001), activities of daily living (ADL) (MD = −5.91; 95% CI = −6.45, −5.36; P < 0.00001) and ADL by Barthel index (BADL) (MD = 13.86; 95% CI = 5.63–22.10; P = 0.001) and increased the total efficacy rate (TEF) (OR = 4.84, 95% CI = 3.19–7.33, P < 0.00001). The adverse events rates were not statistically significant between the HBOT and CT groups (OR = 0.85, 95% CI = 0.26–2.78, P = 0.79).Conclusion: In view of the effectiveness and safety of HBOT, the present meta-analysis suggested that HBOT can be recommended as an effective and safe complementary therapy for the treatment of VD.Protocol Registration: PROSPERO (ID: CRD42019117178). Available online at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42019117178.
Highlights
Vascular dementia (VD), with clinical manifestations of cognitive disorder, cerebrovascular pathologies and progressive memory decline (O’Brien and Thomas, 2015), leads to more than 20% of all aphronesia cases worldwide and is second only to Alzheimer’s disease (AD) (Gorelick et al, 2011)
Group and the control group, including hyperbaric oxygen therapy (HBOT)+conventional therapy (CT)+ oxiracetam vs. CT+ oxiracetam (13 RCTs), HBOT+CT+ butylphthalide vs. CT+ butylphthalide (5 RCTs), HBOT+ CT+ donepezil vs. CT+ donepezil (4 RCTs), HBOT+ CT+ nicergoline vs. CT +nicergoline (2 RCTs), and HBOT+CT vs. CT (1 RCT)
The results showed the participants in the HBOT group (n = 267, 27.2%) had a statistically significant higher BADL score than patients in the conventional group (n = 270, 27.8%) but with substantial heterogeneity (MD = 13.86; 95% confidence intervals (CI) = 5.63–22.10; P = 0.001; heterogeneity: P < 0.00001, χ 2 = 175.49, I2 = 97%)
Summary
Vascular dementia (VD), with clinical manifestations of cognitive disorder, cerebrovascular pathologies and progressive memory decline (O’Brien and Thomas, 2015), leads to more than 20% of all aphronesia cases worldwide and is second only to Alzheimer’s disease (AD) (Gorelick et al, 2011). VD mainly affects patients in developing countries due to poorer health care and control of cardiovascular risk factors. Transient ischemic attack caused by stroke or acute cerebral infarction, which does enormous damage to cerebral vessels, is regarded as the major pathogenic factor of VD (Kalaria et al, 2016), and cerebrovascular diseases (CVDs) leading to lower cognitive performance for both VD and AD, and this has been widely accepted (O’Brien and Markus, 2014). Numerous clinical trials have suggested that hyperbaric oxygen is an effective and safe complementary therapy for aging-related disorders. We performed a meta-analysis to evaluate the clinical efficacy and safety of HBOT in treating VD
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