中等强度有氧运动对Alzheimer's病干预效果的分析

Intervention effect of moderate⁃intensity aerobic exercise on Alzheimer's disease

目的探讨Alzheimer's病(AD)患者中等强度有氧运动干预的效果及其影响因素。方法将98例AD患者随机分为运动组(50例)和对照组(48例),运动组接受3个月中等强度有氧训练,分别在基线、3个月、6个月利用MMSE、AD评定量表-认知量表(ADAS-cog)评估认知功能,AD协作研究-日常生活能力评估量表(ADCS-ADL)评估日常生活能力,神经精神量表(NPI)评估精神行为症状,老年性痴呆生活质量量表(QOL-AD)评估生活质量。以ADAS-cog评分3个月与基线时差值(ADAS-cog3-0)为因变量通过多因素线性回归分析患者基线特征是否会影响运动的疗效。将ADAS-cog3-0改善≥4分的患者纳入预后良好组,其他则纳入非预后良好组,将多因素线性回归分析中P<0.05的变量纳入逻辑回归进行分析,通过ROC曲线确定最佳分界值。结果与对照组相比,运动组在3个月和6个月时MMSE、QOL-AD评分显著升高,ADAS-cog评分显著降低(均P<0.05);在3个月时ADCS-ADL评分显著升高,NPI评分显著下降(均P<0.05);在6个月时,ADCS-ADL、NPI评分与对照组比较差异无统计学意义。回归分析显示,基线时MMSE评分对运动组认知功能改善有负性影响,而年龄、性别、教育水平、缺血症状、基线时日常生活能力、精神行为症状、生活质量对其没有影响。敏感、特异性分析显示,以MMSE>21.5分为界,界内的AD患者有氧运动效果好。结论有氧运动对AD患者的认知功能、日常生活能力、精神行为症状、生活质量均有明显改善作用,且认知水平越保留的AD患者,有氧运动对其近期作用越好。

Objective To investigate the effects of moderate⁃intensity aerobic exercise intervention and its influencing factors in patients with Alzheimer's disease(AD).Methods Ninety⁃eight AD patients were randomly assigned into exercise group(50 cases)and control group(48 cases).The exercise group received moderateintensity aerobic training for 3 months.Cognitive function was assessed using the MMSE and the AD assessment scale⁃cognitive subscale(ADAS⁃cog)at baseline,3 months and 6 months.Daily living abilities was evaluated by the AD cooperative study⁃activities of daily living scale(ADCS⁃ADL),behavioral symptoms was assessed by the neuropsychiatric Inventory(NPI)and life quality was measured by quality of life in AD(QOL⁃AD).The difference between 3 months and baseline ADAS⁃cog(ADAS⁃cog3⁃0)score was used as the dependent variable,multiple⁃factor linear regression was performed to analyze whether baseline characteristics of patients would affect the efficacy of exercise.Patients with an improvement of≥4 points in ADAS⁃cog3⁃0 were classified into good prognosis group,and the others were classified into non⁃good prognosis group.Variables with P<0.05 in the multiple⁃factor linear regression analysis were included in Logistic regression analysis to determine the best cutoff value through ROC curve.Results Compared with the control group,the exercise group showed a significant increase in MMSE and QOL⁃AD scores at 3 and 6 months,a significant decrease in ADAS⁃cog score at 3 and 6 months,a significant increase in ADCS⁃ADL score at 3 months,and a significant decrease in NPI score at 3 months(all P<0.05).However,there was no significant difference between the two groups in ADCS⁃ADL and NPI scores at 6 months.Regression analysis showed that baseline MMSE score had a negative impact on cognitive function improvement in the exercise group,while age,gender,education level,ischemic symptoms,baseline activities of daily living,behavioral and psychological symptoms,and quality of life had no impact.Sensitivity and specificity analysis showed that aerobic exercise was more effective in AD patients with an MMSE score>21.5 points,and aerobic exercise was still effective but had moderate effects in patients with an MMSE score below this cutoff.Conclusions Aerobic exercise has a significant improvement on cognitive function,activities of daily living,behavioral and psychological symptoms,and quality of life in AD patients.The better the cognitive level is preserved in AD patients,the better the short⁃term effects of aerobic exercise are.