中国循证医学杂志

中国循证医学杂志

多种干预措施对老年痴呆患者认知能力影响的网状 meta 分析

查看全文

目的采用网状 meta 分析方法比较 7 种干预措施对老年痴呆患者认知能力的影响。方法计算机检索 The Cochrane Library、PubMed、EMbase、CNKI、WanFang Data、VIP 和 CBM 数据库,搜集不同干预措施对老年痴呆患者认知能力影响的随机对照试验,检索时限均从建库至 2018 年 1 月。由 2 位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 Stata 14.0 软件进行分析。结果共纳入 49 个研究,3 768 名老年痴呆患者。网状 meta 分析结果显示,每种认知干预措施均对老年痴呆患者的认知能力有提高作用:护理干预[MD=3.10,95%CI(1.70,4.50),P<0.005]对认知能力的改善最有效,其次分别是音乐治疗[MD=2.6,95%CI(0.96,4.30),P<0.001]、体育锻炼[MD=2.4,95%CI(1.0,3.9),P<0.001]、认知康复[MD=2.3,95%CI(0.92,3.7),P=0.013]、认知刺激[MD=1.7,95%CI(1.2,2.3),P=0.037]、电脑认知训练[MD=1.6,95%CI(0.42,2.8),P<0.001]和药物治疗[MD=1.5,95%CI(0.24,2.8),P=0.041]。结论7 种认知干预措施均对老年痴呆患者认知能力的改善有所帮助,其中护理干预是最有效的认知干预措施,且非药物治疗要比药物治疗的干预效果好。受所纳入文献的数量及质量的影响,上述结论需在今后研究中得到验证。

ObjectivesTo systematically review the efficacy of seven types of cognitive interventions for older adults with mild to moderate Alzheimer's Disease (AD).MethodsWe searched The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM databases to collect randomized controlled trials on cognitive interventions for mild to moderate Alzheimer's Disease (AD) from inception to January 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. STATA 14.0 software was then used to perform a meta-analysis.ResultsA total of 49 randomized controlled trials (RCTs) were included. The results of network meta-analysis revealed that each cognitive intervention had significantly improved the cognitive ability of AD patients. Specifically, nursing intervention (NI) (MD=3.01, 95%CI 1.70 to 4.50, P<0.005) was the most effective enhancer of cognitive ability, followed by music therapy (MT) (MD=2.60, 95%CI 0.96 to 4.30,P<0.001), physical exercise (PE) (MD=2.4, 95%CI 1.0 to 3.9,P<0.001), cognitive rehabilitation (CR) (MD=2.3, 95% CI 0.92 to 3.7,P=0.013), cognitive simulation (CS) (MD=1.7, 95%CI 1.2 to 2.3, P=0.037), computerized cognitive training (CCT) (MD=1.6, 95%CI 0.42 to 2.8, P<0.001), and pharmacological therapies (PT) (MD=1.5, 95%CI 0.24 to 2.8,P=0.041).ConclusionsThe seven types of cognitive interventions are helpful in improving the cognitive ability of Alzheimer's patients, and nursing intervention is the most effective cognitive intervention. Moreover, non-pharmacological therapies may be better than pharmacological therapies.

关键词: 老年痴呆; 认知干预措施; 网状 Meta 分析; 随机对照试验

Key words: Alzheimer's disease; Cognitive interventions; Bayesian network meta-analysis; Randomized controlled trial

引用本文: 梁景宏, 徐勇, 贾瑞霞, 王英全. 多种干预措施对老年痴呆患者认知能力影响的网状 meta 分析. 中国循证医学杂志, 2019, 19(1): 18-27. doi: 10.7507/1672-2531.201710116 复制

登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 肖闻宇, 郑舒华, 何小珍. 社区护理干预对老年痴呆患者及照料者生活质量影响的研究. 中华全科医学, 2016, 14(1): 150-152.
2. 邢秀吉. 老年痴呆症研究现状及中医治疗对策. 康复学报, 2002, 12(1): 58-60.
3. 康宝仁, 庞声航. 中医防治老年痴呆概述. 实用中医药杂志, 2013, 29(4): 327-329.
4. Clare L, Woods RT, Moniz Cook ED, et al. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev, 2003, (4): CD003260.
5. Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med, 2002, 21(16): 2313-2324.
6. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). Available at: http://handbook.cochrance.org.
7. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol, 2011, 64(2): 163-171.
8. Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med, 2004, 23(20): 3105-3124.
9. Salanti G, Higgins JP, Ades AE, et al. Evaluation of networks of randomized trials. Stat Methods Med Res, 2008, 17(3): 279-301.
10. Caldwell DM, Ades AE, Higgins JP. Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ, 2005, 331(7521): 897-900.
11. Mavridis D, Salanti G. A practical introduction to multivariate meta-analysis. Stat Methods Med Res, 2013, 22(2): 133-158.
12. Brooks SP, Gelman A. General methods for monitoring convergence of iterative simulations. J Comput Graph Stat, 1997, 7(4): 434-455.
13. Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med, 2010, 29(7-8): 932-944.
14. 袁虎, 张俊. 阿尔茨海默病采用中药治疗临床效果观察. 中医临床研究, 2017, 9(7): 93-95.
15. 彭顺兰. 安理申治疗阿尔茨海默病的临床研究. 中国医药指南, 2008, (8): 41-42.
16. 赵瑾, 王琳, 贾晓军, 等. 美金刚治疗阿尔茨海默病的临床研究. 重庆医学, 2008, 37(7): 712-713.
17. 陈美玲, 关素芳, 郑玉娥. 个性化护理对改善老年痴呆患者生活能力的影响. 现代诊断与治疗, 2017, 28(10): 1940-1941.
18. 姜敏. 个性化护理对老年痴呆患者的影响及效果探讨. 中外医疗, 2015, 34(16): 146-147.
19. 李玲. 护理干预对老年痴呆患者生活能力及生活质量的影响. 中外医学研究, 2016, 14(11): 81-82.
20. 来梦, 缪琴华, 袁彩萍, 等. 护理干预在老年血管性痴呆患者中的疗效. 当代护士 (下旬刊), 2015, (6): 43-45.
21. 陈晓飞, 倪姣娜, 林阁. 计算机辅助技术对血管性痴呆患者的认知康复的疗效观察. 心脑血管病防治, 2013, 13(3): 196-199.
22. 周惠嫦, 张盘德, 陈丽珊, 等. 计算机辅助认知训练对血管性认知障碍的疗效观察. 中国康复医学杂志, 2012, 27(6): 551-553.
23. 郭冬梅. 康复训练对老年痴呆患者认知功能、生活质量及抑郁的影响. 齐鲁护理杂志, 2016, 22(1): 26-28.
24. 王怀静, 徐运田, 王相立. 康复训练对血管性痴呆的影响. 西南军医, 2007, 9(4): 21-22.
25. 仲伟爱, 曹丽青, 高文钑. 老年痴呆患者的团体音乐治疗效果. 中国民康医学, 2015, 27(3): 82-82.
26. 唐志敏, 王进, 张春琳, 等. 老年痴呆康复训练的三要素. 广西医学, 2008, 30(5): 631-634.
27. 赵瑾, 王延江, 张涛, 等. 安理申治疗阿尔茨海默病的临床研究. 重庆医学, 2008, 37(7): 716-717.
28. 冯德琳, 张倩, 孙远征. 头穴丛刺为主治疗血管性痴呆的临床研究. 中医药信息, 2014, 31(4): 139-141.
29. 于向华, 张海峰. 头穴丛刺长留针法治疗血管性痴呆的临床观察. 上海中医药杂志, 2012, 46(12): 41-42.
30. 常嵘. 盐酸多奈哌齐治疗老年痴呆的临床分析. 中国卫生标准管理, 2015, 6(33): 82-83.
31. 郝文莉. 盐酸多奈哌齐治疗血管性痴呆 33 例临床疗效观察. 中国现代药物应用, 2010, 4(8): 125-126.
32. 单志愿. 盐酸多奈哌齐治疗血管性痴呆 40 例疗效分析. 医药论坛杂志, 2011, 32(3): 89-90.
33. 欧阳晓春, 余小骊, 景少巍, 等. 盐酸美金刚治疗血管性痴呆的疗效观察. 临床军医杂志, 2012, 40(6): 1528-1530.
34. 张冬梅, 李德香. 银杏叶制剂治疗血管性痴呆的疗效观察. 实用老年医学, 2003, (4): 197-199.
35. 何静. 银杏注射液治疗老年痴呆症的疗效. 中国老年学杂志, 2015, 35(20): 5787-5788.
36. 于涛, 石江伟, 韩景献. 针刺治疗轻中度血管性痴呆临床观察. 辽宁中医杂志, 2007, 34(7): 978-980.
37. 陆卫卫, 周健. 针刺治疗血管性痴呆的临床观察. 辽宁中医杂志, 2009, 36(10): 1784-1785.
38. 管叶明, 唐巍, 汪青松. 针灸治疗 68 例血管性痴呆患者的临床疗效观察. 安徽医学, 2009, 30(4): 452-453.
39. 董克礼, 杨聘. 中西医结合治疗阿尔茨海默病 20 例. 湖南中医学院学报, 2005, 25(3): 36-37.
40. 吴翠娥. 中西医结合治疗老年性痴呆 46 例. 河南中医, 2015, 35(4): 753-755.
41. 胡文雷, 林海飞. 中医辨证治疗老年性痴呆的疗效分析. 辽宁中医杂志, 2014, 41(10): 2164-2166.
42. 刘月平, 徐永涛, 扶治霞. 综合康复治疗对轻、中度阿尔茨海默病的疗效观察. 中国康复, 2013, 28(5): 373-374.
43. Suzuki M, Kanamori M, Watanabe M, et al. Behavioral and endocrinological evaluation of music therapy for elderly patients with dementia. Nurs Health Sci, 2004, 6(1): 11-18.
44. 俞璐, 林水淼, 周如倩, 等. 中医辨证治疗轻中度阿尔茨海默病的随机对照试验. 中西医结合学报, 2012, 10(7): 766-776.
45. Bottino CM, Carvalho IA, Alvarez AM, et al. Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study. Clin Rehabil, 2005, 19(8): 861-869.
46. Capotosto E, Belacchi C, Gardini S, et al. Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia. Int J Geriatr Psychiatry, 2017, 32(3): 331-340.
47. Niu YX, Tan JP, Guan JQ, et al. Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer's disease: a randomized controlled trial. Clin Rehabil, 2010, 24(12): 1102-1111.
48. Kwak YS, Um SY, Son TG, et al. Effect of regular exercise on senile dementia patients. Int J Sports Med, 2008, 29(6): 471-474.
49. Yang SY, Shan CL, Qing H, et al. The effects of aerobic exercise on cognitive function of alzheimer's disease patients. CNS Neurol Disord Drug Targets, 2015, 14(10): 1292-1297.
50. Orgogozo JM, Rigaud AS, Stöffler A, et al. Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300). Stroke, 2002, 33(7): 1834-1839.
51. Rozzini L, Costardi D, Chilovi BV, et al. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr Psychiatry, 2007, 22(4): 356-360.
52. Lee GY, Yip CC, Yu EC, et al. Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer's disease in Hong Kong: a pilot study. Clin Interv Aging, 2013, 8: 623-633.
53. Arroyo-Anlló EM, Díaz JP, Gil R. Familiar music as an enhancer of self-consciousness in patients with Alzheimer's disease. Biomed Res Int, 2013, 2013: 752965.
54. Jelcic N, Agostini M, Meneghello F, et al. Feasibility and efficacy of cognitive telerehabilitation in early Alzheimer's disease: a pilot study. Clin Interv Aging, 2014, 9: 1605-1611.
55. Chu H, Yang CY, Lin Y, et al. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biol Res Nurs, 2014, 16(2): 209-217.
56. Satoh M, Yuba T, Tabei K, et al. Music therapy using singing training improves psychomotor speed in patients with Alzheimer's disease: a neuropsychological and fMRI study. Dement Geriatr Cogn Dis Extra, 2015, 5(3): 296-308.
57. Barban F, Annicchiarico R, Pantelopoulos S, et al. Protecting cognition from aging and Alzheimer's disease: a computerized cognitive training combined with reminiscence therapy. Int J Geriatr Psychiatry, 2016, 31(4): 340-348.
58. Tárraga L, Boada M, Modinos G, et al. A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer's disease. J Neurol Neurosurg Psychiatry, 2006, 77(10): 1116-1121.
59. Arcoverde C, Deslandes A, Moraes H, et al. Treadmill training as an augmentation treatment for Alzheimer's disease: a pilot randomized controlled study. Arq Neuropsiquiatr, 2014, 72(3): 190-196.
60. 周婷, 胡培佳, 程红亮. 电针相关井穴治疗血管性认知障碍临床研究. 中医药临床杂志, 2013, 25(8): 684-686.
61. Spector A, Thorgrimsen L, Woods B, et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. Br J Psychiatry, 2003, 183: 248-254.
62. Vreugdenhil A, Cannell J, Davies A, et al. A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial. Scand J Caring Sci, 2012, 26(1): 12-19.
63. Liang JH, Xu Y, Lin L, et al. Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: a PRISMA-compliant network meta-analysis. Medicine (Baltimore), 2018, 97(20): e10744.
64. Hill NT, Mowszowski L, Naismith SL, et al. Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. Am J Psychiatry, 2017, 174(4): 329-340.
65. García-Casal JA, Loizeau A, Csipke E, et al. Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis. Aging Ment Health, 2017, 21(5): 454-467.
66. Fang R, Ye S, Huangfu J, et al. Music therapy is a potential intervention for cognition of Alzheimer's disease: a mini-review. Transl Neurodegener, 2017, 6: 2.
67. Groot C, Hooghiemstra AM, Raijmakers PG, et al. The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev, 2016, 25: 13-23.
68. Mohajeri MH, Troesch B, Weber P. Inadequate supply of vitamins and DHA in the elderly: implications for brain aging and Alzheimer-type dementia. Nutrition, 2015, 31(2): 261-275.
69. Coyle H, Traynor V, Solowij N. Computerized and virtual reality cognitive training for individuals at high risk of cognitive decline: systematic review of the literature. Am J Geriatr Psychiatry, 2015, 23(4): 335-359.
70. Ueda T, Suzukamo Y, Sato M, et al. Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis. Ageing Res Rev, 2013, 12(2): 628-641.
71. Littbrand H, Stenvall M, Rosendahl E. Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. Am J Phys Med Rehabil, 2011, 90(6): 495-518.
72. Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil, 2004, 85(10): 1694-1704.
73. Ades AE, Sculpher M, Sutton A, et al. Bayesian methods for evidence synthesis in cost-effectiveness analysis. Pharmacoeconomics, 2006, 24(1): 1-19.
74. Sutton A, Ades AE, Cooper N, et al. Use of indirect and mixed treatment comparisons for technology assessment. Pharmacoeconomics, 2008, 26(9): 753-767.
75. Song F, Altman DG, Glenny AM, et al. Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ, 2003, 326(7387): 472.
76. Van de Winckel A, Feys H, De Weerdt W, et al. Cognitive and behavioural effects of music-based exercises in patients with dementia. Clin Rehabil, 2004, 18(3): 253-260.
77. Christofoletti G, Oliani MM, Gobbi S, et al. A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia. Clin Rehabil, 2008, 22(7): 618-626.
78. Lam FMH, Liao LR, Kwok TCY, et al. Effects of adding whole-body vibration to routine day activity program on physical functioning in elderly with mild or moderate dementia: a randomized controlled trial. Int J Geriatr Psychiatry, 2018, 33(1): 21-30.
79. Yang SY, Shan CL, Qing H, et al. The effects of aerobic exercise on cognitive function of Alzheimer's disease patients. CNS Neurol Disord Drug Targets, 2015, 14(10): 1292-1297.
80. Holthoff VA, Marschner K, Scharf M, et al. Effects of physical activity training in patients with Alzheimer's dementia: results of a pilot RCT study. PLoS One, 2015, 10(4): e0121478.
81. Rolland Y, Pillard F, Klapouszczak A, et al. Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial. J Am Geriatr Soc, 2007, 55(2): 158-165.
82. Hoffmann K, Sobol NA, Frederiksen KS, et al. Moderate-to-high intensity physical exercise in patients with Alzheimer's disease: a randomized controlled trial. J Alzheimers Dis, 2016, 50(2): 443-453.
83. Venturelli M, Scarsini R, Schena F. Six-month walking program changes cognitive and ADL performance in patients with Alzheimer. Am J Alzheimers Dis Other Demen, 2011, 26(5): 381-388.
84. 杨绪菊. 老年痴呆患者的个性化护理探析. 中国卫生标准管理, 2015, 6(9): 67-68.
85. Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review. Alzheimers Res Ther, 2013, 5(4): 35.
86. 祁冬晴, 江钟立. 老年人轻度认知功能障碍的康复干预策略. 中华老年医学杂志, 2014, 33(7): 714-717.
87. Mortby ME, Black SE, Gauthier S, et al. Dementia clinical trial implications of mild behavioral impairment. Int Psychogeriatr, 2018, 30(2): 171-175.
88. 苗迎春, 田金洲, 时晶, 等. 补肾化痰祛瘀中药治疗遗忘型轻度认知损害的随机、双盲、平行对照临床研究(英文). 中西医结合学报, 2012, 10(4): 390-397.
89. Lampit A, Hallock H, Valenzuela M. Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers. PloS Med, 2014, 11(11): e1001756.
90. Shah TM, Weinborn M, Verdile G, et al. Enhancing cognitive functioning in healthly older adults: a systematic review of the clinical significance of commercially available computerized cognitive training in preventing cognitive decline. Neuropsychol Rev, 2017, 27(1): 62-80.
91. Rozzini L, Costardi D, Chilovi BV, et al. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr Psychiatry, 2007, 22(4): 356-360.
92. Cipriani A, Higgins JP, Geddes JR, et al. Conceptual and technical challenges in network meta-analysis. Ann Intern Med, 2013, 159(2): 130-137.