轻度老年认知障碍的非药物整合式干预:单个案研究

Non-pharmacological Integrated Interventions in Older Adults with Mild Cognitive Impairment:a Single Case Pilot Study

背景认知障碍可导致老年人认知功能下降、抑郁、孤独感,以及自我效能感和生活质量的下降。目的探讨非药物整合式干预对轻度老年认知障碍患者认知功能、抑郁、孤独感、自我效能感和生活质量的干预效果。方法基于认知障碍的风险因素研发了认知功能训练、身体运动、情绪管理、社会连结、健康生活习惯5个维度的非药物整合式干预方案,采用A-B-A单个案受试者设计,于2021年6—12月展开对3名确诊为轻度认知障碍的老年人进行为期3个月,1次/周,60 min/次的干预。于基线、干预3个月后、干预结束后3个月时采用蒙特利尔认知评估量表(MoCA)、自我效能感量表(GSES)、简版生活质量量表(SF-12)、简版老年抑郁量表(GDS-15)、中文版孤独量表(DJGLS)从认知功能、自我效能感、生活质量、抑郁情绪、孤独感5个维度评估3名老年人各量表得分并分析其变化。并在干预结束后3个月进行半结构式访谈,从认知功能、生活质量、抑郁情绪、自我效能感和孤独感维度评估干预效果。结果纳入研究的3名老年人年龄为74、70、73岁,均已婚、与配偶和孙辈共同居住。3名老年人的MoCA基线得分为21、22、24分,干预3个月后为28、26、27分,干预结束后3个月为25、19、23分;GSES基线得分为25、30、27分,干预3个月后为29、29、30分,干预结束后3个月为28、31、28分。SF-12基线时得分为69、32、51分,干预3个月后为81、81、83分,干预结束后3个月为78、38、59分。GDS-15基线得分为4、8、2分,干预3个月后为2、6、1分,干预结束后3个月为1、8、4分。DJGLS基线得分为8、7、8分,干预3个月后为5、5、4分,干预结束后3个月为5、5、7分。半结构访谈资料表明,受试者在认知功能、生活质量、抑郁情绪、孤独感、自我效能感5个维度均有改善。结论对于患有轻度老年认知障碍的受试老年人而言,从认知功能训练、身体运动、情绪调节、社会连结、健康生活习惯5个维度开展非药物整合式的干预是有意义的,轻度老年认知障碍老年人的MoCA、SF-12、GDS-15、DJGLS得分在干预3个月后均有改善,GSES得分在干预后效果不理想,所有维度得分在干预结束后3个月呈递减趋势。

Background Cognitive impairment can lead to a decline in cognitive function,depression,and loneliness,as well as decreased self-efficacy and quality of life in older adults.Objective To investigate the effects of nonpharmacological integrated interventions on cognitive function,depression,loneliness,self-efficacy,and quality of life in older adults with mild cognitive impairment.Methods Based on risk factors for cognitive impairment,a non-pharmacological integrated intervention program was developed in five dimensions of cognitive training,physical exercise,emotional management,social connection,and healthy lifestyle habits.Using a single-subject A-B-A experimental design,a 3-month intervention,which was conducted once a week for 60 minutes,was performed in three elderly individuals with mild cognitive impairment from June to December 2021.The Montreal Cognitive Assessment(MoCA),Geriatric Depression Scale-15(GDS-15),12-item Short Form Health Surve(y SF-12),General Self-Efficacy Scale(GSES),and De Jong Gierveld Loneliness Scale(DJGLS)were administered to the 3 older adults at baseline,3 months of the intervention,and 3 months after the intervention,to assess the scores of each scale from the 5 dimensions of cognitive function,self-efficacy,quality of life,depression,and loneliness,the changes in the scores were analyzed.A semi-structured interview was conducted 3 months after the intervention to evaluate the intervention effects in terms of cognitive function,quality of life,depression,self-efficacy,and loneliness dimensions.Results The 3 older adults included in the study were 74,70,73 years old,all married,living with their spouses and grandchildren.The three older adults had MoCA scores of 21,22,and 24 at baseline,28,26,and 27 at 3 months of intervention,and 25,19,and 23 at 3 months after intervention;GSES scores were 25,30,and 27 at baseline,29,29,and 30 at 3 months of intervention,and 28,31,and 28 at 3 months after intervention.SF-12 scores were 69,32,and 51 at baseline,81,81,and 83 at 3 months of intervention,and 78,38,and 59 at 3 months after intervention.The GDS-15 scale scores were 4,8,and 2 at baseline,2,6,and 1 at 3 months of intervention,and 1,8,and 4 at 3 months after intervention.The DJGLS scores were 8,7,and 8 at baseline,5,5,and 4 at 3 months of intervention,and 5,5,and 7 at 3 months after intervention.Semi-structured interview data indicated improvement in all five dimensions of cognitive function,quality of life,depression,loneliness,and self-efficacy of the subjects.Conclusion For older adults with mild cognitive impairment,it is of great significance to perform a non-pharmacological integrated intervention in terms of cognitive training,physical exercise,emotional management,social connection,and healthy lifestyle habits.The MoCA,SF-12,GDS-15,and DJGLS scores of older adults with mild cognitive impairment improved at 3 months of intervention,while the GSES scores improved at 3 months after intervention.GSES scores were not as effective after the intervention.All dimension scores showed a decreasing trend at 3 months after the intervention.