认知干预对血管性痴呆患者作用效果的Meta分析

Efficacy of cognitive intervention in patients with vascular dementia:a Meta-analysis

目的系统评价认知干预对血管性痴呆患者的整体认知功能、记忆力和日常生活能力的影响。方法计算机检索PubMed、Embase、JBI Library、Cochrane Library、CINAHL、APA PsyCNET、中国知网、万方等数据库,收集其中收录的自2000年1月至2017年12月公开发表的关于血管性痴呆患者进行认知干预与常规干预比较的随机对照试验(RCT)文献。依据纳入与排除标准筛选文献,并提取资料及评价文献质量。采用RevMan 5.3软件进行Meta分析,采用Stata11.0软件进行敏感性分析及采用Begg’s检验进行发表偏倚分析。结果研究共纳入14篇RCT文献。Meta分析结果显示,与常规干预相比,认知训练[均数差(MD)=2.07,95%CI:1.29~2.86,P=0.000]、认知刺激(MD=1.63,95%CI:0.61~2.65,P=0.002)与认知康复(MD=3.36,95%CI:1.94~4.79,P=0.000)均有利于提高血管性痴呆患者的整体认知功能,认知干预能提高血管性痴呆患者的记忆力(MD=5.53,95%CI:1.09~9.97,P=0.010)和日常生活能力(MD=2.85,95%CI:0.95~4.74,P=0.003)。敏感性分析提示结果较稳定,Begg’s检验显示未见明显发表偏倚。结论认知干预有利于提高血管性痴呆患者的整体认知功能、记忆力和日常生活能力。

Objective To evaluate the efficacy of cognitive intervention in general cognitive function,memory ability and ability of daily life in patients with vascular dementia by systematic review. Methods The randomized controlled clinical trials(RCTs)comparing cognitive intervention versus general measurement in patients with vascular dementia were collected through databases,such as PubMed,Embase,JBI Library,Cochrane Library,CINAHL,APA PsyCNET,CNKI and Wanfang Data,from January 2000 to December 2017.The reviewers extracted the data and assessed the quality.And then,RevMan 5.3 software was used for Meta-analysis.Sensitivity analysis and publication bias analysis were performed using Stata 11.0 software and Begg's inspection. Results Fourteen RCTs were included.Meta-analysis showed that as compared with general measurement,cognitive training(mean difference[MD]=2.07,95%CI:1.29-2.86,P=0.000),cognitive stimulation(MD=1.63,95%CI:0.61-2.65,P=0.002)and cognitive rehabilitation(MD=3.36,95%CI:1.94-4.79,P=0.000)were proved to be effective in improving the general cognitive function.The application of cognitive intervention in patients with vascular dementia could contribute to memory ability(MD=5.53,95%CI:1.09-9.97,P=0.010)and ability of daily life(MD=2.85,95%CI:0.95-4.74,P=0.000).The sensitivity analysis for studies enrolled in Meta-analysis showed that individual research results were stable,and no significant publication bias was found by Begg's inspection. Conclusion Cognitive intervention in patients with vascular dementia could contribute to their general cognitive function,memory ability and ability of daily life.