音乐治疗对轻度阿尔茨海默病患者记忆、语言和精神症状的作用

The effect of music therapy on memory, language and psychological symptoms of patients with mild Alzheimer＇s disease

目的 评价音乐治疗对轻度阿尔茨海默病（AD）患者记忆力、语言功能和精神症状的作用.方法 收集2012年1月至2014年4月就诊于北京老年医院记忆门诊的轻度AD患者93例,按照随机数字表法随机分为音乐治疗组（A组,32例）、歌词对照组（B组,31例）和空白对照组（C组,30例）.A组在音乐治疗师指导下跟唱熟悉的老歌;B组朗读与音乐治疗组歌曲一致的歌词,无音乐.两组均每日1次,每次30 min,持续3个月,之后随访3个月.C组按常规诊疗,无特殊干预.所有受试者在基线期（t0）、3个月（t1）、6个月（t2）时接受相关神经心理学测验.结果 A组世界卫生组织-加利福尼亚听觉词语测试（WHO-UCLA AVLT）即刻回忆得分（分）t1（7.38±1.45）及t2（7.24±1.42）均高于t0（6.81±1.40）,差异有统计学意义（t=3.79、t =3.62,P＜0.05）.A组WHO-UCLAAVLT延迟回忆得分（分）t1高于t0（6.51±1.52与5.88±1.34,t=4.06,P＜0.05）.词语流畅性测试得分（分）t1时A组（8.63±1.94）和B组（8.58±1.75）均高于C组（7.54±2.03）,差异有统计学意义（t =5.57、t=2.48,P＜0.05）;t2时A组（8.45±1.69）高于B组（7.89±1.74）和C组（7.43±1.52）,差异有统计学意义（t=2.37、t =4.55,P＜0.05）;A组t1（8.63±1.94）及t2（8.45±1.69）均高于t0 （7.62±1.70）,差异有统计学意义（=3.92、t =3.65,P＜0.05）;B组t1高于t0（8.58±1.75与7.68±1.76,t=3.31,P＜0.05）.A组神经精神问卷评分（分）t1（13.52±11.63）及t2（13.01±11.72）均低于t0（16.37±11.72）,差异有统计学意义（t=33.07、t=29.65,P＜0.05）.A组照料者苦恼程度得分（分）t1（16.43±11.90）及t2（15.02±10.56）均低于t0 （21.72±12.88）,差异有统计学意义（t=32.44、t =31.68,P＜0.05）.结论 音乐治疗可增强轻度AD患者记忆能力和语言功能,减轻精神症状和照料者的苦恼程度.演唱歌曲效果优于朗读歌词.

Objective To explore the effect of music therapy on memory,language,and psychological symptoms of patients with mild Alzheimer＇ s disease （AD）.Methods Ninety-three patients with mild AD from Beijing Geriatric Hospital between January 2012 and April 2014 were recruited and divided randomly into three groups：music therapy group （group A,n =32）,lyrics control group （group B,n =31）,and blank control group （group C,n =30）.Patients in group A sung familiar lyrics,while patients in group B read the same lyrics without music,supervised by music therapist for 30 minutes every day over a period of three months.All participants were followed up for another three months.Patients in group C received no special intervention except routine treatment.All participants completed scheduled neuropsychological tests on baseline （t0）,three months later （t1）,and six months later （t2）.Results The World Health Organization-University of California Los Angeles Auditory Verbal Learning Test （WHO-UCLA AVLT） scores of immediate recall at t1 （7.38 ± 1.45） and t2 （7.24 ± 1.42） were both higher than that at t0 （6.81 ± 1.40） in group A （t =3.79,t =3.62,P ＜ 0.05）.WHO-UCLA AVLT score of delayed recall at t1 was higher than that at t0 in group A （6.51 ± 1.52 vs 5.88 ± 1.34,t =4.06,P ＜ 0.05）.In verbal fluency test,group A （8.63 ± 1.94） and group B （8.58 ± 1.75） scored higher than group C （7.54 ± 2.03） at t1 （t =5.57,t =2.48,P ＜ 0.05） ; Group A （8.45 ± 1.69） scored higher than group B （7.89 ± 1.74） and group C （7.43 ± 1.52） at t2 （t =2.37,t =4.55,P ＜ 0.05） ; Group A scored higher at t1（8.63±1.94） andt2（8.45±1.69）,compared with that at t0（7.62±1.70,t=3.92,t=3.65,P＜0.05） ; Group B scored higher at t1 compared with that at t0 （8.58 ± 1.75 vs 7.68 ± 1.76,t =3.31,P ＜0.05）.Group A scored lower at t1 （13.52 ± 11.63） and t2 （13.01 ± 11.72）,compared with that at t0 （16.37 ± 11.72） in neuropsychiatric inventory score （t =33.07,t =29.65,P ＜ 0.05）.Group A scored lower at t1 （16.43 ± 11.90） and t2 （15.02 ± 10.56）,compared with that at t0 （21.72 ± 12.88） in Caregiver Distress Scale （t =32.44,t =31.68,P ＜ 0.05）.Conclusions Music therapy significantly enhances memory and language ability of patients with mild AD.It relieves the psychological symptoms and reduces caregiver distress.Training of singing lyrics is superior to reading lyrics.