阿尔茨海默病患者应用3R疗法延缓认知功能减退的研究

The research of 3R therapy improving cognitive of patients with Alzheimer＇s disease

目的 评价Reminiscence（往事回忆）,Reality Orientation（现实定向）和Remotivation（再激发）的3R疗法对延缓阿尔茨海默病患者认知功能减退的效果.方法 本研究选取阿尔茨海默病患者34例,进行神经心理学指标[简易精神状态量表（MMSE）、日常生活能力量表（ADL）、社会功能活动调查（FAQ）、神经精神量表（NPI）]、P300的基线评定,完全随机分为2组,各17例,对照组给予常规治疗,治疗组在常规治疗基础上采用3R疗法进行认知功能训练.在开始实施训练后的第3、6个月时分别对治疗组和对照组患者进行各项指标的评定与分析.结果 治疗组经过3、6个月的3R训练后ADL、FAQ、NPI评分减低（P＜0.01,P＜0.05）,明显低于对照组[3个月：（37.4±4.2）比（36.4±3.2）,（15.5±2.3）比（14.8 ±2.3）,（13.5±1.1）比（12.3±1.1）；6个月：（32.0±2.0）比（37.5±3.2）；（12.0±1.1）比（14.2±2.1）,（10.2±1.2）比（12.1±1.9）；P＜0.05]；MMSE评分有改善,但差异无统计学意义（P＞0.05）；P300潜伏期缩短,波幅增加（P＜0.01）.结论 3R疗法能有效提高阿尔茨海默病患者的生活自理能力、社会活动能力,延缓其认知功能减退.

Objective To systematically evaluate the effects of the 3R therapy with reminiscence, reality o- rientation and remotivation on cognitive decline of patients with Alzheimer＇s disease via neuropsychological assessment and the determination of event-related potential P300. Methods In this study, experimental study design, selected Thirty-four cases of Alzheimer＇s disease were chosen, were assessed on neuropsyehologieal indicators [（Mini- Mental State Examination （MMSE）, ability of daily living scale （ADL）, functional activities questionnaire （FAQ）, Neuropsychiatric Inventory （NPI）] and event-related potential P300, and were divided into control group and treatment group at random. The control group received conventional therapy and the treatment group were given 3R therapy treatment based on the use of the cognitive training. After 3 months and 6 months of training, the indica- tors in the treatment group and control group were assessed and analyzed. Results Treatment group and control group had no significant differences in MMSE, ADL, FAQ, NPI before training （P 〉 0. 05）. ADL, FAQ and NPI scores in treatment group decreased （ P 〈 0. 01 ,P 〈 0. 05 ） significantly more than control group [after three months ： （37.4±4. 2） scores vs （36.4±3.2） scores, （ 15.5±2. 3 ） scores vs （ 14. 8± 2. 3 ） scores, （ 13.5±1.1 ） scores vs （12.3±1.1） scores; after six months： （32.0±2.0） scores vs （37.5±3.2） scores; （12.0 ±1.1）scores vs （ 14. 2±2. 1 ） scores, （ 10. 2±1.2） scores vs （ 12. 1±1.9） scores ; P 〈 0. 051 ; MMSE score was improved but the difference was not statistically significant（ P 〉 0. 05 ） ; latency P300 in treatment group was shortened and amplitude increased （P 〈 0. 01 ）. Conclusion 3R can effectively improve both the daily living and social skill, and slow cognitive decline of patients with Alzheimer＇s disease.