中国循证医学杂志

中国循证医学杂志

多成分非药物干预用于轻度认知功能障碍效果的 Meta 分析

查看全文

目的 系统评价多成分非药物干预对轻度认知功能障碍(MCI)患者的效果。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、PsycINFO、Web of Science、CINAHL、VIP、CBM、WanFang Data 和 CNKI 数据库,收集关于多成分非药物干预治疗 MCI 患者障碍效果的随机对照试验(RCT),检索时限均为建库至 2017 年 11 月。由两名研究人员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 12 个 RCT,包括 1 359 例 MCI 患者。Meta 分析结果显示,在整体认知功能方面,多成分非药物组的 MMSE 评分[SMD=0.33,95%CI(–0.13,0.78),P=0.16]与对照组差异无统计学意义,多成分非药物组的 MoCA 评分[SMD=0.52,95%CI(0.38,0.67),P<0.000 01]及 ADAS-Cog 评分[SMD=1.13,95%CI(0.75,1.51),P<0.000 01]均优于对照组。与对照组相比,多成分非药物干预能提高日常生活能力[SMD=–0.64,95%CI(–0.83,–0.45),P<0.000 01],改善生存质量[MD=3.65,95%CI(1.03,6.27),P=0.006],缓解 MCI 患者抑郁情绪[SMD=–0.83,95%CI(–1.41,–0.26),P=0.005]。但在延缓 MCI 患者发展成 AD 方面,两组差异无统计学意义[RR=0.27,95%CI(0.06,1.26),P=0.10]。 结论 当前证据显示,多成分非药物干预对 MCI 患者的整体认知功能、日常生活能力、生存质量和抑郁情绪方面均有积极作用。受纳入研究数量和质量限制,上述结论尚待开展更多高质量的研究予以验证。

Objective To systematically review the efficacy of multimodal nonpharmacological interventions in mild cognitive impairment(MCI). Methods An electronically search was conducted in PubMed, EMbase, The Cochrane Library, PsycINFO, Web of Science, CINAHL, VIP, CBM, WanFang Data and CNKI databases from inception to November 2017 to collect randomized controlled trials (RCTs) about multimodal nonpharmacological interventions for MCI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 1 359 patients were finally included. The results of meta-analysis showed that there were no statistical differences between two groups in MMSE scores (SMD=0.33, 95%CI–0.13 to 0.78, P=0.16). However, the MoCA scores (SMD=0.52, 95%CI 0.38 to 0.67, P<0.000 01) and ADAS-Cog scores (SMD=1.13, 95%CI 0.75 to 1.51,P<0.000 01) in the multimodal nonpharmacological interventions group were better than those in the control group. Besides, multimodal nonpharmacological interventions produced significant effects on ADL (SMD=–0.64, 95%CI–0.83 to–0.45,P<0.000 01), QOL-AD (MD=3.65, 95%CI 1.03 to 6.27,P=0.006) and depression (SMD=–0.83, 95%CI–1.41 to–0.26, P=0.005). There were no statistical differences between two groups on conversion rate to Alzheimer's disease (RR=0.27, 95%CI 0.06 to 1.26, P=0.10). Conclusion The current evidence shows that multimodal nonpharmacological interventions are feasible for patients with MCI as it has positive effects on overall cognitive abilities, daily living skills, quality of life and depression. Nevertheless, due to the limited quantity and quality of included studies, more high quality studies are required to verify the conclusion.

关键词: 非药物干预; 轻度认知功能障碍; Meta 分析; 随机对照试验

Key words: Nonpharmacological interventions; Mild cognitive impairment; Meta-analysis; Randomized controlled trial

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol, 1999, 56(3): 303-308.
2. Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment-beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. J Intern Med, 2004, 256(3): 240-246.
3. Ward A, Tardiff S, Dye C, et al. Rate of conversion from prodromal Alzheimer's disease to Alzheimer's dementia: a systematic review of the literature. Dement Geriatr Cogn Dis Extra, 2013, 3(1): 320-332.
4. Clare L, Woods RT, Moniz CE, et al. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev, 2003, (4): CD003260.
5. Erickson KI, Prakash RS, Voss MW, et al. Aerobic fitness is associated with hippocampal volume in elderly humans. Hippocampus, 2009, 19(10): 1030-1039.
6. Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci USA, 2011, 108(7): 3017-3022.
7. Voss MW, Prakash RS, Erickson KI, et al. Plasticity of brain networks in a randomized intervention trial of exercise training in older adults. Front Aging Neurosci, 2010, 2(1): 1-16.
8. Anderson JG, Lopez RP, Rose KM, et al. Nonpharmacological strategies for patients with early-stage dementia or mild cognitive impairment: a 10-year update. Res Gerontol Nurs, 2017, 10(1): 5-11.
9. Simon SS, Yokomizo JE, Bottino CM. Cognitive intervention in amnestic mild cognitive impairment: a systematic review. Neurosci Biobehav Rev, 2012, 36(4): 1163-1178.
10. Kurz A, Pohl C, Ramsenthaler M, et al. Cognitive rehabilitation in patients with mild cognitive impairment. Int J Geriatr Psychiatry, 2009, 24(2): 163-168.
11. 李志武, 黄悦勤, 刘杰, 等. 南苑地区老年轻度认知损害社区干预效果评价研究. 中国医药导报, 2012, 9(34): 50-51.
12. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available at: http://handbook.cochrane.org.
13. Follmann D, Elliott P, Suh I, et al. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol, 1992, 45(7): 769-773.
14. Tsolaki M, Kounti F, Agogiatou C, et al. Effectiveness of nonpharmacological approaches in patients with mild cognitive impairment. Neurodegener Dis, 2011, 8(3): 138-145.
15. Buschert VC, Friese U, Teipel SJ, et al. Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer's disease: a pilot study. J Alzheimers Dis, 2011, 25(4): 679-694.
16. Buschert VC, Giegling I, Teipel SJ, et al. Long-term observation of a multicomponent cognitive intervention in mild cognitive impairment. J Clin Psychiatry, 2012, 73(12): e1492-e1498.
17. 黄鑫, 张耀东, 徐勇, 等. 老年轻度认知障碍综合干预效果初步研究. 中外医疗, 2012, 31(14): 102-103.
18. Rojas GJ, Villar V, Iturry M, et al. Efficacy of a cognitive intervention program in patients with mild cognitive impairment. Int Psychogeriatr, 2013, 25(5): 825-831.
19. 殷淑琴, 宋瑜, 徐勇, 等. 湖州市老年人轻度认知功能障碍早期干预研究. 中国现代医生, 2013, 51(3): 67-68.
20. Maffei L, Picano E, Andreassi MG, et al. Randomized trial on the effects of a combined physical/cognitive training in aged MCI subjects: the Train the Brain study. Sci Rep, 2017, 7: 39471.
21. 沈红仙, 殷淑琴, 方玉红. 老年轻度认知功能障碍患者社区护理的干预效果. 解放军护理杂志, 2013, 30(16): 23-25.
22. 何璐. 江西省社区老年人轻度认知功能障碍的评估和干预研究. 南昌: 南昌大学, 2015.
23. 陈庆友, 张艳蕉, 姜敏, 等. 齐齐哈尔市社区老年人轻度认知功能障碍的现况调查和干预性研究. 中国实用神经疾病杂志, 2015, 18(19): 37-38.
24. 潘惠英. 金华市社区老年人轻度认知功能障碍的现况调查和干预性研究. 上海: 复旦大学, 2012.
25. 聂晓璐, 吕晓珍, 卓琳, 等. 2001–2015 年中国轻度认知功能障碍患病率的 Meta 分析. 中华精神科杂志, 2016, 49(5): 298-306.
26. Karp A, Paillard-Borg S, Wang HX, et al. Mental, physical and social components in leisure activities equally contribute to decrease dementia risk. Dement Geriatr Cogn Disord, 2006, 21(2): 65-73.
27. Zanetti O, Vallotti B, Frisoni GB, et al. Insight in dementia: when does it occur? Evidence for a nonlinear relationship between insight and cognitive status. J Gerontol B Psychol Sci Soc Sci, 1999, 54(2): 100-106.
28. Francomarina F, Garcíagonzález JJ, Wagnerecheagaray F, et al. The mini-mental state examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population. Int Psychogeriatr, 2010, 22(1): 72-81.
29. 葛芳芳. 北京社区老人的神经心理标记物研究和颞叶变异型语义性痴呆的临床神经心理特征分析. 北京: 北京协和医学院, 2014.
30. Olazarán J, Clare L. Non-pharmacological therapies in Alzheimer’s disease: a systematic review of efficacy. Dement Geriatr Cogn Disord, 2010, 30(2): 161-178.
31. Chan SS, Lam LC, Tam CW, et al. Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR. Int J Geriatr Psychiatry, 2010, 23(6): 611-617.
32. Rosenberg PB, Mielke MM, Appleby BS, et al. The association of neuropsychiatric symptoms in MCI with incident dementia and Alzheimer disease. Am J Geriatr Psychiatry, 2013, 21(7): 685-695.
33. 李杭霏, 苏向妮, 徐莎莎, 等. 社区认知障碍老年人生活质量调查及影响因素分析. 护理学报, 2016, 23(4): 41-43.
34. 史亚楠, 方柳絮, 孙秋华. 抑郁对老年轻度认知障碍病人生活质量的影响. 护理研究, 2017, 31(33): 4288-4291.