老年性痴呆患者认知功能训练指南的系统评价

Guidelines on Cognitive Function Training of Alzheimer's Disease:A Systematic Review

目的评价有关老年性痴呆患者认知功能训练的指南质量,并提取相关推荐意见,以期为老年性痴呆患者临床认知功能训练提供依据。方法计算机检索国际指南联盟(GIN)、美国国家临床指南中心(NGC)、英国国家卫生和临床优化研究所(NICE)、加拿大安大略注册护士专业协会(RNAO)、苏格兰学院间指南网络(SIGN)、世界卫生组织(WHO)六大指南数据库,PubMed和Cochrane图书馆两大英文数据库,以及知网、万方、维普三大中文数据库,搜集老年性痴呆患者认知功能训练相关循证指南,期限为建库至2017年12月25日。纳入指南的质量通过指南研究与评价的评审工具(AGREE)Ⅱ进行评价。结果共纳入10部指南。指南质量评价者之间具有较好的一致性(组间相关系数0.98～1.00)。总体得分较高的维度为范围和目的;得分较低的维度为参与人员、清晰性、严谨性、应用性、独立性。共提取出20条推荐意见,分别围绕认知训练、认知刺激、认知康复等认知干预给出意见,一致性较好。结论纳入指南的质量不高,指南的应用性、严谨性和独立性维度得分甚低,不利于指南在临床中的应用,建议今后指南的制定应注重其质量。多部指南给出老年性痴呆患者的认知干预推荐,国内医务人员可结合临床,应用证据,推广认知干预。

Objective Appraise the quality of evidence?based guidelines on cognitive function training of Alzheimer??s disease(AD)and provide clinical references for the AD with cognitive impairment.Methods Guidelines concerning AD were searched from GIN(Guidelines International Network),NGC(National Guideline Clearinghouse),NICE(National Institution for Health and Clinical Excellence),RNAO(Registered Nurses??Association of Ontario),SIGN(Scottish Intercollegiate Guidelines Network),WHO(World Health Organization),PubMed,Cochrane,CNKI,WanFang Data and VIP from creating database date to December 25th 2017.Based on the AGREE(Appraisal of Guidelines Research and Evaluation)Ⅱ,quality of included guidelines were evaluated.Results A total of 10 guidelines were included.There was good consistency among quality evaluators of the guidelines(interclass correlation ceofficient 0.98~1.00).The domains with higher scores include scope and purpose,participants and clarity.Domains with lower scores are preciseness,applicability and independence.A total of 20 recommendations concerning cognitive training,cognitive stimulation,cognitive rehabilitation and other cognitive interventions were extracted,and consistency was good.Conclusion The quality of the included guidelines is general.The scores in applicability,preciseness and independence are low,which is not conducive to the implementation of the guidelines in clinical practice.It is suggested that future guidelines should pay more attention.Multiple guidelines recommend cognitive interventions for AD.Domestic medical staff can combine clinical practice,apply evidence,and popularize cognitive interventions.