认知干预对遗忘型轻度认知障碍老年患者干预效果的meta分析

doi:10.3969/j.issn.1004-583X.2024.01.002

摘要/Abstract

摘要：

目的系统评价认知干预对遗忘型轻度认知障碍老年患者认知功能、生存质量的干预效果。方法计算机检索PubMed、Embase、CINAHL、The Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据库、维普数据库中关于认知干预对遗忘型轻度认知障碍老年患者应用效果的随机对照试验研究,检索时限为2005年1月-2023年1月。由2名评价人员根据 Cochrane 5.1.0版手册中RCT评价标准独立进行文献筛选、资料提取和质量评价后,使用Rev Man 5.4软件对数据进行meta分析。结果共纳入10篇文献,总样本量671例。Meta分析结果显示,干预结束后认知干预组简易精神状态量表(MMSE)得分优于对照组[ $M D$ =1.99, 95% $C I$ (1.40, 2.58), $P$ <0.01];认知干预组阿尔茨海默病评估量表(ADAS-cog)和改良版阿尔茨海默病评估量表(Modified- ADAS-cog)的得分优于对照组[ $M D$ =-3.65, 95% $C I$ (-4.89, -2.41), $P$ <0.01];认知干预组记忆满意度(MMQ-Contentment)和行为记忆测试量表(RBMT)得分优于对照组[ $M D$ =1.68, 95% $C I$ (-2.24, 5.60), $P$ =0.40, $M D$ =4.69, 95% $C I$ (3.41, 5.97), $P$ <0.01];认知干预组生存质量评分(QOL-AD)高于对照组[ $M D$ =1.79, 95% $C I$ (0.60, 2.97), $P$ =0.003]。结论现有证据表明,认知干预可提高遗忘型轻度认知障碍患者的记忆满意度、行为记忆能力、生存质量以及延缓发展阿尔茨海默病的进程,但在改善其认知功能方面尚未达到一致效果,可能与纳入研究样本量小、丢失率高、认知功能基线水平不一致有关,未来还需大量随机对照试验进一步探讨。

关键词: 遗忘型轻度认知障碍, 认知康复, 记忆训练, 阿尔茨海默病, meta分析

Abstract:

Objective To systematically evaluate the effect of cognitive interventions on elderly patients with amnestic mild cognitive impairment (aMCI). Methods Randomized controlled trials (RCTs) reporting the effects of cognitive interventions on patients with aMCI published from 2005 to January 2023 were searched in the PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature (CINAHL), The Cochrane Library, Web of Science, China Biomedical Literature Database, China National Knowledge Internet (CNKI), Wanfang and VIP Database. Two investigators were responsible for literature screening, data collection and quality assessment based on the RCT evaluation criteria in the Cochrane 5.1.0 manual. Meta-analysis was performed using Rev Man 5.4. Results A total of 10 eligible studies involving 671 cases were included. Meta-analysis results showed that after the intervention, patients in the cognitive intervention group had significantly better scores of the Mini-Mental State Examination (MMSE) ( $M D$ =1.99, 95% $C I$ 1.40, 2.58; $P$ <0.01), the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and the Modified Alzheimer's Disease Assessment Scale-Cognitive Subscale (Modified-ADAS-Cog) ( $M D$ =-3.65, 95% $C I$ -4.89, -2.41; $P$ <0.01), the Contentment Subscale of the Multifactorial Memory Questionnaire (MMQ-Contentment) ( $M D$ =1.68, 95% $C I$ -2.24, 5.60; $P$ =0.40) and the Rivermead Behavioral Memory Test (RBMT) ( $M D$ =4.69, 95% $C I$ 3.41, 5.97; $P$ <0.01) than those of the control group. The Quality of Life in Alzheimer Disease (QOL-AD) score was significantly higher in the cognitive intervention group than that of control group ( $M D$ =1.79, 95% $C I$ 0.60, 2.97; $P$ =0.003). Conclusion The existing evidences have suggested that cognitive interventions may improve memory satisfaction, behavioral memory capacity and quality of survival, and delay the development of Alzheimer's disease in patients with aMCI. The effect of cognitive interventions on improving their cognitive function has been controversial possibly due to the small sample size, high rate of drop-out, and inconsistent baseline levels of cognitive function. Large-scale randomized controlled trials are needed to explore the function of cognitive interventions in Alzheimer's disease patients with aMCI.

Key words: amnestic mild cognitive impairment, cognitive rehabilitation, memory training, alzheimer's disease, meta-analysis

中图分类号:

R741

肖煌怡, 袁建坤, 严梓予, 曾雯姝, 鲁兰莫, 王峻. 认知干预对遗忘型轻度认知障碍老年患者干预效果的meta分析[J]. 临床荟萃, 2024, 39(1): 12-19.

Xiao Huangyi, Yuan Jiankun, Yan Ziyu, Zeng Wenshu, Lu Lanmo, Wang Jun. Effectiveness of cognitive interventions on elderly patients with amnestic mild cognitive impairment: A meta-analysis[J]. Clinical Focus, 2024, 39(1): 12-19.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.01.002

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I1/12

图/表 8

表1 纳入文献的基本特征( n=10)

Tab.1 Basic characteristics of included studies( n=10)

纳入文献		发表年份	国家	研究场所		样本量 (例,试验组/对照组)	年龄 (岁, $x -$ ±s,试验组/对照组)
Troyer等^[8]		2008	加拿大	社区		24/24	76.00±5.60/74.80±7.70
Jean 等^[9]		2010	美国	家庭		11/11	68.55±9.16/68.55±5.91
Buschert 等^[10]		2011	德国	研究所		12/12	71.80±8.60/70.70±5.70
Förster等^[11]		2011	德国	研究所		9/12	74.50±8.60/72.00±7.10
景静^[12]		2013	中国	社区		31/36	73.39±5.57/71.94±6.57
Jeong等^[13]		2016	韩国	诊所		71/76	70.80±6.90/71.60±6.50
Shimada等^[14]		2018	日本	社区		80/79	71.60±5.00/71.60±4.90
Savulich等^[15]		2017	英国	诊所		21/21	75.20±7.40/76.90±8.30
Park等^[16]		2019	韩国	家庭		25/25	70.70±7.50/69.70±8.40
潘利妞^[17]		2019	中国	社区		44/47	75.45±4.87/75.91±5.41
纳入文献	干预措施				随访时间			结局指标	丢失率 (%)
纳入文献	认知干预组			观察组	随访时间			结局指标	丢失率 (%)
Troyer等^[8]	日常记忆训练			健康教育	干预前、干预后、干预后3个月			①	11.11
Jean 等^[9]	认知训练计划			常规护理	干预前、干预后1周、干预后1个月			①②③	9.10
Buschert 等^[10]	多组分认知干预			常规护理	干预前、干预后6个月			②④⑤	5.10
Förster等^[11]	多元认知干预			常规护理	干预前、干预后6个月			②④	9.30
景静^[12]	记忆训练			健康教育	干预前、干预后、干预后2周、干预后2个月			①③⑤	6.94
Jeong等^[13]	小组结合家庭认知训练			健康教育	干预前、干预后、干预后6个月			②⑤⑥	3.60
Shimada等^[14]	运动结合认知训练			健康教育	干预前、干预后10个月			②	4.5
Savulich等^[15]	基于iPad游戏记忆训练			常规护理	干预前、干预后1个月			②	0
Park等^[16]	居家人机交互认知训练			常规护理	干预前、干预后3个月			②⑥	12.28
潘利妞^[17]	基于IMB模型的记忆训练计划			常规护理	干预前、干预后、干预后2个月			②③	12.5

表1 纳入文献的基本特征( n=10)

Tab.1 Basic characteristics of included studies( n=10)

纳入文献		发表年份	国家	研究场所		样本量 (例,试验组/对照组)	年龄 (岁, $x -$ ±s,试验组/对照组)
Troyer等^[8]		2008	加拿大	社区		24/24	76.00±5.60/74.80±7.70
Jean 等^[9]		2010	美国	家庭		11/11	68.55±9.16/68.55±5.91
Buschert 等^[10]		2011	德国	研究所		12/12	71.80±8.60/70.70±5.70
Förster等^[11]		2011	德国	研究所		9/12	74.50±8.60/72.00±7.10
景静^[12]		2013	中国	社区		31/36	73.39±5.57/71.94±6.57
Jeong等^[13]		2016	韩国	诊所		71/76	70.80±6.90/71.60±6.50
Shimada等^[14]		2018	日本	社区		80/79	71.60±5.00/71.60±4.90
Savulich等^[15]		2017	英国	诊所		21/21	75.20±7.40/76.90±8.30
Park等^[16]		2019	韩国	家庭		25/25	70.70±7.50/69.70±8.40
潘利妞^[17]		2019	中国	社区		44/47	75.45±4.87/75.91±5.41
纳入文献	干预措施				随访时间			结局指标	丢失率 (%)
纳入文献	认知干预组			观察组	随访时间			结局指标	丢失率 (%)
Troyer等^[8]	日常记忆训练			健康教育	干预前、干预后、干预后3个月			①	11.11
Jean 等^[9]	认知训练计划			常规护理	干预前、干预后1周、干预后1个月			①②③	9.10
Buschert 等^[10]	多组分认知干预			常规护理	干预前、干预后6个月			②④⑤	5.10
Förster等^[11]	多元认知干预			常规护理	干预前、干预后6个月			②④	9.30
景静^[12]	记忆训练			健康教育	干预前、干预后、干预后2周、干预后2个月			①③⑤	6.94
Jeong等^[13]	小组结合家庭认知训练			健康教育	干预前、干预后、干预后6个月			②⑤⑥	3.60
Shimada等^[14]	运动结合认知训练			健康教育	干预前、干预后10个月			②	4.5
Savulich等^[15]	基于iPad游戏记忆训练			常规护理	干预前、干预后1个月			②	0
Park等^[16]	居家人机交互认知训练			常规护理	干预前、干预后3个月			②⑥	12.28
潘利妞^[17]	基于IMB模型的记忆训练计划			常规护理	干预前、干预后、干预后2个月			②③	12.5

表2 纳入文献的方法学质量评价结果

Tab. 2 Methodological quality assessment for included studies

纳入文献	随机方法	分配隐藏	受试者和研究人员盲法	结局评估盲法	结果数据完整性	选择性报告研究结果	其他偏倚来源	文献质量等级
Troyer等^[8]	低风险	低风险	不清楚	不清楚	低风险	低风险	低风险	A
Jean 等^[9]	低风险	低风险	低风险	低风险	低风险	低风险	低风险	A
Buschert 等^[10]	低风险	低风险	低风险	低风险	低风险	低风险	低风险	A
Förster等^[11]	低风险	不清楚	低风险	不清楚	低风险	低风险	低风险	A
景静^[12]	低风险	低风险	高风险	低风险	低风险	低风险	低风险	B
Jeong 等^[13]	低风险	不清楚	不清楚	低风险	低风险	低风险	低风险	A
Shimada等^[14]	低风险	低风险	低风险	低风险	低风险	低风险	低风险	A
Savulich等^[15]	低风险	不清楚	高风险	低风险	低风险	低风险	低风险	B
Park等^[16]	低风险	低风险	高风险	低风险	低风险	低风险	低风险	B
潘利妞^[17]	低风险	不清楚	高风险	低风险	低风险	低风险	低风险	B

图1 认知干预对aMCI老年患者认知功能的影响

Fig. 1 Effect of cognitive intervention on cognitive function in elderly patients with aMCI

图2 认知干预对aMCI老年患者记忆满意度的影响

Fig. 2 Effect of cognitive intervention on memory satisfaction in elderly patients with aMCI

图3 认知干预对aMCI老年患者行为记忆能力的影响

Fig. 3 Effect of cognitive intervention on behavioral memory ability of elderly patients with aMCI

图4 认知干预对aMCI患者进展阿尔茨海默病的影响

Fig. 4 Effect of cognitive intervention on progressive Alzheimer's disease in patients with aMCI

图5 认知干预对aMCI患者生存质量的影响

Fig. 5 Effect of cognitive intervention on the quality of survival in patients with aMCI

图6 认知功能状况发表的偏倚漏斗图

Fig. 6 Funnel plot of publication bias of cognitive function status

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