简单反应速度训练对轻度认知障碍老年人执行功能的影响

Effect of Simple Reaction Speed Training on Executive Function of the Elderly with Mild Cognitive Impairment

目的:观察简单反应速度训练对轻度认知障碍(MCI)老年人执行功能的影响。方法:于2016年1月—2018年6月在成都市新都区采用方便抽样的方法选择MCI老年人64例,按照随机数字表法分为对照组和观察组,每组32例。对照组每2周进行1次轻度认知障碍健康教育宣教,连续干预3个月。观察组在对照组的基础上进行简单反应速度训练。(1)分解训练:平地行走、上下楼梯和跨越障碍分解训练,10次/组,2组/d。(2)完整训练:平地行走、上下楼梯完整训练,10次/组,1组/d;跨越障碍完整训练,5次/组,1组/d。(3)变换训练:根据口令指示或信号灯指示,受试者做出相应动作或与指令相反的动作,3次/组,1组/d。(4)运动感觉训练:进行平地行走、上下楼梯和跨越障碍训练的单次训练,3次/组,1组/d。每次训练时间为30~40 min,1次/d,5次/周,共持续干预3个月。分别在干预前后采用执行功能行为评定量表成人版(BRIEF-A)自评问卷[行为管理指数(BRI)、元认知指数(MI)]、执行功能缺陷综合征的行为学评价测验(BADS)[规则转换卡片测验(RSCT)、动作计划测验(APT)、找钥匙测验(KST)、时间判断测验(TJT)、动物园分布图测验(ZMT)、修订的六元素测验(MSET)]和连线测验(TMT)评价患者执行功能情况;采集血液标本使用酶联免疫吸附法(ELISA)进行血清脑源性神经营养因子(BDNF)水平检测。结果:与干预前比较,观察组干预3个月后转换、工作记忆、计划、任务监控、MI、总分评分和TMT-B、干扰量水平均明显降低,观察组KST、TJT、ZMT、总标准分和血清BDNF水平均明显升高(P<0.05);与对照组比较,观察组转换、任务启动、工作记忆、计划、BRI、MI、总分评分和TMT-A、TMT-B、干扰量水平均明显更低,观察组RSCT、KST、TJT、ZMT、总标准分和血清BDNF水平均明显更高(P<0.05)。结论:简单反应速度训练可提高MCI老年人执行功能、脑神经功能,有效延缓认知衰退。

Objective:To observe the effect of simple reaction speed training on executive function of the elderly with mild cognitive impairment(MCI).Methods:A total of 64 elderly with MCI were selected by convenient sampling method from Xindu district of Chengdu City from January 2016 to June 2018,which were randomly divided into the control group and the observation group,with 32 cases in each group.The control group only received MCI health education,once every two weeks,continuous intervention for three months.The observation group received simple reaction speed training on the basis of the control group.①Decomposition training:walking on flat ground decomposition training,going up and down stairs decomposition training,crossing obstacles decomposition training,10 times a group,two groups a day.②Complete training:walking on flat ground complete training,going up and down stairs complete training,10 times a group,one group a day;crossing obstacles complete training,five times a group,one group a day.③Change training:according to the instruction of command or signal light,the subject makes corresponding actions or actions contrary to the instruction,three times a group,one group a day.④Sense of movement training:single training of walking on flat ground training,going up and down stairs training and crossing obstacles training,three times a group,one group a day.Each training time was 30-40 min,once a day,five times a week,continuous intervention for three months.The behavior rating inventory of executive function-adult version[BRIEF-A,including behavior regulation index(BRI),metacognitive index(MI)],behavioral assessment of dysexecutive syndrome[BADS,including rule switching card test(RSCT),action plan test(APT),key seek test(KST),time judgment test(TJT),zoo map test(ZMT),modified six-element test(MSET)]and trail making test(TMT,including TMT-A and TMT-B)were used to evaluate the executive function of patients with MCI before and after intervention,respectively.Moreover,the serum brain-derived neurotrophic factor in the blood before and after intervention was detected by using enzyme linked immunosorbent assay(ELISA),respectively.Results:Compared with before intervention,the scores of conversion,working memory,planning,task monitoring,MI,total standard scores,TMT-B and interference in the observation group after intervention for three months were significantly lower,KST,TJT,ZMT,total standard scores and level of serum BDNF of the observation group after intervention were significantly higher(P<0.05);compared with the control group,the scores of conversion,task initiation,working memory,planning,BRI,MI,total standard scores,TMT-B and interferences of the observation group were significantly lower,and RSCT,KST,TJT,ZMT,total standard scores and level of serum brain-derived neurotrophic factor(BDNF)of the observation group were significantly high(P<0.05).Conclusion:Simple reaction speed training can improve the executive function,brain nerve function,and effectively delay cognitive decline of elderly with MCI.