轻度认知障碍患者记忆力下降体验的质性研究

doi:10.3761/j.issn.0254-1769.2022.10.008

摘要/Abstract

摘要：

目的探讨轻度认知障碍患者记忆力下降的体验,为临床护理人员开展护理干预提供参考。方法采用目的抽样法,选取2021年5月—6月北京市某三级甲等医院神经内科门诊的9例轻度认知障碍患者作为研究对象进行半结构访谈,采用现象学研究中Colaizzi 7步分析法进行资料分析。结果轻度认知障碍患者记忆力下降的体验可归纳为3个主题：记忆力下降的疾病感知（轻视与否认的态度、反思与溯源的自省、互动关系的改变）;记忆力下降的情感体验（焦虑与恐惧情绪的产生、自我效能感的降低、自我开解态度的形成、对未来的期待）;记忆力下降的应对策略（生活方式的应对、体力与脑力活动的应对、未来规划的应对）。结论应加强对轻度认知障碍患者记忆力下降医疗知识的普及,关注其情感需求,给予心理疏导、家庭支持和社会支持,并进行个性化的认知干预,促进其认知改善,提高生活质量。

关键词: 轻度认知障碍, 记忆力下降, 体验, 质性研究, 护理

Abstract:

Objective To explore the real experience of mild cognitive impairment patients with memory decline,and to provide references for clinical staff to carry out follow-up medical nursing intervention. Methods Using objective sampling method,9 patients with mild cognitive impairment in the Department of Neurology of a tertiary hospital in Beijing from May to June 2021 were selected as the research subjects for semi-structured interviews,and the data were analyzed by Colaizzi 7-step analysis method in phenomenological research. Results The real experience of memory loss in patients with mild cognitive impairment can be summarized into 3 themes：disease perception of memory loss（attitude of contempt and denial,introspection of reflection and traceability,and change of interactive relationship）;emotional experience of memory decline（generation of anxiety and fear,reduction of self-efficacy,formation of self enlightening attitude,expectation of facing the future）;coping strategies for memory loss （lifestyle coping,physical and mental activity coping,future planning coping）. Conclusion We should strengthen the popularization of medical knowledge about memory loss in patients with mild cognitive impairment,pay attention to their emotional needs,give psychological counseling,family support and social support,and carry out personalized cognitive intervention to promote their cognitive improvement and return to family and society.

Key words: Mild Cognitive Impairment, Impairment of Memory, Experience, Qualitative Research, Nursing Care

田思颖, 常红, 李佩佩, 张欣悦, 乔雨晨, 王蕊, 孙静, 于燕, 杨璇. 轻度认知障碍患者记忆力下降体验的质性研究[J]. 中华护理杂志, 2022, 57(10): 1206-1212.

TIAN Siying, CHANG Hong, LI Peipei, ZHANG Xinyue, QIAO Yuchen, WANG Rui, SUN Jing, YU Yan, YANG Xuan. A qualitative study on emotional experience of patients with mild cognitive impairment[J]. Chinese Journal of Nursing, 2022, 57(10): 1206-1212.

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参考文献 33

[1]	Petersen RC. Mild cognitive impairment[J]. N Engl J Med, 2011, 364(23):2227-2234. DOI URL
[2]	中国痴呆与认知障碍诊治指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(五):轻度认知障碍的诊断与治疗[J]. 中华医学杂志, 2018, 98(17):1294-1301.
	Writing Group of Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment, Professional Committee of Cognitive Impairment of Neurophysicians Branch of Chinese Medical Association. 2018 Chinese guidelines for the diagnosis and treatment of dementia and cognitive impairment(V):diagnosis and treatment of mild cognitive impairment[J]. Natl Med J China, 2018, 98(17):1294-1301.
[3]	Xue J, Li JR, Liang JM, et al. The prevalence of mild cognitive impairment in China:a systematic review[J]. Aging Dis, 2018, 9(4):706-715. DOI URL
[4]	Petersen RC. Mild cognitive impairment as a diagnostic entity[J]. J Intern Med, 2004, 256(3):183-194. DOI PMID
[5]	Jia LF, Du YF, Chu L, et al. Prevalence,risk factors,and management of dementia and mild cognitive impairment in adults aged 60 years or older in China:a cross-sectional study[J]. Lancet Public Health, 2020, 5(12):e661-e671.
[6]	李树亚. 轻度认知障碍患者淡漠、抑郁表现与认知功能各维度关系的研究[D]. 北京:北京协和医学院, 2018.
	Li SY. The relationship between apathy,depression and domains of cognitive function in people with mild cognitive impairment[D]. Beijing:Peking Union Medical College, 2018.
[7]	Parikh PK, Troyer AK, Maione AM, et al. The impact of memory change on daily life in normal aging and mild cognitive impairment[J]. Gerontologist, 2016, 56(5):877-885. DOI URL
[8]	Berg AI, Wallin A, Nordlund A, et al. Living with stable MCI:experiences among 17 individuals evaluated at a memory clinic[J]. Aging Ment Health, 2013, 17(3):293-299. DOI URL
[9]	Voros V, Martin Gutierrez D, Alvarez F, et al. The impact of depressive mood and cognitive impairment on quality of life of the elderly[J]. Psychogeriatrics, 2020, 20(3):271-277. DOI URL
[10]	张琪, 宋慧敏, 曹睿, 等. 太极拳对轻度认知障碍老年人认知功能干预效果的Meta分析[J]. 中国护理管理, 2020, 20(6):865-871.
	Zhang Q, Song HM, Cao R, et al. Effects of Tai Chi on cognitive function for aged with Mild Cognitive Impairment:a Meta-analysis[J]. Chin Nurs Manag, 2020, 20(6):865-871.
[11]	赵春善, 高玲, 孟繁明. 认知训练对老年轻度认知障碍认知功能影响的meta分析[J]. 中国老年学杂志, 2018, 38(22):5487-5492.
	Zhao CS, Gao L, Meng FM. Meta analysis of the effect of cognitive training on cognitive function in elderly patients with mild cognitive impairment[J]. Chin J Gerontol, 2018, 38(22):5487-5492.
[12]	Lu JH, Li D, Li F, et al. Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals:a population-based study[J]. J Geriatr Psychiatry Neurol, 2011, 24(4):184-190. DOI URL
[13]	American Psychiatric Association. Diagnostic and statistical ma-nual IV[M]. Washington, DC: American Psychiatric Association, 1994.
[14]	Portacolone E, Rubinstein RL, Covinsky KE, et al. The precarity of older adults living alone with cognitive impairment[J]. Gerontologist, 2019, 59(2):271-280. DOI PMID
[15]	Prince M, Bryce R, Ferri C. World Alzheimer’s Report 2011:The benefits of early diagnosis and intervention[R]. Alzheimer’s Disease International, 2011.
[16]	Department of Health. Living well with dementia:a national dementia strategy[M]. Northern Ireland: Department of Health, 2009.
[17]	Matthews ML, Wells Y, Pike KE, et al. Long-term effects of a memory group intervention reported by older adults[J]. Neuropsychol Rehabil, 2020, 30(6):1044-1058. DOI PMID
[18]	王丽娜, 赵岳. 轻度认知障碍的早期识别及相关理论模型的研究进展[J]. 中华护理杂志, 2018, 53(5):612-617.
	Wang LN, Zhao Y. Early recognition of mild cognitive impairment and research progress of relevant theoretical models[J]. Chin J Nurs, 2018, 53(5):612-617.
[19]	张利, 郑颖婧, 朱琳, 等. 慢性乙型肝炎患者角色适应障碍的定性研究[J]. 中国社会医学杂志, 2020, 37(2):139-142.
	Zhang L, Zheng YJ, Zhu L, et al. Qualitative study of role adaptation disorders in patients with chronic hepatitis B[J]. Chin J Soc Med, 2020, 37(2):139-142.
[20]	马佳, 张韶伟, 刘文斌, 等. 社区老年轻度认知障碍患者抑郁焦虑状况及影响因素研究[J]. 中国全科医学, 2020, 23(33):4246-4251. DOI
	Ma J, Zhang SW, Liu WB, et al. Prevalence and associated factors of depression and anxiety in elderly patients with mild cognitive impairment in community:a cross-sectional study[J]. Chin Gen Pract, 2020, 23(33):4246-4251.
[21]	Li XX, Li Z. The impact of anxiety on the progression of mild cognitive impairment to dementia in Chinese and English data bases:a systematic review and meta-analysis[J]. Int J Geriatr Psychiatry, 2018, 33(1):131-140. DOI URL
[22]	Mourao RJ, Mansur G, Malloy-Diniz LF, et al. Depressive symptoms increase the risk of progression to dementia in subjects with mild cognitive impairment:systematic review and meta-analysis[J]. Int J Geriatr Psychiatry, 2016, 31(8):905-911. DOI URL
[23]	李树亚, 李峥. 轻度认知障碍老年人精神行为症状及影响因素的调查研究[J]. 中华护理杂志, 2018, 53(10):1192-1198.
	Li SY, Li Z. Incidence and its influencing factors of psychological and behavioral symptoms among older adults with mild cognitive impairment[J]. Chin J Nurs, 2018, 53(10):1192-1198.
[24]	Saevareid TJL, Pedersen R, Thoresen L. Nursing home residents with cognitive impairment can participate in advance care planning:a qualitative study[J]. J Adv Nurs, 2021, 77(2):879-888. DOI PMID
[25]	彭希哲, 王伟. 中国认知障碍老人照护支持面临的风险及政策应对[J]. 西南民族大学学报(人文社科版), 2019, 40(12):40-47.
	Peng XZ, Wang W. Risks and policy responses to care support for the elderly with cognitive impairment in China[J]. J Southwest Minzu Univ Humanit Soc Sci, 2019, 40(12):40-47.
[26]	Johansson MM, Marcusson J, Wressle E. Cognitive impairment and its consequences in everyday life:experiences of people with mild cognitive impairment or mild dementia and their relatives[J]. Int Psychogeriatr, 2015, 27(6):949-958. DOI PMID
[27]	Barha CK, Hsiung GYR, Liu-Ambrose T. The role of S100B in aerobic training efficacy in older adults with mild vascular cognitive impairment:secondary analysis of a randomized controlled trial[J]. Neuroscience, 2019, 410:176-182. DOI PMID
[28]	Tang Y, Xing Y, Zhu ZD, et al. The effects of 7-week cognitive training in patients with vascular cognitive impairment,no dementia(the Cog-VACCINE study):a randomized controlled trial[J]. Alzheimers Dement, 2019, 15(5):605-614. DOI PMID
[29]	郑洁, 施加加, 顾丽萍, 等. 高频重复经颅磁刺激对脑卒中后非痴呆型血管性认知障碍患者的疗效观察[J]. 中国康复, 2017, 32(6):488-491.
	Zheng J, Shi JJ, Gu LP, et al. Therapeutic effects of high frequency repetitive transcranial magnetic stimulation in treating vascular cognitive impairment after stroke but no dementia[J]. Chin J Rehabil, 2017, 32(6):488-491.
[30]	Chen LF, Fang JQ, Ma RJ, et al. Additional effects of acupunc-ture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke:a multicenter randomized controlled trial[J]. BMC Complement Altern Med, 2016, 16:226. DOI URL
[31]	李晨曦, 尚云峰, 王丽云, 等. 计算机认知训练对轻度认知障碍老年人认知功能的影响研究[J]. 中华护理杂志, 2021, 56(5):667-673.
	Li CX, Shang YF, Wang LY, et al. Research on the influence of computer cognitive training on the cognitive function of the elderly with mild cognitive impairment[J]. Chin J Nurs, 2021, 56(5):667-673.
[32]	常红, 乔雨晨. 认知训练护理门诊构建的专家共识[J]. 中华护理杂志, 2019, 54(10):1504-1508.
	Chang H, Qiao YC. Expert consensus on cognitive training nursing clinic[J]. Chin J Nurs, 2019, 54(10):1504-1508.
[33]	Hedman A, Lindqvist E, Nygård L. How older adults with mild cognitive impairment relate to technology as part of present and future everyday life:a qualitative study[J]. BMC Geriatr, 2016, 16:73. DOI URL

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