基于老年综合评估的个体化康复训练对阿尔茨海默病患者认知功能、风险防范的影响

Effects of individualized rehabilitation training based on comprehensive geriatric assessment on cognitive function and risk prevention of patients with Alzheimer's disease

目的构建基于阿尔茨海默病(AD)患者老年综合评估(CGA)的个体化康复训练干预模式,并从认知功能、风险防范等角度进行成效分析。方法采用前瞻性随机对照研究,选取220例AD患者为研究对象,按照随机数字表法将患者均分为对照组(110例)和观察组(110例)。对照组给予常规药物治疗及康复训练,观察组增加基于CGA的个体化康复训练干预。比较2组干预前、干预3个月后的认知功能[阿尔茨海默病痴呆评定量表(ADASCog)、简易精神状态量表(MMSE)],风险防范[美国约翰霍普金斯跌倒量表(JHFRAT)、激越行为量表(CMAI)],心境状态[心境状态量表(POMS)],躯体功能[Berg平衡量表(BBS)、Barthel指数评定量表(BI)]变化。结果干预3个月后,观察组患者ADAS-Cog、JHFRAT、CMAI量表评分显著降低,MMSE量表、BBS量表评分显著升高(P<0.01),对照组干预前后比较无统计学意义(P>0.05)。干预3个月后,2组患者POMS量表活动-好动分量表、BI量表评分显著升高(P<0.01),而POMS量表中紧张-焦虑、忧郁-沮丧、愤怒-敌意、疲惫-惰性、困惑-迷惑分量表评分显著降低(P<0.01),观察组变化更明显(P<0.01)。结论基于CGA的个体化康复训练干预AD患者,可对其认知功能、跌倒风险、激越行为、心境状态、躯体功能等方面产生积极影响,是一种值得推广的模式。

Objective To construct an individualized rehabilitation training intervention model based on comprehensive geriatric assessment(CGA)for patients with Alzheimer's disease(AD),and perform the effect analysis from the perspectives of cognitive function and risk prevention.Methods According to the prospective randomized controlled study,220 patients with AD were selected as the research subjects.Patients were equally divided into control group(n=110)and observation group(n=110)by the random number table method.The control group was given conventional medication therapy and rehabilitation training,and the observation group was additionally given individualized rehabilitation training intervention based on CGA.Data of the cognitive function[Alzheimer's Disease Assessment Scale-Cognitive Subscale(ADAS-Cog),Mini-Mental State Examination(MMSE)],risk prevention[Johns Hopkins Fall Risk Assessment Tool(JHFRAT),Cohen-Mansfield Agitation Inventory(CMAI)],mood state[Profile of Mood States(POMS)],physical function[Berg Balance Scale(BBS)and Barthel index(BI)]before intervention and after 3-month intervention were compared between the two groups.Results After 3 months of intervention,the scores of ADAS-Cog scale,JHFRAT scale and CMAI scale were significantly reduced in observation group(P<0.01),while the scores of MMSE scale and BBS scale were significantly increased(P<0.01).There were no significant differences in the above indexes before and after intervention in control group(P>0.05).After 3 months of intervention,the scores of activity-hyperactivity subscale of POMS scale and BI scale were significantly increased in the two groups of patients(P<0.01),while the scores of subscales(tension-anxiety,melancholy-depression,anger-hostility,exhaustion-indolence,bewilderment-confusion)of POMS scale were significantly reduced(P<0.01),and the changes were more significant in observation group(P<0.01).Conclusion CGA-based individualized rehabilitation training intervention for patients with AD has a positive impact on cognitive function,fall risk,agitation behavior,mood state and physical function,which is worthy of promotion.