不同社区干预模式对痴呆患者认知功能的作用

The effects of different community intervention model for the cognitive function of dementia patients

目的了解不同的社区干预模式对痴呆患者认知功能的作用。方法将222例痴呆或轻微认知功能损害患者,分为综合干预组(16例)、心理社会干预组(29例)和对照组(177例),心理社会干预组采用心理社会干预,综合干预组则另加药物干预,对照组只进行日常看护工作。在干预开始时、干预后3个月、干预后6个月,分别评定各组患者的认知功能。结果综合干预组简易智力状况检查量表(MMSE)、数字广度测验(DS)评分较基线升高[干预前后差值:MMSE:(-2.800±2.111)分,P<0.01;DS:(-2.077±2.565)分,P<0.05],对照组MMSE、积木测验(BD)评分较基线降低[干预前后差值:MMSE:(0.788±2.587)分,P<0.01;BD:(0.642±2.670)分,P<0.05],综合干预组较之心理社会干预组和对照组,MMSE评分升高更多,差异有显著性。结论在社区支持网络中,药物联合心理社会干预的效果最佳,单纯心理社会干预的效果次之,对照组呈逐渐恶化趋势。

Objective To examine the effects of different community intervention model for the cognitive of demented patients in community. Methods The sample was composed of 222 patients with dementia or mild cognitive impairment. They were divided into 3 groups： the control group （ n = 177） received no special intervention, while the psychosocial interventions group （ n = 29） received psychosocial intervention alone, and the integrated group （ n = 16） received both psychosocial intervention and pharmaceutical intervention. Cognitive level of the patients was assessed at baseline, the end of the 3rd and 6th month. Results Compared with baseline, the integrated group showed a significant increment in the scores of MMSE and DS （ difference ： MMSE. - 2. 800 ± 2.111, P 〈 0.001 ; DS ： - 2. 077 ± 2.565, P 〈 0. 05）. For the control group, some expected results were found, including a significant decrease in the scores of MMSE and BD （difference： MMSE ：0.788 ± 2. 587, P 〈 0.01 ;BD： 0. 642± 2. 670, P〈 0.05）. Compared with the psychosocial interventions group and the control group, the integrated group also presented with interesting results, the differences of MMSE was negative, which implied a increase in their scores of MMSE （ mean difference = - 3. 050, P 〈 0. 001 ; mean difference = - 3. 598, P 〈 0. 001, respectively）. Conclusion In the community support system, the cognitive level of patients in the control group deteriorated gradually, the effects of the psyehosocial interventions group were acceptable, while the effectiveness of the integrated group was better than that of the psyehosocial interventions group.