Mental and Physical Activities Delay Cognitive Decline in Older Persons with Dementia
Mental and Physical Activities Delay Cognitive Decline in Older Persons with Dementia
复制标题
DOI：
10.1016/j.jagp.2013.01.060
复制
发表时间：
2014-01-01
影响因子：
7.2
通讯作者：
Lam, John H. M.
中科院分区：
文献类型：
--
作者：
Cheng, Sheung-Tak;Chow, Pizza K.;Lam, John H. M.
目的：研究认知刺激（麻将）和体育锻炼（太极拳[TC]）对痴呆患者认知能力的影响。设计：随机、开放、对照设计。环境：疗养院。参与者：110名居民，其中大多数是胆碱酯酶抑制剂的初治者。入选标准是简易精神状态检查（MMSE）= 10-24并且患有至少非常轻度的痴呆（临床痴呆评级>= 0.5）。排除标准为卧床不起、听力/视力受损、研究前定期参加活动或身体或团体活动禁忌症。干预措施：家庭被随机分为三个条件（麻将，TC和简单的手工艺品[对照]）。活动每周进行三次，持续12周。测量：主要结果是MMSE。次要结果是即时/延迟回忆、分类流畅性和数字广度。包括载脂蛋白E等位基因在内的各种生物学风险因素作为协变量。在0（基线）、3（治疗后）、6和9个月收集测量值。结果：使用混合效应回归进行意向治疗分析。麻将对MMSE、延迟回忆和向前数字广度的影响随时间而变化。TC有类似的效果，但不是延迟回忆。典型的模式是，控制参与者恶化，而麻将和TC参与者保持他们的能力随着时间的推移，导致扩大的治疗效果随着时间的推移。9个月时，麻将和TC在MMSE上分别与对照组相差4.5分（95%置信区间：2.0-6.9; d = 0.48）和3.7分（95%置信区间：1.4-6.0; d = 0.40）。未观察到即刻回忆和向后数字广度的治疗效应。结论：麻将和TC可以保持某些认知领域的功能或延迟衰退，即使是那些有严重认知障碍的人。
Objectives: To examine the effects of cognitive stimulation (mahjong) and physical exercise (tai chi [TC]) on cognitive performance in persons with dementia. Design: Cluster-randomized open-label controlled design. Setting: Nursing homes. Participants: One hundred ten residents, most of whom were cholinesterase-inhibitor naive. Inclusion criteria were Mini-Mental State Examination (MMSE) = 10-24 and suffering from at least very mild dementia (Clinical Dementia Rating >= 0.5). Exclusion criteria were being bedbound, audio/visual impairment, regular activity participation before study, or contraindications for physical or group activities. Interventions: Homes were randomized into three conditions (mahjong, TC, and simple handicrafts [control]). Activities were conducted three times weekly for 12 weeks. Measurements: Primary outcome was MMSE. Secondary outcomes were immediate/delayed recall, categorical fluency, and digit span. Various biological risk factors, including apolipoprotein E epsilon 4 allele, were included as covariates. Measures were collected at 0 (baseline), 3 (posttreatment), 6, and 9 months. Results: Intent-to-treat analyses were performed using mixed-effects regression. Mahjong's effect varied by time for MMSE, delayed recall, and forward digit span. TC had similar effects but not for delayed recall. The typical pattern was that control participants deteriorated while mahjong and TC participants maintained their abilities over time, leading to enlarged treatment effects as time progressed. By 9 months, mahjong and TC differed from control by 4.5 points (95% confidence interval: 2.0-6.9; d = 0.48) and 3.7 points (95% confidence interval: 1.4-6.0; d = 0.40), respectively, on MMSE. No treatment effects were observed for immediate recall and backward digit span. Conclusions: Mahjong and TC can preserve functioning or delay decline in certain cognitive domains, even in those with significant cognitive impairment.