结构性个体认知刺激疗法对轻中度失智症患者干预效果的Meta分析

doi:10.3761/j.issn.0254-1769.2023.15.015

摘要/Abstract

摘要：

目的评价结构性个体认知刺激疗法在轻中度失智症患者中的应用效果。方法检索PubMed、Embase、Web of Science、Cochrane Library、CINAHL、PsycInfo及中国知网、万方数据库和中国生物医学文献数据库中关于结构性个体认知刺激疗法在轻中度失智症患者中应用效果的研究，检索时限为建库至2022年9月。由2名研究者独立进行文献筛选、资料提取和质量评价，并采用RevMan 5.4软件进行统计分析。结果共纳入9篇文献，总计617例患者。Meta分析结果显示，在认知能力方面，试验组由简易精神状态检查量表[MD=1.15，95%CI（0.34，1.96），P=0.005]和蒙特利尔认知评估量表[MD=4.88，95%CI（2.16，7.60），P<0.001]评定的认知得分优于对照组，阿尔茨海默病认知评估量表评分差异无统计学意义[MD=-1.20，95%CI（-3.02，0.62），P=0.200]；试验组抑郁情绪改善优于对照组[MD=-0.81， 95%CI（-1.31，-0.31），P=0.001]，两组生活质量[MD=1.65，95%CI（-0.58，3.88），P=0.150]和神经精神症状[MD=-0.23， 95%CI（-2.77，2.32），P=0.860]的差异无统计学意义。结论现有证据表明，结构性个体认知刺激疗法可以在一定程度上提高轻中度失智症患者的认知能力，改善其抑郁情绪，但在改善生活质量和神经精神症状方面的作用不显著，有待大样本高质量随机对照试验进一步论证。

关键词: 个体认知刺激疗法, 失智症, 认知能力, 抑郁, Meta分析, 循证护理学

Abstract:

Objective To evaluate the effect of structured individual cognitive stimulation therapy in patients with mild to moderate dementia. Methods Pubmed，Embase，Web of science，Cochrane library，CINAHL，APA PsycInfo and CNKI，Wanfang Database，CBM were searched by computers for the research on the efficacy of structured individual cognitive stimulation therapy for patients with dementia from inception to September of 2022. 2 researchers conducted literature screening，data extraction and quality evaluation independently，and meta-analysis was performed by RevMan 5.4 software. Results A total of 9 pieces of literature were included，in which 617 patients with mild to moderate dementia were studied. The results of meta-analysis showed that the test group was better than the control group in Mini-Mental State Examination scale scores[MD=1.15，95%CI（0.34，1.96），P=0.005] and Montreal Cognitive Assessment scale scores[MD=4.88，95%CI（2.16，7.60），P<0.001]，but there was no significant difference in ADAS-cognitive portion scale scores[MD=-1.20，95%CI（-3.02，0.62），P=0.200]. The improvement on depression in the test group is better than that of control group[MD=-0.81，95%CI（-1.31，-0.31），P=0.001].However，there is no statistically significant differences in the quality of life[MD=1.65, 95%CI（-0.58, 3.88）, P=0.150） and neuropsychological symptoms[MD=-0.23，95%CI（-2.77，2.32），P=0.860] between 2 groups. Conclusion The existing evidence shows that the structured individual cognitive stimulation therapy could alleviate the depression of patients with mild to moderate dementia，and improve the cognitive ability to a certain extent，but the effect on improving the quality of life and neuropsychological symptoms is not evident，which needs to be further studied with high-quality randomized controlled trials in a larger sample size.

Key words: Individual Cognitive Stimulation Therapy, Dementia, Cognitive Ability, Depression, Meta-Analysis, Evidence-Based Nursing

刘泽玉, 凌颜, 涂萍, 姚萦, 华雅琪, 王欣, 胡敏. 结构性个体认知刺激疗法对轻中度失智症患者干预效果的Meta分析[J]. 中华护理杂志, 2023, 58(15): 1878-1884.

LIU Zeyu, LING Yan, TU Ping, YAO Ying, HUA Yaqi, WANG Xin, HU Min. Effects of structured individual cognitive stimulation therapy on patients with mild to moderate dementia：a meta-analysis[J]. Chinese Journal of Nursing, 2023, 58(15): 1878-1884.

图/表 4

图1 文献筛选流程

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=9）

Table 1 Basic characteristics of the included studies（n=9）

表2 纳入文献质量评价结果（n=9）

Table 2 Quality assessment of included studies（n=9）

图2 简易精神状态检查量表效应量汇总及异质性检验结果

Figure 2 Effect size summary and heterogeneity test results of MMSE scale

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