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Little evidence that cholinesterase inhibitors prevent progression of mild cognitive impairment to dementia, but they are associated with adverse effects

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Question

Question: How effective and safe are cholinesterase inhibitors for mild cognitive impairment?

Outcomes: Progression to dementia or Alzheimer's disease (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association (NINDS-ARDRA), International Classification of Diseases (ICD)-10 or Diagnostic and Statistical Manual (DSM-IV criteria), dementia with Lewy bodies or vascular dementia (consensus criteria) at 12, 24 and 36 months and adverse events.

Methods

Design: Systematic review with meta-analysis.

Data sources: Cochrane Dementia and Cognitive Improvement Group's Specialised Register ALOIS was searched for randomised controlled trials (RCTs). ALOIS is populated from searches in MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), WHO trials portal (ICTRP), selected trial registries and grey literature resources. Additional searches were run in MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, CENTRAL, ICTRP and Clinicaltrials.gov to retrieve most recent papers. Reference lists of identified studies were hand searched. Search dates were not stated.

Study selection and analysis: Two reviewers appraised studies and selected double-blind RCTs comparing any cholinesterase inhibitor (galantamine, donepezil or rivastigmine) used for at least 1 month …

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