认知功能训练治疗轻中度阿尔茨海默病疗效的Meta分析

发布时间：2018-02-09 10:37

本文关键词： 认知功能训练阿尔茨海默病药物治疗非药物治疗 meta分析　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景及研究目的:阿尔茨海默病(Alzheimer’s disease,AD),又称老年性痴呆,是痴呆最常见的类型,也是目前威胁老年人身体健康的第四大疾病。目前AD的治疗以药物治疗为主,药物治疗主要包括:胆碱酯酶抑制剂,如:多奈哌齐、加兰他敏等;NMDA受体拮抗剂,代表药物为:美金刚;钙离子拮抗剂,如:尼莫地平、氟桂利嗪等;神经功能保护药物,如丁苯酞;另外中医中药治疗,如金纳多等。目前AD药物治疗多以改善患者临床症状为主,尚不能从根本上逆转本病的病程,且一部分患者不能耐受药物相关副反应。近年来,AD的非药物疗法(nonpharmacologic treatments,NPT)已日益受到关注,目前NPT主要包括:心理治疗、3R疗法、怀旧治疗、音乐治疗及认知功能训练。AD多隐匿性起病,初期以近期记忆力下降为主要临床表现,常被临床所忽视,因此对AD的早期干预在该病的治疗策略中具有重要意义,NPT的主要获益人群为轻中度AD患者。已有一定数量的临床研究证实了药物结合认知功能训练治疗可以改善患者的精神智能等认知功能,减慢病程进展的速度,但由于各临床研究中样本数量少、临床试验时间短,结果循证级别不高,且在患者日常生活能力的提高方面的结论尚不一致。本研究通过对认知功能训练及药物治疗后轻中度AD患者的各项测量量表结果进行Meta分析,为其临床应用提供更高级别的循证医学证据。方法:通过限定关键词进行计算机检索及手动检索2000年1月到2017年1月期间发表的关于认知功能训练治疗阿尔茨海默病的文献,根据已经制定的纳入及排除标准筛选出符合标准的质量较高的中英文文献,阅读全文后剔除不符合要求的文献,在符合要求的文献中提取认知功能训练及药物治疗后各常用量表的有效结果,常用量表包括:简易智力状态检查量表(Mini-mental State Examination,MMSE)、日常生活能力量表(activities of daily learning,ADL)、工具性日常生活能力量表(instrumental activities of daily learning,IADL)、阿尔茨海默病评定量表认知分量表(Alzheimer’s disease assessment scale-cognitive subscale,ADAS-Cog)、汉密顿焦虑量表(Hamilton Anxiety Scale,HAMA)及汉密顿抑郁量表(Hamilton Depression Scale,HAMD),应用Revman5.3软件对其进行Meta分析,并对国内外各项评分分别分析,计算比值比(OR)值、均数差(MD)、标准差(SD)及95%可信区间(95%CI),进行Z检验。本研究认为P0.05具有统计学意义。结果:结果显示认知功能训练组与对照组比较MMSE总分升高幅度较大、ADAS-Cog、HAMD及HAMA总分明显降低且差异具有统计学意义(P0.05)。而ADL及IADL的总分无明显差异(P0.05)。结论:认知功能训练治疗AD的疗效确切,可以延缓AD病程的进展,改善患者的精神智能状态,延缓患者认知功能障碍发生发展的进程,改善患者的焦虑、抑郁状态,延缓患者人格、精神改变的进程,对患者的日常生活能力改善不明显。由于认知功能训练的操作需要专业的医务人员或者经过专业培训的人员给予患者进行规律、系统的训练治疗,故其可行性及大范围推广尚需要更多的高质量的循证医学证据进一步指导。
[Abstract]:Background: Alzheimer's disease (Alzheimer 's disease, AD), also known as Alzheimer's disease, is the most common form of dementia, is the threat to the health of the elderly fourth disease. The treatment of AD is dominated by drug treatment, drug treatment mainly includes: cholinesterase inhibitors, such as: donepezil, galantamine NMDA; receptor antagonist, on behalf of drugs: memantine; calcium antagonists, such as nimodipine and flunarizine; neuroprotective drugs, such as Ding Bentai; other Chinese medicine treatment, such as Ginaton. Current AD drugs to improve clinical symptoms, still can not fundamentally reverse the disease of course, and some patients cannot tolerate the drug related adverse reactions. In recent years, non drug therapy of AD (nonpharmacologic treatments NPT) has been increasingly recognized, at present NPT mainly include: psychological treatment, 3R therapy, reminiscence therapy, music therapy and cognitive function training.AD occult onset, early in recent memory decline as the main clinical manifestations, often neglected by clinical, therefore early intervention of AD plays an important role in the strategy for the treatment of this disease, the main benefit NPT population with mild and moderate AD clinical research. For a certain number of confirmed drugs combined with cognitive training can improve the treatment of mental patients with cognitive function, slowing the progression of speed, but because of the number of samples in clinical research, clinical trials of a short time, the evidence-based level is not high, and the daily life ability of patients to improve the conclusion is not consistent through the research of the measurement. The amount of cognitive function in patients with mild to moderate AD training and after treatment results were analyzed by Meta, provide evidence of evidence-based medicine higher level for its clinical application According to the published. Method: computer retrieval and manual retrieval from January 2000 to January 2017 during a cognitive training in the treatment of Alzheimer's disease literature by defining key words, according to the inclusion and exclusion criteria selected high quality standards have been developed in the literature English, after reading the article does not conform to the requirements of the literature, extracted the common results the scale of cognitive training and drug treatment in line with the requirements in the literature, including the commonly used scale: MMSE (Mini-mental State Examination, MMSE), ADL (activities of daily learning, ADL), instrumental activities of daily living scale (instrumental activities of daily learning. IADL), Alzheimer's disease assessment scale cognitive subscale (Alzheimer 's disease assessment Scale-Cognitive subscale, ADAS-Cog) The Hamilton Anxiety Scale (Hamilton, Anxiety Scale, HAMA) and the Hamilton Depression Scale (Hamilton Depression Scale, HAMD), using Revman5.3 software Meta to carry on the analysis, and the score at home and abroad were analyzed, calculated the odds ratio (OR) value, mean difference (MD), standard deviation (SD) and 95% confidence interval (95%CI), Z test. This study suggests that P0.05 was statistically significant. Results: the results showed that the cognitive training group compared with the control group, the total score of MMSE increased greatly, ADAS-Cog, HAMD and HAMA obviously decreased and the difference was statistically significant (P0.05). But there was no significant difference in the total score of IADL and ADL (P0.05). Conclusion: the effect of cognitive function training in the treatment of AD is effective, which can delay the progress of the course of AD, improve the state of mental patients, delaying cognitive dysfunction in patients with the occurrence and development process, improve the patient's anxiety, depression, patients delay The spirit of lattice, the process of change, the ability of daily life of patients improved obviously. The cognitive function training operation requires professional medical personnel or personnel through professional training for patients with law, training and treatment system, so the feasibility of promotion and a wide range of high quality still needs more evidence of further guidance.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.16

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