多种干预措施对老年痴呆患者认知能力影响的网状meta分析
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摘要
目的采用网状meta分析方法比较7种干预措施对老年痴呆患者认知能力的影响。方法计算机检索The Cochrane Library、PubMed、EMbase、CNKI、WanFang Data、VIP和CBM数据库,搜集不同干预措施对老年痴呆患者认知能力影响的随机对照试验,检索时限均从建库至2018年1月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.0软件进行分析。结果共纳入49个研究,3 768名老年痴呆患者。网状meta分析结果显示,每种认知干预措施均对老年痴呆患者的认知能力有提高作用:护理干预[MD=3.10,95%CI(1.70,4.50),P<0.005]对认知能力的改善最有效,其次分别是音乐治疗[MD=2.6,95%CI(0.96,4.30),P<0.001]、体育锻炼[MD=2.4,95%CI(1.0,3.9),P<0.001]、认知康复[MD=2.3,95%CI(0.92,3.7),P=0.013]、认知刺激[MD=1.7,95%CI(1.2,2.3),P=0.037]、电脑认知训练[MD=1.6,95%CI(0.42,2.8),P<0.001]和药物治疗[MD=1.5,95%CI(0.24,2.8),P=0.041]。结论 7种认知干预措施均对老年痴呆患者认知能力的改善有所帮助,其中护理干预是最有效的认知干预措施,且非药物治疗要比药物治疗的干预效果好。受所纳入文献的数量及质量的影响,上述结论需在今后研究中得到验证。
Objectives To systematically review the efficacy of seven types of cognitive interventions for older adults with mild to moderate Alzheimer's Disease(AD). Methods We searched The Cochrane Library, PubMed,EMbase, CNKI, Wan Fang Data, VIP and CBM databases to collect randomized controlled trials on cognitive interventions for mild to moderate Alzheimer's Disease(AD) from inception to January 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. STATA 14.0 software was then used to performa meta-analysis. Results A total of 49 randomized controlled trials(RCTs) were included. The results of network meta-analysis revealed that each cognitive intervention had significantly improved the cognitive ability of AD patients.Specifically, nursing intervention(NI)(MD=3.01, 95%CI 1.70 to 4.50, P<0.005) was the most effective enhancer ofcognitive ability, followed by music therapy(MT)(MD=2.60, 95%CI 0.96 to 4.30, P<0.001), physical exercise(PE)(MD=2.4, 95%CI 1.0 to 3.9, P<0.001), cognitive rehabilitation(CR)(MD=2.3, 95% CI 0.92 to 3.7, P=0.013), cognitive simulation(CS)(MD=1.7, 95%CI 1.2 to 2.3, P=0.037), computerized cognitive training(CCT)(MD=1.6, 95%CI 0.42 to2.8, P<0.001), and pharmacological therapies(PT)(MD=1.5, 95%CI 0.24 to 2.8, P=0.041). Conclusions The seven types of cognitive interventions are helpful in improving the cognitive ability of Alzheimer's patients, and nursing intervention is the most effective cognitive intervention. Moreover, non-pharmacological therapies may be better than pharmacological therapies.
Objectives To systematically review the efficacy of seven types of cognitive interventions for older adults with mild to moderate Alzheimer's Disease(AD). Methods We searched The Cochrane Library, PubMed,EMbase, CNKI, Wan Fang Data, VIP and CBM databases to collect randomized controlled trials on cognitive interventions for mild to moderate Alzheimer's Disease(AD) from inception to January 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. STATA 14.0 software was then used to performa meta-analysis. Results A total of 49 randomized controlled trials(RCTs) were included. The results of network meta-analysis revealed that each cognitive intervention had significantly improved the cognitive ability of AD patients.Specifically, nursing intervention(NI)(MD=3.01, 95%CI 1.70 to 4.50, P<0.005) was the most effective enhancer ofcognitive ability, followed by music therapy(MT)(MD=2.60, 95%CI 0.96 to 4.30, P<0.001), physical exercise(PE)(MD=2.4, 95%CI 1.0 to 3.9, P<0.001), cognitive rehabilitation(CR)(MD=2.3, 95% CI 0.92 to 3.7, P=0.013), cognitive simulation(CS)(MD=1.7, 95%CI 1.2 to 2.3, P=0.037), computerized cognitive training(CCT)(MD=1.6, 95%CI 0.42 to2.8, P<0.001), and pharmacological therapies(PT)(MD=1.5, 95%CI 0.24 to 2.8, P=0.041). Conclusions The seven types of cognitive interventions are helpful in improving the cognitive ability of Alzheimer's patients, and nursing intervention is the most effective cognitive intervention. Moreover, non-pharmacological therapies may be better than pharmacological therapies.
引文
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2邢秀吉.老年痴呆症研究现状及中医治疗对策.康复学报,2002,12(1):58-60.
3康宝仁,庞声航.中医防治老年痴呆概述.实用中医药杂志,2013,29(4):327-329.
4 Clare L, Woods RT, Moniz Cook ED, et al. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev, 2003,(4):CD003260.
5 Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med, 2002, 21(16):2313-2324.
6 Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions(Version 5.1.0). Available at:http://handbook.cochrance.org.
7 Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multipletreatment meta-analysis:an overview and tutorial. J Clin Epidemiol, 2011, 64(2):163-171.
8 Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med, 2004, 23(20):3105-3124.
9 Salanti G, Higgins JP, Ades AE, et al. Evaluation of networks of randomized trials. Stat Methods Med Res, 2008,17(3):279-301.
10 Caldwell DM, Ades AE, Higgins JP. Simultaneous comparison of multiple treatments:combining direct and indirect evidence. BMJ,2005, 331(7521):897-900.
11 Mavridis D, Salanti G. A practical introduction to multivariate meta-analysis. Stat Methods Med Res, 2013, 22(2):133-158.
12 Brooks SP, Gelman A. General methods for monitoring convergence of iterative simulations. J Comput Graph Stat, 1997,7(4):434-455.
13 Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med, 2010, 29(7-8):932-944.
14袁虎,张俊.阿尔茨海默病采用中药治疗临床效果观察.中医临床研究,2017, 9(7):93-95.
15彭顺兰.安理申治疗阿尔茨海默病的临床研究.中国医药指南,2008,(8):41-42.
16赵瑾,王琳,贾晓军,等.美金刚治疗阿尔茨海默病的临床研究.重庆医学,2008, 37(7):712-713.
17陈美玲,关素芳,郑玉娥.个性化护理对改善老年痴呆患者生活能力的影响.现代诊断与治疗,2017,28(10):1940-1941.
18姜敏.个性化护理对老年痴呆患者的影响及效果探讨.中外医疗,2015, 34(16):146-147.
19李玲.护理干预对老年痴呆患者生活能力及生活质量的影响.中外医学研究,2016, 14(11):81-82.
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