非药物干预对老年人记忆抱怨主诉干预效果的系统评价  

Effects of Nonpharmacological Interventions on Elderly People with Subjective Memory Complaints:a Systematic Review

作　　者：赵青 陈珮 朱姝芹[1] 唐慧婷[1] 丁晓彤 吕启圆 刘海宁[3] 李现文[1] ZHAO Qing;CHEN Pei;ZHU Shuqin;TANG Huiting;DING Xiaotong;LYU Qiyuan;LIU Haining;LI Xianwen(School of Nursing,Nanjing Medical University,Nanjing 211166,China;School of Nursing,Sun Yat-sen University,Guangzhou 510080,China;Chengde Medical University,Chengde 067000,China)

机构地区：[1]南京医科大学护理学院,江苏省南京市211166 [2]中山大学护理学院,广东省广州市510080 [3]承德医学院,河北省承德市067000

出　　处：《中国全科医学》2020年第29期3719-3728,共10页Chinese General Practice

基　　金：国家自然科学基金资助项目(71804204);江苏省高校哲学社会科学项目(2017SJB0285)。

摘　　要：背景记忆抱怨主诉(SMC)作为老化过程中认知功能下降的最初阶段,可能成为改善认知障碍的关键机会窗口,但目前对SMC干预的相关研究较少。目的系统评价非药物干预(NPI)对于SMC老年患者的干预效果。方法计算机系统检索PubMed、EMBase、CENTRAL、PsycINFO、CINAHL、万方数据知识服务平台、中国知网数据库中NPI对于SMC老年患者干预效果的随机对照试验(RCT),检索时限均为建库至2018年12月。由两名研究者进行文献筛选、质量评价、数据提取和核对,对SMC老年患者焦虑、主观记忆、记忆策略、语言记忆、视觉空间记忆、延迟回忆、短时回忆、整体认知功能、执行功能、注意力功能、生活质量、抑郁等情况进行Meta分析。结果共纳入18篇文献,1074例患者。Meta分析结果显示,认知干预能改善SMC老年患者的焦虑症状〔SMD=-0.34,95%CI(-0.67,-0.01),P=0.04〕、主观记忆〔SMD=-0.29,95%CI(-0.52,-0.06),P=0.01〕、延迟回忆〔SMD=0.42,95%CI(0.04,0.80),P=0.03〕、整体认知功能〔SMD=0.41,95%CI(0.02,0.81),P=0.04〕,效果均为中等效应;认知干预能改善SMC老年患者语言记忆〔SMD=0.45,95%CI(0.15,0.75),P=0.003〕、短时回忆〔SMD=0.69,95%CI(0.02,1.35),P=0.04〕,效果均为高等效应。干预持续时间和单次干预时间是记忆和执行功能的调节变量(P<0.05);认知干预联合认知重构对于SMC老年患者主观记忆、执行功能、抑郁情况无明显改善(P>0.05);运动干预、生活方式干预针对部分认知域有一定程度的改善(P<0.05)。结论NPI能改善SMC老年患者的焦虑症状、主观记忆、延迟回忆、整体认知功能、语言记忆、短时回忆等认知域水平,而适当地设计干预特征如采用短时间的非长期干预方法,对结果改善更为有效。Background Subjective memory complaints(SMC),the initial stage of cognitive decline during aging,could be a key window of opportunity for improving cognitive impairment.However,studies on the intervention of SMC are scarce.Objective To evaluate the effects of nonpharmacological interventions on elderly people with SMC.Methods Databases including PubMed,EMBase,CENTRAL,PsycINFO,CINAHL,WanFang and CNKI were retrieved from inception to December 2018 for randomized clinical trials(RCTs)about effects of nonpharmacological interventions in elderly people with SMC.The screening of RCTs,quality assessment,data extraction and verification were conducted by two researchers,separately.Meta-analysis was performed on anxiety,subjective memory,memory strategy,verbal memory,visual spatial memory,delayed recall,immediate recall,global cognitive function,executive function,attention function,quality of life and depression in elderly people with SMC.Results 18 RCTs,including a total of 1074 patients,were included in the metaanalysis.The result showed that cognitive intervention could moderately improve anxiety〔SMD=-0.34,95%CI(-0.67,-0.01),P=0.04〕,subjective memory〔SMD=-0.29,95%CI(-0.52,-0.06),P=0.01〕,delayed memory〔SMD=0.42,95%CI(0.04,0.80),P=0.03〕,and global cognitive function〔SMD=0.41,95%CI(0.02,0.81),P=0.04〕,and could significantly improve verbal memory〔SMD=0.45,95%CI(0.15,0.75),P=0.003〕,and immediate recall〔SMD=0.69,95%CI(0.02,1.35),P=0.04〕.The overall duration of intervention and intervention session time were moderator variables of memory and executive function(P<0.05).Cognitive intervention combined with cognitive restructuring could not obviously improve subjective memory,executive function and depression(P>0.05).Exercise intervention and lifestyle intervention improved partial cognitive domains(P<0.05).Conclusion Nonpharmacological intervention may improve the anxiety,subjective memory,delayed memory,global cognitive function,verbal memory,and immediate recall in elderly people with SMC.Appropriatel

关 键 词：认知障碍 非药物干预 老年人 记忆抱怨主诉 系统评价 META分析 

分 类 号：R741[医药卫生—神经病学与精神病学]