阿尔茨海默病患者情绪障碍管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2021.11.020

摘要/Abstract

摘要：

目的检索、总结阿尔茨海默病患者情绪障碍管理的最佳证据,为临床工作提供参考,帮助改善阿尔茨海默病患者的情绪障碍。方法遵循“6S”证据模型,计算机检索国际指南协作网、美国指南网、英国国家卫生与临床优化研究所、苏格兰校际指南网、加拿大安大略注册护士协会、中国指南网、UpToDate、乔安娜布里格斯研究所循证卫生保健中心数据库、中国知网等数据库有关阿尔茨海默病患者情绪障碍管理的高级别证据。检索时段为建库至2021年5月。结果共纳入12篇文献,包括指南7篇、专家共识4篇、系统评价1篇,最后从5个方面总结了23条最佳证据。结论阿尔茨海默病患者情绪障碍管理的最佳证据可为临床医护人员提供循证证据,以科学的方法管理阿尔兹海默病患者的情绪障碍,有助于提高患者的生活质量。

关键词: 阿尔茨海默病, 老年痴呆, 情绪障碍, 证据总结, 循证护理学

Abstract:

Objective To search and summarize the best evidence for the management of emotional disorders in patients with Alzheimer’s disease,so as to provide references for clinical practice and to help improve the emotional disorders of patients with Alzheimer’s disease. Methods Following the "6S" evidence model,we searched the high-level evidence about the management of mood disorders in patients with Alzheimer’s disease in databases such as International Guide Collaboration Network,American Guide Network,National Institute for Clinical Optimization of UK,Scottish Intercollegiate Guide Network,Ontario Nurse Registration Network of Canada,China Guide Network,UpToDate,JBI Library,CNKI and so on. The retrieval period is from the establishment of the databases to May 2021. Results A total of 12 articles were included,including 7 clinical guidelines,4 expert consensuses and 1 systematic review. Finally,23 pieces of best evidence were summarized from 5 aspects. Conclusion The best evidence summary of the management of emotional disorders in patients with Alzheimer’s disease provides evidence-based references for clinical medical staff to manage the emotional disorders of patients with Alzheimer’s disease in a scientific way,which is helpful to improve their quality of life.

Key words: Alzheimer’s Disease, Senile Dementia, Mood Disorder, Evidence Summary, Evidence-Based Nursing

邓泽南, 马秋平, 吴彬, 黎琼, 谭思岚, 韦敏, 林雯琼, 唐海姗, 韦国信, 黎学敏, 银星凤, 兰艺, 冯超, 石文青, 李睿琳, 黎剑云. 阿尔茨海默病患者情绪障碍管理的最佳证据总结[J]. 中华护理杂志, 2021, 56(11): 1714-1720.

DENG Zenan, MA Qiuping, WU Bin, LI Qiong, TAN Silan, WEI Min, LIN Wenqiong, TANG Haishan, WEI Guoxin, LI Xuemin, YIN Xingfeng, LAN Yi, FENG Chao, SHI Wenqing, LI Ruilin, LI Jianyun. Summary of the best evidence for the management of emotional disorders in patients with Alzheimer’s disease[J]. Chinese Journal of Nursing, 2021, 56(11): 1714-1720.

图/表 4

图1 文献筛选流程

Figure 1 Literature screening process

表1 纳入文献的一般特征（n=12）

Table 1 General characteristics of the literature（n=12）

表2 纳入指南的质量评价结果

Table 2 Results of quality evaluation included in the guidelines

表3 阿尔茨海默病患者情绪障碍管理的最佳证据总结

Table 3 Summary of the best evidence for the management of emotional disorders in patients with Alzheimer’s disease

参考文献 26

[1]	张静爽, 王蓉. 阿尔茨海默病发生机制的研究进展[J]. 首都医科大学学报, 2014, 35(6):721-724.
	Zhang JS, Wang R. Research progress in the pathogenesis of Alzheimer’s disease[J]. J Cap Med Univ, 2014, 35(6):721-724.
[2]	van der Linde RM, Dening T, Matthews FE, et al. Grouping of behavioural and psychological symptoms of dementia[J]. Int J Geriatr Psychiatry, 2014, 29(6):562-568. DOI URL
[3]	张明园, Robert Katzman, 陈佩俊. 痴呆和阿尔茨海默病的发病率[J]. 中华精神科杂志, 1998, 31(4):195.
	Zhang MY, Katzman R, Chen PJ. Incidence of dementia and Alzheimer’s disease[J]. Chin J Psychiatry, 1998, 31(4):195.
[4]	向琴. 早期老年性痴呆患者的心理行为特点及其干预效果[J]. 中国老年学杂志, 2011, 31(22):4334-4335.
	Xiang Q. Early psychological behavior characteristics and the intervention effect of senile dementia patients[J]. Chin J Geron-tol, 2011, 31(22):4334-4335.
[5]	王华丽. 神经认知障碍精神行为症状群临床诊疗专家共识[J]. 中华精神科杂志, 2017, 50(5):335-339.
	Wang HL. Expert consensus on neuropsychiatric syndrome of neural cognitive impairment[J]. Chin J Psych, 2017, 50(5):335-339.
[6]	田金洲, 解恒革, 王鲁宁, 等. 中国阿尔茨海默病痴呆诊疗指南(2020年版)[J]. 中华老年医学杂志, 2021, 40(3):269-283.
	Tian JZ, Xie HG, Wang LN, et al. Chinese guideline for the diagnosis and treatment of Alzheimer’s disease dementia(2020)[J]. Chin J Geriatr, 2021, 40(3):269-283.
[7]	谢利民, 王文岳. 《临床指南研究与评价系统Ⅱ》简介[J]. 中西医结合学报, 2012, 10(2):160-165.
	Xie LM, Wang WY. Introduction of appraisal of guidelines for research and evaluationⅡ[J]. J Chin Integrat Med, 2012, 10(2):160-165.
[8]	The Joanna Briggs Institute（JBI）. JBI grades of recommendation[EB/OL].(2017-07-15)[2020-10-12]. https://jbi.global/critical-appraisal-tools .
[9]	Xiong J, Chen RX. An introduction to a measurement tool to assess the methodological quality of systematic reviews/Meta-analysis:AMSTAR[J]. Chin J Evidence-Based Med, 2011, 11(9):1084-1089.
[10]	米元元, 沈月, 王宗华, 等. 机械通气患者误吸预防及管理的最佳证据总结[J]. 中华护理杂志, 2018, 53(7):849-856.
	Mi YY, Shen Y, Wang ZH, et al. Evidence summary for aspiration patients receiving mechanical ventilation[J]. Chin J Nurs, 2018, 53(7):849-856.
[11]	Connelly PJ, James R. SIGN guideline for the management of patients with dementia[J]. Internat J Geriat Psych, 2006, 21(1):14-16. DOI URL
[12]	Cherry D, Segal-Gidan F. Guideline for Alzheimer’s disease management[C]// Apha Meeting & Exposition, October, 27, 2008. California.
[13]	Dyer SM, Laver K, Pond CD, et al. Clinical practice guidelines and principles of care for people with dementia in Australia[J]. Aus Fam Physic, 2016, 45(12):884.
[14]	National Institue for Health and Clinical Excellence. Dementia：assessment,management and support for people living with dementia and their carers[EB/OL].(2018-06-20)[2020-09-01]. http://www,nice.org.uk/guidance/ng97 .
[15]	贾建平, 魏翠柏. 2018中国痴呆与认知障碍诊治指南(二):阿尔茨海默病诊治指南[J]. 中华医学杂志, 2018, 98(13):971-977.
	Jia JP, Wei CB. 2018 Chinese guidelines for the diagnosis and treatment of dementia and cognitive impairment(2):the guidelines for the diagnosis and treatment of Alzheimer’s disease[J]. Natl Med J China, 2018, 98(13):971-977.
[16]	中国痴呆与认知障碍诊治指南写作组. 2018中国痴呆与认知障碍诊治指南(十):痴呆精神行为症状鉴别诊断和治疗[J]. 中华医学杂志, 2020, 100(17):1290-1293.
	Writing Group of Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment. 2018 Chinese guidelines for the diagnosis and treatment of dementia and cognitive impairment(10):the differential diagnosis and treatment of behavioral and psychological symptoms of dementia[J]. Natl Med J China, 2020, 100(17):1290-1293.
[17]	中国老年医学学会认知障碍分会. 中国认知障碍患者照料管理专家共识[J]. 中华老年医学杂志, 2016, 35(10):1051-1060.
	Academy of Cognitive Disorder of China. Expert consensus on long-term healthcare of patients with cognitive disorders in China[J]. Chin J Geriatr, 2016, 35(10):1051-1060.
[18]	Kales HC, Lyketsos CG, Miller EM, et al. Management of behavioral and psychological symptoms in people with Alzhei-mer’s disease:an international Delphi consensus[J]. Int Psych-ogeriatr, 2018, 31(1):1-8.
[19]	中国老年医学学会认知障碍分会. 阿尔茨海默病患者日常生活能力和精神行为症状及认知功能全面管理中国专家共识(2019)[J]. 中华老年医学杂志, 2020, 39(1):1-8.
	Academy of Cognitive Disorder of China. Chinese expert consensus on activity behavior and cognition comprehensive management of Alzheimer’s disease(2019)[J]. Chin J Geriatr, 2020, 39(1):1-8.
[20]	Steen JTVD, Soest-Poortvliet MCV, Wouden JCVD, et al. Music-based therapeutic interventions for people with dementia[M]. Cochrane Database Syst Rev, 2017.
[21]	王含笑, 陈素虹, 林恺, 等. 长期护理机构老年痴呆照顾者负担与患者精神行为症状的相关性[J]. 中国老年学杂志, 2017, 37(18):4651-4654.
	Wang HX, Chen SH, Lin K, et al. The correlation of the dementia caregivers burden of long-term care institutions and symptoms of patients with mental behavior[J]. Chin J Geron, 2017, 37(18):4651-4654.
[22]	杨姗姗, 杨秀娟, 李敏, 等. 中度有氧运动对阿尔茨海默病患者干预效果的Meta分析[J]. 中华护理杂志, 2017, 52(6):686-691.
	Yang SS, Yang XJ, Li M, et al. The intervention effectiveness of moderate aerobic exercise for patients with Alzheimer’s disease:a meta-analysis[J]. Chin J Nurs, 2017, 52(6):686-691.
[23]	Kasper S, Schubert H. Ginkgo biloba extract EGb 761 in the treatment of dementia:evidence of efficacy and tolerability[J]. Fortschritte Der Neurol-Psychiatr, 2009, 77(9):494-506. DOI URL
[24]	程健, 吴文. 高频重复经颅磁刺激治疗阿尔茨海默症效果的Meta分析[J]. 实用医学杂志, 2016, 32(15):2539-2543.
	Chen J, Wu W. Clinical effects of high frequency repeated transcranial magnetic stimulation therapy on Alzheimer’s dis-ease:a meta-analysis[J]. J Pract Med, 2016, 32(15):2539-2543.
[25]	陈春英, 陆子琴, 孟莉萍, 等. 整合照护对阿尔茨海默病患者长期管理的效果评价[J]. 中华护理杂志, 2019, 54(7):999-1004.
	Chen CY, Lu ZQ, Meng LP, et al. Evaluation of effect of nurse-led integrated care on long-term management of patients with Alzheimer’s disease[J]. Chin J Nurs, 2019, 54(7):999-1004.
[26]	周滢, 李峥. 老年痴呆照顾者哀伤的研究进展[J]. 中华护理杂志, 2018, 53(4):488-492.
	Zhou Y, Li Z. Research progress of dementia caregivers grief[J]. Chin J Nurs, 2018, 53(4):488-492.