沉浸式虚拟现实认知训练对认知障碍患者干预效果的系统评价

Effects of immersive virtual reality-based cognitive training for people with cognitive impairment:a systematic review

目的评价沉浸式虚拟现实(immersive virtual reality,IVR)认知训练对主观认知下降(subjective cognitive decline,SCD)、轻度认知障碍(mild cognitive impairment,MCI)、阿尔茨海默病(Alzheimer’s disease,AD)患者认知功能、日常生活活动能力和负性情绪的影响。方法计算机检索Pubmed、Embase、CINAHL、PsycINFO等11个中英文数据库和临床试验注册平台,检索时限为从建库至2021年4月27日。纳入IVR认知训练对SCD、MCI、AD患者认知功能等的干预效果的随机对照试验和类实验性研究。由2名研究者独立进行文献筛选、资料提取、文献质量评价后,采用RevMan 5.4进行Meta分析。结果共纳入8篇文献,包括406例患者。Meta分析结果显示,IVR认知训练有助于改善MCI或AD患者的总体认知功能[SMD=0.37,95%CI(0.15,0.60),P=0.001],短期记忆[SMD=0.62,95%CI(0.19,1.04),P=0.005],日常生活活动能力[SMD=0.84,95%CI(0.57,1.11),P<0.001],但在执行功能[SMD=-0.24,95%CI(-0.56,0.08),P=0.140],长期记忆[SMD=0.00,95%CI(-0.42,0.41),P=0.990]方面差异无统计学意义,在负性情绪方面的干预效果尚不明确。此外,目前尚缺乏IVR认知训练对SCD人群的干预研究。结论IVR认知训练有助于改善MCI或AD患者的认知功能和日常生活活动能力。受纳入研究数量的限制及干预任务有一定的异质性,上述结论尚待更多大样本研究进行验证。此外,IVR认知训练在SCD人群中的干预效果尚待探索。

Objective To evaluate the impact of immersive virtual reality(IVR)-based cognitive training on the cognitive function,activity of daily living(ADL)and negative emotion for people with subjective cognitive decline(SCD),mild cognitive impairment(MCI)or Alzheimer’s disease(AD).Methods 11 electronic databases,such as PubMed,Embase,CINAHL etc.,and clinical trials registry platforms were searched for related articles published in English and Chinese from inception until April 27th,2021.We retrieved randomized controlled trials or quasi-experience studies focused on IVR-based cognitive training in adults with SCD,MCI or AD.Literature search,study selection,data extraction and methodological quality evaluation were conducted by 2 researchers independently.Meta-analysis was performed by RevMan 5.4.Results 8 studies involving 406 patients were included.Meta-analysis indicated that IVR-based cognitive training significantly enhanced the overall cognition[SMD=0.37,95%CI(0.15,0.60),P=0.001],short-term memory[SMD=0.62,95%CI(0.19,1.04),P=0.005]and ADL[SMD=0.84,95%CI(0.57,1.11),P<0.001]in people with MCI or AD.However,after IVR-based cognitive training,effects on executive function[SMD=-0.24,95%CI(-0.56,0.08),P=0.140]and long-term memory[SMD=0.00,95%CI(-0.42,0.41),P=0.990]were not statistically significant in people with MCI or AD,and effects on negative emotion was unclear.Moreover,there was a paucity of intervention studies on IVR-based cognitive training for SCD.Conclusion This meta-analysis suggests that IVR-based cognitive training can provide positive influences on cognitive function and ADL in people with MCI or AD.Due to limited quantity and different interventions of the included studies,more studies with larger sample sizes are required to verify the above conclusions.Moreover,more studies are needed to explore the effects of IVR-based cognitive training for people with SCD.