计算机化认知功能训练对轻度认知功能障碍老年人的干预效果研究

Outcomes of computerized cognitive function training in elderly patients with mild cognitive impairment

背景计算机化认知训练以其精准化、多样化和个性化等特点逐渐成为预防和缓解轻度认知功能障碍(mild cognitive impairment,MCI)患者认知功能下降的重要方法。目的探讨不同次均训练时间和频率的计算机化认知训练改善MCI老年人认知功能和日常生活能力的作用。方法连续纳入2020年1-12月在解放军总医院第八医学中心记忆门诊就诊的≥60周岁军队离退休MCI老年人,按照随机数字法分为3组进行计算机化认知功能训练,G1组训练时长为30 min/次,每周3次;G2组训练时长为18 min/次,每周5次;G3组训练时长、次数不限,但是周时长共计90 min。训练14周,总训练时长为21 h。训练前及训练14周结束时,分别应用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、简易智力精神状态量表(min-mental state examination,MMSE)、日常生活能力评定量表(activity of daily living scale,ADL)对三组患者进行评价,比较三组患者在认知功能和日常生活能力方面的变化。结果共纳入90例MCI患者,每组30例,研究过程中G2组退出4例,G3组退出4例,病情加重无法继续实施训练1例,脱落患者占10%,最终完成认知训练81例。G1组男14例,女16例,平均年龄(71.13±8.37)岁;G2组男11例,女14例,平均年龄(73.40±9.39)岁;G3组男10例,女16例,平均年龄(68.89±5.71)岁。三组患者基线资料差异无统计学意义。干预前三组MoCA、MMSE、ADL得分差异无统计学意义,训练14周后三组MoCA、MMSE、ADL均显著改善,差异有统计学意义(P<0.05)。训练后组间比较,G1组MMSE得分显著高于G2组(P<0.05),其他组间比较差异均无统计学意义(P>0.05)。结论通过计算机开展认知训练可有效改善MCI患者整体认知功能、提高日常生活能力。训练量和训练持续时间是保证计算机化认知干预效果的关键。

Background Computerized cognitive training has gradually become an important method to prevent and alleviate the cognition decline of patients with mild cognitive impairment(MCI)due to its unique characteristics of precision,diversification and individualization.Objective To explore the effect of computerized cognitive training with different training duration and frequency on the improvement of the cognitive function and daily life ability of the elderly with MCI.Methods Military retirees(≥60 years)who admitted to the Memory Clinic of the Eighth Medical Center of Chinese PLA General Hospital from January to December in 2020 were continuously enrolled.Patients were divided into three groups by random number method,and received different computer-based cognitive training programs.The training time of G1 group was 30 min per time,3 times a week;G2 group 18 min per time,5 times a week;The training time in G3 group was unlimited,but the total training duration was 90 min.The program lasted for 14 weeks with the total training duration of 21 hours.Before and after 14 weeks of training,patients in the three groups were evaluated using MoCA,MMSE,and ADL scales,and the changes in cognitive function and ADL of the three groups were compared.Results A total of 90 MCI patients were enrolled,with 30 cases in each group.During the study,4 cases in G2 group and4 cases in G3 group quitted,and symptom worsen in one case and he was unable to continue training.The dropped-out patients accounted for 10%,and finally 81 patients completed cognitive training.There were 14 males and 16 females in the G1 group,with an average age of(71.13±8.37)years;11 males and 14 females in the G2 group,with an average age of(73.40±9.39)years;10 males and 16 females in the G3 group,with an average age of(68.89±5.71)years.No statistically significant difference in baseline data between the three groups was found,including MoCA,MMSE,and ADL.After 14 weeks of training,the MoCA,MMSE,ADL scores in the three groups increased significantly compared to those before intervention(all P<0.05).After training,the MMSE score in the G1 group was significantly higher than that of the G2 group(P<0.05),and there was no statistically significant difference in other indicators between the three groups(P>0.05).Conclusion Computer-based cognitive training can effectively improve the overall cognitive function and ADL in elderly patients with MCI.The amount of training and certain frequency are the key to ensure the effect of computerized cognitive intervention.