网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
非药物干预对老年认知衰弱患者改善效果的网状Meta分析
作者:李萌1 2  周雪梅3  赵莉华3  张鑫1 2  马丹妮1 2  唐佳敏1 2  何红2 
单位:1. 南通大学 护理与康复学院, 江苏 南通 226001;
2. 南通大学附属医院 护理部, 江苏 南通 226001;
3. 南通大学附属医院 心血管内科, 江苏 南通 226006
关键词:老年 认知衰弱 非药物干预 网状Meta分析 
分类号:R592
出版年·卷·期(页码):2024·52·第四期(571-581)
摘要:

目的:评价非药物干预方法对老年认知衰弱患者的应用效果。方法:计算机检索PubMed、the Cochrane Library、Web of Science、Embase、中国知网、中国生物医学数据库、维普、万方等,检索时间为建库至2023年7月1日。两名研究者独立使用Cochrane手册偏倚风险评估工具进行文献质量评价,采用Stata 15.0进行频率学网状Meta分析。结果:最终纳入19项干预性研究,包括13种非药物干预方式,共2 743例老年患者。网状Meta分析结果显示,与多组分运动相比,双重任务训练可显著改善患者的认知功能(SMD=-2.64,95%CI -4.88~-0.40,P<0.05)。与常规护理相比,口服营养补充(SMD=4.02,95%CI 1.58~6.45,P<0.05)、有氧运动(SMD=3.36,95%CI 0.27~6.45,P<0.05)、双重任务训练(SMD=4.43,95%CI 1.01~7.85,P<0.05)、有氧联合抗阻运动(SMD=-3.44,95%CI -6.78~-0.11,P<0.05)、高强度间歇训练(SMD=-5.28,95%CI -9.87~-0.69,P<0.05)可以较好地改善患者的衰弱状态。累积排序概率图下面积显示,双重任务训练和口服营养补充是改善老年人认知衰弱状态的最佳非药物干预方式。 结论:在改善老年认知衰弱患者的认知功能方面,双重任务训练是目前最优的非药物干预措施,口服营养补充在改善躯体衰弱状态方面效果最佳,因此在实施干预措施改善患者认知衰弱时可优先考虑应用以上干预方式。

参考文献:

[1] TANG K F,TEH P L,LEE S W H.Cognitive frailty and functional disability among community-dwelling older adults:a systematic review[J].Innov Aging,2023,7(1):igad005.
[2] QIU Y,LI G,WANG X,et al.Prevalence of cognitive frailty among community-dwelling older adults:a systematic review and meta-analysis[J].Int J Nurs Stud,2022,125:104112.
[3] KELAIDITI E,CESARI M,CANEVELLI M,et al.Cognitive frailty:rational and definition from an(I.A.N.A./I.A.G.G.) international consensus group[J].J Nutr Health Aging,2013,17(9):726-734.
[4] BRIGOLA A G,OTTAVIANI A C,ALEXANDRE T D S,et al.Cumulative effects of cognitive impairment and frailty on functional decline,falls and hospitalization:a four-year follow-up study with older adults[J].Arch Gerontol Geriatr,2020,87:104005.
[5] 刘津池,刘畅,华成舸.随机对照试验偏倚风险评价工具RoB2(2019修订版)解读[J].中国循证医学杂志,2021,21(6):737-744.
[6] CUMPSTON M,LI T,PAGE M J,et al.Updated guidance for trusted systematic reviews:a new edition of the Cochrane handbook for systematic reviews of interventions[J].Cochrane Database Syst Rev,2019,10(10):ED000142.
[7] THOM H,WHITE I R,WELTON N J,et al.Automated methods to test connectedness and quantify indirectness of evidence in network meta-analysis[J].Res Synth Methods,2019,10(1):113-124.
[8] WATT J,TRICCO A C,STRAUS S,et al.Research techniques made simple:network Meta-analysis[J].J Invest Dermatol,2019,139(1):4-12.e1.
[9] TONIN F S,BORBA H H,MENDES A M,et al.Description of network meta-analysis geometry:a metrics design study[J].PLoS One,2019,14(2):e0212650.
[10] 叶明,李书国.口服营养补充肠内营养混悬液对认知衰弱患者的影响[J].中华老年心脑血管病杂志,2019,21(4):349-352.
[11] 俞沛文,包海童,陈星,等.口服营养补充在老年认知衰弱病人中的应用研究[J].实用老年医学,2021,35(12):1265-1268.
[12] 白治繁,宋明芳,沈军.怀旧联合认知行为干预对养老机构老年人认知衰弱的效果研究[J].护理管理杂志,2022,22(3):210-214.
[13] MOLLINEDO C I,LÓPEZ A,CANCELA C J M.The effects of different types of physical exercise on physical and cognitive function in frail institutionalized older adults with mild to moderate cognitive impairment.A randomized controlled trial[J].Arch Gerontol Geriatr,2019,83:223-230.
[14] Z.J Y,J.X Z,M.L N,et al.Effects of mindfulness-based Tai Chi Chuan on physical performance and cognitive function among cognitive frailty older adults:a six-month follow-up of a randomized controlled trial[J].J Prev Alzheimers Dis,2022,9(1):104-112.
[15] CHEN L,HWANG A,LEE W,et al.Efficacy of multidomain interventions to improve physical frailty,depression and cognition:data from cluster-randomized controlled trials[J].J Cachexia Sarcopenia Muscle,2020,11(3):650-662.
[16] LIAO Y Y,CHEN I H,HSU W C,et al.Effect of exergaming versus combined exercise on cognitive function and brain activation in frail older adults:a randomised controlled trial[J].Ann Phys Rehabil Med,2021,64(5):101492.
[17] 韩君,王君俏,高键,等.弹力带运动联合认知训练对社区老年人认知衰弱的干预效果[J].护理研究,2022,36(4):624-629.
[18] 杨柳,王晓云,闫慧楠.八段锦联合认知训练对老年糖尿病患者认知衰弱干预的临床研究[J].中国全科医学,2023,26(23):2848-2853.
[19] KWAN R Y,LEE D,LEE P H,et al.Effects of an mHealth Brisk walking intervention on increasing physical activity in older people with cognitive frailty:pilot randomized controlled trial[J].JMIR Mhealth Uhealth,2020,8(7):e16596.
[20] WAN M,XIA R,LIN H,et al.Baduanjin exercise modulates the hippocampal subregion structure in community-dwelling older adults with cognitive frailty[J].Front Aging Neurosci,2022,14:956273.
[21] LIN H,YE Y,WAN M,et al.Effect of Baduanjin exercise on cerebral blood flow and cognitive frailty in the community older adults with cognitive frailty:a randomized controlled trial[J].J Exerc Sci Fit,2023,21(1):131-137.
[22] YOON D H,LEE J Y,SONG W.Effects of resistance exercise training on cognitive function and physical performance in cognitive frailty:a randomized controlled trial[J].J Nutr Health Aging,2018,22(8):944-951.
[23] KWAN R Y C,LIU J Y W,FONG K N K,et al.Feasibility and effects of virtual reality motor-cognitive training in community-dwelling older people with cognitive frailty:a pilot randomized controlled trial[J].JMIR Serious Games,2021,9(3):e28400.
[24] 叶明,李书国,朱正庭,等.多组分运动处方对认知衰弱老年人的影响研究[J].中国全科医学,2021,24(4):460-466.
[25] 陈航言,韦丽华,钟美容,等.高强度间歇训练对老年冠心病患者认知衰弱的影响[J].中国实用护理杂志,2023,39(8):587-592.
[26] 陈管洁,张海林,尹丽霞,等.透析中运动对维持性血液透析认知衰弱患者的影响[J].护理学杂志,2022,37(20):33-37.
[27] 杜瑾.双重任务训练在社区老年认知衰弱患者中的应用效果研究[D].郑州:郑州大学,2022.
[28] HUANG C H,UMEGAKI H,MAKINO T,et al.Effect of various exercises on frailty among older adults with subjective cognitive concerns:a randomised controlled trial[J].Age Ageing,2020,49(6):1011-1019.
[29] DOWNEY R,BHERER L,POTHIER K,et al.Multiple routes to help you roam:a comparison of training interventions to improve cognitive-motor dual-tasking in healthy older adults[J].Front Aging Neurosci,2022,14:710958.
[30] GHOSH T S,RAMPELLI S,JEFFERY I B,et al.Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status:the NU-AGE 1-year dietary intervention across five European countries[J].Gut,2020,69(7):1218-1228.
[31] JANCZYK M,KUNDE W.Dual tasking from a goal perspective[J].Psychol Rev,2020,127(6):1079-1096.
[32] CORDES T,BISCHOFF L L,SCHOENE D,et al.A multicomponent exercise intervention to improve physical functioning,cognition and psychosocial well-being in elderly nursing home residents:a study protocol of a randomized controlled trial in the PROCARE(prevention and occupational health in long-term care) project[J].BMC Geriatr,2019,19(1):369.
[33] KARAMACOSKA D.Brain function effects of exercise interventions for cognitive decline:a systematic review and meta-analysis[J].Front Neurosci,2023,17:1127065.
[34] KEY M N,SZABO-REED A N.Impact of diet and exercise interventions on cognition and brain health in older adults:a narrative review[J].Nutrients,2023,15(11):2495.
[35] ALI N,TIAN H,THABANE L,et al.The effects of dual-task training on cognitive and physical functions in older adults with cognitive impairment; a systematic review and Meta-analysis[J].J Prev Alzheimers Dis,2022,9(2):359-370.
[36] KUO H T,YEH N C,YANG Y R,et al.Effects of different dual task training on dual task walking and responding brain activation in older adults with mild cognitive impairment[J].Sci Rep,2022,12(1):84-90.
[37] LEE S,HARADA K,BAE S,et al.A non-pharmacological multidomain intervention of dual-task exercise and social activity affects the cognitive function in community-dwelling older adults with mild to moderate cognitive decline:a randomized controlled trial[J].Front Aging Neurosci,2023,15:1005410.
[38] LUGER E,DORNER T E,HAIDER S,et al.Effects of a home-based and volunteer-administered physical training,nutritional,and social support program on malnutrition and frailty in older persons:a randomized controlled trial[J].J Am Med Dir Assoc,2016,17(7):671.e9-671.e16.
[39] PEREIRA S L,SHOEMAKER M E,GAWEL S,et al.Biomarker changes in response to a 12-week supplementation of an oral nutritional supplement enriched with protein,vitamin D and HMB in malnourished community dwelling older adults with sarcopenia[J].Nutrients,2022,14(6):1196.
[40] KHOR P Y,VEARING R M,CHARLTON K E.The effectiveness of nutrition interventions in improving frailty and its associated constructs related to malnutrition and functional decline among community-dwelling older adults:a systematic review[J].J Hum Nutr Diet,2022,35(3):566-582.
[41] MALAFARINA V,SERRA REXACH J A,MASANES F,et al.Effects of high-protein,high-calorie oral nutritional supplementation in malnourished older people in nursing homes:an observational,multi-center,prospective study(PROT-e-GER).Protocol and baseline population characteristics[J].Maturitas,2019,126:73-79.
[42] ZHONG Y,COHEN J T,GOATES S,et al.The cost-effectiveness of oral nutrition supplementation for malnourished older hospital patients[J].Appl Health Econ Health Policy,2017,15(1):75-83.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 792602 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541