七种非药物干预对认知衰退老年人认知功能改善效果的贝叶斯网状Meta分析

Effectiveness of seven non-pharmacological interventions to improve cognitive function in aged adults with cognitive decline:a Bayesian network meta-analysis

目的 评价不同的非药物干预对认知衰退老年人认知功能的效果,为改善认知衰退老年人的认知功能提供参考。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、维普、万方、中国生物医学文献数据库有关非药物干预认知衰退老年人的随机对照试验,检索时限均从建库至2023年10月9日。由2名评价员独立筛选文献、提取信息并采用RevMan 5.4软件进行文献偏倚风险评价,Stata 16.0、R 4.3.0软件进行网状Meta分析。结果 共纳入27篇文献,涉及2 149例老年患者、7种干预方案;文献质量A级8篇,B级19篇。网状Meta分析显示,以蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)为评价指标,虚拟现实[均数差(mean difference, MD)=6.01分,95%置信区间(confidence interval, CI)(0.90,10.75)分]、认知训练[MD=4.99分,95%CI(0.56,9.12)分]、运动训练[MD=3.88分,95%CI(0.47,7.27)分]优于社区服务,运动训练优于常规护理[MD=3.05分,95%CI(0.92,5.12)分],差异均有统计学意义(P<0.05);以简易智力状态检查量表(Mini-Mental State Examination, MMSE)为评价指标,多模式运动[MD=3.00分,95%CI(0.89,4.96)分]、认知训练[MD=2.50分,95%CI(0.27,4.82)分]、中国传统运动[MD=2.30分,95%CI(0.34,4.28)分]、心理疗法[MD=1.76分,95%CI(0.56,2.96)分]、运动训练[MD=1.36分,95%CI(0.18,2.59)分]优于常规护理,多模式运动[MD=3.32分,95%CI(0.62,5.81)分]、认知训练[MD=2.82分,95%CI(0.75,4.90)分]、中国传统运动[MD=2.63分,95%CI(0.08,5.13)分]优于社区服务,差异均有统计学意义(P<0.05)。累计概率排序结果显示,在提高MoCA方面,虚拟现实为最佳干预措施的概率最大(0.863);在提高MMSE方面,多模式运动为最佳干预措施的概率最大(0.868)。结论 以MoCA为评价指标,虚拟现实可能为最佳非药物干预措施;以MMSE为评价指标,多模式运动可能为最佳非药物干预措施。

Objective To evaluate the effect of different non-pharmacological interventions on the cognitive function of elderly people with cognitive decline,and provide useful reference for improving cognitive function of the elderly.Methods Computer searches of PubMed,Embase,the Cochrane Library,Web of Science,China National Knowledge Infrastructure,VIP Database,Wanfang Data,and China Biomedical Literature Database for randomized controlled trials on non-pharmacological interventions for aged adults with cognitive decline were conducted,all with a search time frame from database inception to October 9th,2023.Literature screening,information extraction and bias risk assessment using RevMan 5.4 software were performed by two evaluators independently,and Stata 16.0 and R 4.3.0 software was used for network meta-analysis.Results A total of 27 articles involving 2149 elderly patients and 7 intervention protocols were included. Among the 27 articles, 8 were graded A and 19 were graded B for quality. Thenetwork meta-analysis revealed that, using the Montreal Cognitive Assessment (MoCA) as the evaluating metric, virtualreality [mean difference (MD)=6.01, 95% confidence interval (CI) (0.90, 10.75)], cognitive training [MD=4.99, 95%CI(0.56, 9.12)], and exercise training [MD=3.88, 95%CI (0.47, 7.27)] were better than community services, respectively(P<0.05), and exercise training was also better than conventional care [MD=3.05, 95%CI (0.92, 5.12), P<0.05];using theMini-Mental State Examination (MMSE) as the evaluation indicator, multimodal exercise [MD=3.00, 95%CI (0.89, 4.96)],cognitive training [MD=2.50, 95%CI (0.27, 4.82)], traditional Chinese exercise [MD=2.30, 95%CI (0.34, 4.28)],psychotherapy [MD=1.76, 95%CI (0.56, 2.96)], and exercise training [MD=1.36, 95%CI (0.18, 2.59)] were better thanconventional care, respectively (P<0.05), and multimodal exercise [MD=3.32, 95%CI (0.62, 5.81)], cognitive training[MD=2.82, 95%CI (0.75, 4.90)], and traditional Chinese exercise [MD=2.63, 95%CI (0.08, 5.13)] were also better thancommunity service, respectively (P<0.05). The results of the cumulative probability ranking showed that virtual reality hadthe highest probability of being the best intervention in terms of improving MoCA metrics (0.863), and multimodalexercise had the highest probability of being the best intervention in terms of improving MMSE metrics (0.868).Conclusion Using MoCA as an evaluation indicator, virtual reality may be the best non-pharmacological intervention;using MMSE as an evaluation indicator, multimodal exercise may be the best non-pharmacological intervention.