轻度认知障碍老年人认知功能干预模式的构建及其干预效果评价

发布时间：2018-01-18 13:27

  本文关键词：轻度认知障碍老年人认知功能干预模式的构建及其干预效果评价　出处：《延边大学》2016年博士论文　论文类型：学位论文

  更多相关文章： 老年人 轻度认知障碍 患病情况 结构方程模型 meta分析 认知功能干预模式

【摘要】：目的：(1)了解吉林地区社区老年人轻度认知障碍患病情况,以及轻度认知障碍相关知识知晓和需求情况。(2)分析社区老年人轻度认知障碍的影响因素,构建社区老年人轻度认知障碍影响因素的结构方程模型,揭示各影响因素之间的关系,及其在轻度认知障碍患病中发挥的作用。(3)通过Meta分析,探讨轻度认知障碍老年人有效的认知训练方法。(4)结合Meta分析结果,以及社区老年人轻度认知障碍影响因素的结构方程模型,初步构建轻度认知障碍老年人认知功能干预模式。(5)以社区轻度认知障碍老年人为研究对象,通过随机对照试验,验证轻度认知障碍老年人认知功能干预模式的应用效果。方法：(1)采用整群分层抽样的方法,首先选取吉林地区5个行政区(昌邑区、船营区、丰满区、龙潭区、高新区),然后在每个区随机抽取2个社区卫生服务中心,并选取10个社区卫生服务中心内全部老年人。由研究者及经过统一培训的调查员进行现场流行病学调查,其内容包括问卷调查和生理生化指标测量。(2)运用Amos7.0统计软件构建老年轻度认知障碍影响因素的结构方程模型。(3)运用RevMan5.2统计软件分析轻度认知障碍老年人有效的认知训练方法。(4)以社会认知理论、认知行为疗法及阶段性行为改变模式为基础,构建适合轻度认知障碍老年人的认知功能干预模式。(5)采用随机抽样的方法,以前期筛查的吉林地区轻度认知障碍老年人为基础,随机抽取6个社区卫生服务中心,其中随机抽取3个社区卫生服务中心作为干预组,另外3个社区卫生服务中心作为对照组。随后在每个社区卫生服务中心按照随机数字表法随机抽取25人,共抽取150人作为研究对象,即干预组75人,对照组75人。结果：(1)本次研究共调查2920名社区老年人,其中男性1148名,女性1172名,平均年龄为69.07±7.28岁。在调查的人群中,患有轻度认知障碍的老年人560名,占19.2%；在轻度认知障碍疾病知识知晓方面,仅有10.9%的老年人了解轻度认知障碍疾病相关知识；在轻度认知障碍疾病知识需求方面,有70.9%的老年人需要轻度认知障碍疾病临床表现知识,有53.4%的老年人需要轻度认知障碍疾病临床诊断知识,有79.6%的老年人需要轻度认知障碍疾病治疗知识。(2)结构方程模型结果显示：影响老年人轻度认知障碍主要因素包括年龄、性别、婚姻、职业、吸烟、喝酒、睡眠、运动、抑郁、DBP、FPG、TC。其中抑郁是轻度认知障碍影响路径中重要的中介变量,无论是直接效果、间接效果还是总效果,都显示抑郁对社区老年人MCI影响作用最大,路径系数分别为0.53、0.04、0.66。(3)Meta分析结果显示,认知训练能够提高轻度认知障碍老年人认知功能总体水平。认知训练中的记忆力训练、运算法训练、回忆疗法训练、语言能力训练及数字法训练等干预方法对提高轻度认知障碍老年人认知功能有效。(4)根据MCI影响因素结构方程模型及其meta分析结果,本研究构建了社区健康教育、生活方式指导、心理疗法、慢性病管理和认知训练为一体的MCI老年人认知功能综合干预框架和模式。(5)干预6个月后,干预组与对照组在抑郁得分(8.67±1.23、13.60±2.18)变化方面差异有统计学意义(p0.05)：在生活方式方面,干预组与对照组在运动人数(60、24)变化方面差异有统计学意义(p0.05),在睡眠得分(6.21±1.30、11.31±1.99)变化方面差异有统计学意义(p0.05),在吸烟人数(18、24)变化方面差异有统计学意义(p0.05)；在生理生化指标方面,干预组与对照组在SBP (125.80±10.33、 146.10±15.69)、DBP (77.31±6.59、88.59±9.10)、FPG (7.09±1.48、8.54±1.91)指标变化方面有显著性差异(p0.05),而血脂中仅TC(5.10±1.09、5.68±1.24)指标变化有显著性差异(p0.05)；在认知功能方面,干预组在视觉网与执行功能(3.93±0.40、3.37±0.76)、命名(2.83±0.49、2.26±0.86)、注意力(4.37±0.39、3.07±0.37)、语言(1.95±1.08、1.30±0.97)、抽象(1.05±0.67、0.58±0.49)、延迟记忆(3.50±1.25、2.81±1.22)及总分(24.83±1.90、20.53±2.39)均高于对照组,差异有统计学意义(p0.05)。(6)干预后,干预组在MoCA总分及其维度中的视觉网与执行功能、命名、注意力、语言、抽象、延迟记忆方面,干预3个月干预6个月干预前(26.17±1.8624.83±1.9020.53±2.39),差异有统计学意义(p0.01)；在抑郁得分方面,干预3个月干预6个月干预前(8.15±1.868.67±1.2314.30±2.57),差异有统计学意义(p0.05)；在睡眠方面,干预6个月干预3个月干预前(6.21±1.307.20±1.8911.09±2.14),差异有统计学意义(p0.05)；在生活方式中,运动人数变化方面,干预3个月干预6个月干预前(616036),差异有统计学意义(p0.05),吸烟人数变化方面,干预6个月干预3个月干预前(182426),差异有统计学意义(p0.05)；在生理生化指标方面,SBP、DBP、FPG、血脂中的TC,干预6个月干预3个月干预前(125.80±10.33130.11±10.50145.85±16.50,77.31±6.5985.69±7.3193.89±8.50,7.09±1.487.64±1.508.44±1.29,5.10±1.095.21±1.035.89±1.20),差异有统计学意义(p0.05)。结论1吉林地区社区老年人总体认知功能较低,其轻度认知障碍患病情况为19.2%,属较高发地区。2吉林地区社区老年人轻度认知障碍知晓率低,但对轻度认知障碍相关疾病知识需求大。3从总体效果和直接效果分析,抑郁对老年人轻度认知障碍影响最大,作用路径最多。从间接作用效果分析,生活方式、睡眠、抑郁作用于慢性病后,对老年人轻度认知障碍产生影响,而影响最大仍然是抑郁。4社区健康教育、生活方式指导、心理疗法、慢性病管理和认知训练为一体的MCI老年人认知功能综合干预模式明显改善本地区轻度认知障碍老年人的认知功能、生活方式、抑郁情绪、睡眠状况和生理生化指标。
[Abstract]:Objective: (1) understanding of mild cognitive impairment in community elderly in Jilin area, the prevalence of mild cognitive impairment, and related knowledge and demand. (2) to analyze the influencing factors of mild cognitive impairment in elderly in the community, construction of community elderly affect people with mild cognitive impairment of structural equation model of factors, reveal the relationship between various influencing factors. And play in the prevalence of mild cognitive impairment in rats. (3) through the Meta analysis, to explore the cognitive training method of mild cognitive impairment in the elderly people. (4) according to the analysis results of Meta, and the influence of community elderly mild cognitive impairment of structural equation model of factors, constructs the model of cognitive intervention for mild cognitive impairment in elderly people. (5) in the elderly with mild cognitive impairment as the research object, through a randomized controlled trial, to verify the application effect of cognitive function of mild cognitive impairment in elderly intervention mode Results. Methods: (1) using stratified sampling method, first select the Jilin area 5 administrative district (Changyi District, Chuanying District, Fengman District, Longtan District, the New District), and in each area were randomly selected from 2 community health service centers, and selected 10 community health service center in all the elderly. By researchers and trained investigators conducted epidemiological survey, which includes the investigation and measurement of physiological and biochemical indexes of the questionnaire. (2) the construction effect of mild cognitive impairment, structural equation model of factors with statistical software Amos7.0. (3) analysis of cognitive training method of mild cognitive impairment in the elderly people using RevMan5.2 statistics software. (4) based on the social cognitive theory, behavior and cognitive behavioral therapy stage change model as the foundation, construct the cognitive intervention model for mild cognitive impairment in elderly people. (5) using the method of random sampling In Jilin area, mild cognitive impairment early screening of human based, 6 community health service centers were randomly selected, which were randomly selected from 3 community health service centers as the intervention group and the other 3 community health service center as the control group. Then in each community health service center were randomly selected from 25 people, 150 students were randomly selected as the research object, namely the intervention group of 75 people, 75 people in the control group. Results: (1) this study investigated a total of 2920 elderly, 1148 males, 1172 females, mean age 69.07 + 7.28 years. Among the crowd, with mild cognitive impairment aged 560, accounting for 19.2%; in mild cognitive impairment disease knowledge awareness, only 10.9% of the old people to understand disease mild cognitive impairment in disease related knowledge; knowledge needs of mild cognitive impairment, 70.9% of the elderly need To the knowledge of clinical manifestations of disease mild cognitive impairment, 53.4% of the elderly need clinical diagnosis knowledge of mild cognitive impairment, 79.6% of the elderly need for treatment of disease with mild cognitive impairment (2). Structural equation model showed that the effects of mild cognitive impairment factors including age, gender, marriage, occupation, smoking. Drink, sleep, exercise, depression, DBP, FPG, TC. which influence depression is mild cognitive impairment in the important intermediary variable path, either directly or indirectly effect effect, total effect, show the depression to the elderly in the community MCI the greatest effect, the path coefficients were 0.53,0.04,0.66. (3) Meta analysis showed that cognitive training can improve the cognitive function of mild cognitive impairment in elderly people. The overall level of cognitive memory training in the training, operation training, reminiscence therapy training, language training and digital Method of training intervention methods to improve the cognitive function of mild cognitive impairment in elderly people. (4) according to the results of structural equation model and meta analysis of MCI effect, the establishment of community health education, lifestyle guidance, psychological therapy, chronic disease management and cognitive training for the integrated intervention of cognitive function of the elderly and the framework of MCI model. (5) 6 months after the intervention, the intervention group and the control group in depression score (8.67 + 1.23,13.60 + 2.18) change was statistically significant difference (P0.05): in terms of lifestyle intervention group and the control group in the moving number (60,24) change was statistically significant difference (P0.05), in sleep score (6.21 + 1.30,11.31 + 1.99) change was statistically significant difference (P0.05), the number of smokers (18,24) change was statistically significant difference (P0.05); the physiological and biochemical indexes, the intervention group and the control group in SBP (125.80卤10.33, 146.10卤15.69),DBP (77.31卤6.59,88.59卤9.10),FPG (7.09卤1.48,8.54卤1.91)鎸囨爣鍙樺寲鏂归潰鏈夋樉钁楁，

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