计算机化适应性认知训练对轻度认知障碍患者的干预效果

Intervention effect of adaptive computerized cognitive training in patients with mild cognitive impairment

目的探讨计算机化适应性认知训练(adaptive computerized cognitive training,ACCT)对轻度认知障碍(mild cognitive impairment,MCI)患者的干预效果。方法选取轻度认知障碍患者114例(治疗组53例,观察组61例)。治疗组一般治疗合并计算机化适应性认知训练24周,停止训练后继续一般治疗24周,共计48周,观察组仅一般治疗48周。在0周、24周、48周对两组被试者使用简易智力状况检查法(mini-mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、数字广度测试(digital span test,DST)、日常生活能力量表、汉密顿抑郁量表17项(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表14项(Hamilton anxiety scale,HAMA)进行评估。统计分析使用SAS 9.4软件。数据采用χ^(2)检验、秩和检验、多水平模型分析进行统计分析。结果MMSE[治疗组:0周22.0(21.0,23.0)分,24周24.0(24.0,25.0)分,48周25.0(24.0,26.0)分;观察组:0周23.0(21.0,24.0)分,24周23.0(21.0,24.0)分,48周23.0(21.0,24.0)分]、MoCA[治疗组:0周18.0(17.0,20.0)分,24周22.0(20.0,23.0)分,48周22.0(20.0,24.0)分;观察组:0周19.0(17.0,20.0)分,24周19.0(18.0,20.0)分,48周19.0(18.0,20.0)分]、IADL[治疗组:0周11.0(10.0,13.0)分,24周12.0(10.0,12.0)分,48周12.0(10.0,12.0)分;观察组:0周12.0(11.0,13.0)分,24周11.0(10.0,12.0)分,48周11.0(10.0,12.0)分]、DST顺背、HAMD评分的组别×时间交互作用显著(均P<0.05),DST倒背组别主效应显著(P<0.05)。进一步简单效应分析:MMSE、MoCA、DST顺背组别和时间的影响均差异有统计学意义(均P<0.05),IADL、HAMD时间影响差异有统计学意义(P<0.05)。进一步比较各时间点间两组差值:治疗组MMSE、MoCA、DST顺背、DST倒背评分差值高于观察组,HAMD评分差值低于观察组,差异有统计学意义(P<0.05)。结论计算机化适应性认知训练对MCI患者的认知功能及抑郁情绪可起到持续的积极改善效果。

Objective To investigate the effect of the adaptive computerized cognitive training(ACCT)on patients with mild cognitive impairment(MCI).Methods A total of 114 patients with mild cognitive impairment(53 cases in the treatment group and 61 cases in the observation group)were selected.In the treatment group,routine treatment combined with ACCT were given for 24 weeks,then routine treatment only for 24 weeks,48 weeks altogether.In the observation group,routine treatment was given for 48 weeks.At week 0,24,48,both groups were assessed by scales including:mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA),numerical memory span test,activities of daily living,Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA).SAS 9.4 was used for statistical analysis.The data were analyzed byχ^(2) test,rank sum test and multi-level model analysis.Results Interactions between group and time on MMSE(treatment group:0 week 22.0(21.0,23.0),24 weeks 24.0(24.0,25.0),48 weeks 25.0(24.0,26.0);observation group:0 week 23.0(21.0,24.0),24 weeks 23.0(21.0,24.0),48 weeks 23.0(21.0,24.0)),MoCA(treatment group:0 week 18.0(17.0,20.0),24 weeks 22.0(20.0,23.0),48 weeks 22.0(20.0,24.0);observation group:0 week 19.0(17.0,20.0),24 weeks 19.0(18.0,20.0),48 weeks 19.0(18.0,20.0)),IADL(treatment group:0 week 11.0(10.0,13.0),24 weeks 12.0(10.0,12.0),48 weeks 12.0(10.0,12.0);observation group:0 week 12.0(11.0,13.0),24 weeks 11.0(10.0,12.0),48 weeks 11.0(10.0,12.0)),DST-forwards and HAMD scores were significant(all P<0.05),and DST-backwards had significant group main effect(P<0.05).Further simple effect analysis showed that the influence of group and time on MMSE,MoCA and DST-forwards were statistically significant(all P<0.05),and the influence of time on IADL and HAMD were statistically significant(both P<0.05).Further comparison of the difference between the two groups at each time point:D-value of MMSE,MoCA,DST-forwards,and DST-backwards score in the treatment group were higher than those in the observation group,while D-value of HAMD score was lower than that in the observation group,and the differences were statistically significant(all P<0.05).Conclusion ACCT may have long term effect on improving the cognitive function and depression of MCI patients.