TY  - JOUR
AU  - Basheer, Aneesh
AU  - Agarwal, Ayush
AU  - Mishra, Biswamohan
AU  - Gupta, Anu
AU  - Padma Srivastava, Madakasira Vasantha
AU  - Kirubakaran, Richard
AU  - Vishnu, Venugopalan
PY  - 2022
DA  - 2022/8/1
TI  - Use of Bacopa monnieri in the Treatment of Dementia Due to Alzheimer Disease: Systematic Review of Randomized Controlled Trials
JO  - Interact J Med Res
SP  - e38542
VL  - 11
IS  - 2
KW  - Bacopa monnieri
KW  - Brahmi
KW  - Ayurveda
KW  - Ayurvedic
KW  - alternative medicine
KW  - traditional medicine
KW  - complementary medicine
KW  - herb
KW  - dementia
KW  - systematic review
KW  - Alzheimer’s disease
KW  - Alzheimer disease
KW  - mild cognitive impairment
KW  - cognition
KW  - neuroprotection
KW  - memory
KW  - cognitive
KW  - treatment
KW  - therapy
KW  - clinical outcome
KW  - memory scale
KW  - neurology
KW  - neurodegenerative disease
KW  - randomized controlled trial
KW  - RCT
AB  - Background: Bacopa monnieri, a herb that has been used for many centuries in India, has shown neuroprotective effects in animal and in vitro studies; human studies on patients with Alzheimer disease have been inconclusive. Objective: The primary objective of this review was to determine the clinical efficacy and safety of B. monnieri in persons with mild, moderate, or severe dementia, or mild cognitive impairment, due to Alzheimer disease. Methods: We searched PubMed, Embase, Cochrane Library, clinical trial registries (World Health Organization, Australia-New Zealand, United States, and South Africa), the metaRegister of Controlled Trials, and CINAHL. We intended to include all randomized and quasi-randomized controlled trials that compared B. monnieri, its extract or active ingredients (at any dosage), with a placebo or a cholinesterase inhibitor among adults with dementia due to Alzheimer disease and in those with mild cognitive impairment due to Alzheimer disease. Results: Our comprehensive search yielded 5 eligible studies. A total of 3 studies used B. monnieri in combination with herbal extracts while the remaining 2 used B. monnieri extracts only. Two studies compared B. monnieri with donepezil while the others used a placebo as the control. There was considerable variation in the B. monnieri dose used (ranging between 125 mg to 500 mg twice daily) and heterogeneity in treatment duration, follow-up, and outcomes. The major outcomes were Mini-Mental State Examination scores reported in 3 trials, Cognitive subscale scores of the Alzheimer’s Disease Assessment Scale in 1 study, and a battery of cognitive tests in 2 studies. Using the Cochrane risk-of-bias tool, overall, we judged all 5 studies to be at high risk of bias. While all studies reported a statistically significant difference between B. monnieri and the comparator in at least one outcome, we rated the overall quality of evidence for the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, Postgraduate Institute Memory Scale, Mini-Mental State Examination, and Wechsler Memory Scale to be very low due to downgrading by 2 levels for high risk of bias and 1 more level for impreciseness due to small sample sizes and wide CIs. Conclusions: There was no difference between B. monnieri and the placebo or donepezil in the treatment of Alzheimer disease based on very low certainty evidence. No major safety issues were reported in the included trials. Future randomized controlled trials should aim to recruit more participants and report clinically meaningful outcomes. Trial Registration: PROSPERO CRD42020169421; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=169421 
SN  - 1929-073X
UR  - https://www.i-jmr.org/2022/2/e38542
UR  - https://doi.org/10.2196/38542
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35612544
DO  - 10.2196/38542
ID  - info:doi/10.2196/38542
ER  -