早期认知干预对中重型颅脑损伤后认知障碍的疗效分析

目的分析早期认知干预对中重型颅脑损伤后认知障碍的疗效。方法选取我院2011年5月至2013年5月收治的86例中重型颅脑损伤后存在认知障碍的患者作为研究对象,随机分两组各43例。对照组患者进行常规的康复治疗和神经外科专科治疗,实验组患者在对照组的基础之上给予认知干预的训练,比较两组患者的临床疗效。结果实验组的治疗总有效率显著高于对照组,差异具有统计学意义(P<0.05)。治疗后实验组在认知定向、视运动组织、知觉、思维运作、注意力的集中方面均显著优于对照组,差异具有统计学意义(P<0.05)。结论早期认知干预对中重型颅脑损伤后认知障碍有着明显的改善作用。     

轻度认知障碍非药物干预研究进展CSCD

轻度认知障碍(MCI)是痴呆的前驱阶段,也是老年人群常见的神经退行性疾病。MCI可由多种病因导致,表现为认知功能的进行性损害,给患者及其家庭造成沉重的心理和社会负担。每年都有一定比例的MCI患者转化为痴呆,因此MCI通常被认为是痴呆早期预防和干预的关键时期。非药物干预是MCI防治的重要措施,可减少患者的神经精神症状,改善心理健康状况,提高生活质量,主要方法包括认知训练、非侵入性脑刺激、社会心理干预、运动干预和营养干预等。本文对MCI非药物干预研究进行总结,以期为MCI临床预防和治疗提供参考。     

艾滋病儿童神经认知障碍相关因素研究进展

目的 总结艾滋病儿童神经认知障碍影响因素。方法 在PubMed、Web of Science、CNKI、万方和维普数据库，以“艾滋病”、“儿童”、“神经认知障碍”、“脑病”、“影响因素”为主题词或关键词，同时辅以手工检索和文献追溯检索近年相关文献。着重整理影响艾滋病儿童神经认知障碍的因素。对资料进行汇总并撰写综述。结果 检索并阅读相关文献100余篇。艾滋病病毒相关因素（HIV损害中枢神经系统、HIV逃逸及病毒储存库、HIV亚型）、宿主因素（启动抗病毒治疗时机、遗传因素、营养状况及合并其他疾病）、抗病毒治疗药物、社会心理因素等均可影响艾滋病感染儿童神经认知。结论 为了尽可能避免或降低艾滋病儿童神经认知障碍，应当尽早诊断、尽早给予高效的抗逆转录病毒治疗；随访中应重视神经认知发育的观察和筛查，及早识别神经认知障碍，积极寻找多方面的原因并进行有效干预。     

社区老年人认知功能障碍及心理干预调查

目的探讨社区老年人认知功能障碍特点及心理行为干预的疗效。方法对某社区随机取样抽取65岁以上老人进行研究,采用简易精神状况检查表(MMSE)对其认知功能进行测试;并对轻度认知障碍组进行心理行为学干预。结果完成认知功能评估1089人,认知损害245人(22.50%),其中轻度认知功能损害195人(17.90%),中重度认知功能损害50人(4.59%)。老年人存在多领域认知功能障碍,其中以记忆损害最为显著;老年人认知功能损害程度随年龄增加而加重,随受教育程度降低而降低,且男性多于女性(P0.05)。对轻度认知障碍者经过为期半年的干预治疗后,其认知功能有明显改善,尤其是记忆功能(P0.05)。结论社区老年人认知功能损害与年龄、性别、教育程度相关,同时存在多领域认知功能障碍,并以记忆衰退最为显著。通过对其积极的干预治疗,能有效改善和提高患者的认知功能,减缓痴呆的发生。     

老年轻度认知障碍患者干预训练的研究进展

老年轻度认知障碍患者作为阿尔茨海默病的高危人群,具有发病隐匿的特性。积极进行干预训练可以延缓病情进展,提高患者生活质量,减轻照顾者的照护负担。本文将老年轻度认知障碍患者的干预现状进行概括,包括疾病认知指导、中医干预训练、功能训练干预、虚拟现实技术干预,并对每种干预方案进行深刻剖析,旨在为未来针对老年轻度认知障碍患者构建体系化的干预方案提供借鉴和参考。     

乳腺癌康复管理新进展

分析乳腺癌康复管理相关研究的热点和进展,为促进乳腺癌康复实施和推广提供依据。总结了现代化乳腺癌康复干预新进展,包括回归家庭康复干预、运动联合饮食干预、基于按摩治疗的综合干预、二元应对干预、针对乳房重建患者康复的个案管理。从患者、家庭—社会支持、医务人员3个方面分析康复服务实施的障碍因素,并提出了相关建议：纠正患者对康复行为的认知偏差;重视患者不良情绪的改善;加强家庭康复指导与社区康复服务;构建系统的乳腺癌康复专业培训体系。     

认知功能训练对脑卒中后认知障碍患者康复疗效的研究

[目的]研究认知功能训练对脑卒中后认知障碍患者康复的疗效. [方法]将96例合并有认知障碍的脑卒中患者随机分为训练组和对照组,训练组在常规康复的基础上给予认知康复训练,对照组予以常规康复训练,训练时间为2个月.在训练前、训练后1个月及2个月分别用简易智能状态检查(mini-mental state examination,MMSE)量表、Fugl-Meyer量表及改良Barthel指数对患者认知、运动功能分级及日常生活活动能力进行评定. [结果]两组患者训练前认知、运动功能分级及日常生活活动能力差异无统计学意义(P>0.05).两组患者训练1个月时Fugl-Meyer量表评分及Barthel指数差异无统计学意义(P>0.05).MMSE评分差异有统计学意义(P<0.05);2个月时,两组患者之间MMSE、Fugl-Meyer量表及Barthel指数差异有统计学意义(P<0.05). [结论]对于合并有认知障碍的脑卒中患者,同时给予认知康复训练和常规康复训练,有利于其认知功能、运动功能和日常生活活动能力的改善,有助于患者的全面康复.     

正念治疗联合甜梦口服液对卒中后抑郁睡眠或认知的改善

目的:探讨正念治疗联合甜梦口服液对卒中后抑郁睡眠或认知的改善。方法:选择我院2017年7月~2019年7月救治的卒中患者120例作为对象,随机数字表分为对照组(n=60)和观察组(n=60)。对照组给予甜梦口服液治疗,观察组采用正念联合甜梦口服液治疗,比较两组患者治疗后抑郁睡眠与认知状态改善情况。结果:观察组患者干预治疗后HAMA、HAMD、PSQI评分均低于对照组(P<0.05);观察组患者干预治疗后定向力、视知觉、空间知觉、动作运用、视运动组织、思维操作、注意力及专注力各项认知功能指标评分均优于对照组(P<0.05)。结论:对卒中后出现抑郁睡眠和认知障碍患者采用正念联合甜梦口服液治疗能够有效改善患者的睡眠质量及焦虑抑郁等负性情绪,提高的认知水平,应在临床中大力推广。     

认知心理护理对脑卒中急性期抑郁症患者认知障碍的影响

目的:研究认知心理护理对脑卒中急性期抑郁症患者认知障碍的影响。方法:选择2016年12月-2018年1月期间在我院治疗的脑卒中急性期抑郁症患者作为样本研究资料,共有74例。依照计算机表法处理为两组,试验组(n=37例)进行认知心理护理干预,对照组(n=37例)进行常规护理干预,比较对脑卒中急性期抑郁症患者认知障碍的影响。结果:试验组37例患者的精神状态评分、神经功能评分,焦虑(SAS)评分、抑郁(SDS)评分以及生活质量各项指标评分与使用常规护理干预的对照组相比,护理干预优势明显,最终结局呈现出P小于0.05的形态,具有探讨研究价值。结论:对脑卒中急性期抑郁症患者进行认知心理护理干预,具有明显的临床应用效果,可改善患者的负性情绪,提升患者的精神状态以及降低神经功能缺损情况,并有效提升患者的生活质量。     

运动对慢性病干预效果的研究进展

目的 总结运动干预常见慢性病的治疗效果，分析各种运动治疗方案适用范围及存在的问题，以期指导临床实践，并为后续研究提供参考。方法 在WHO官网、Web of Science及相关网站和PubMed、Embase、CNKI、维普、知网、万方等数据库中，以“慢性病”、“运动治疗”、“干预效果”、“心脑血管疾病”、“高血压”、“糖尿病”、“恶性肿瘤”等为关键词进行检索，同时追溯检索近几年相关文献。从运动对几种最常见的慢性病治疗效果的角度，分析各种运动方案对慢性病的干预效果。结果 综合研究表明，运动能够预防7种类型癌症，能够延长乳腺癌、结肠癌和前列腺癌患者的生存期。有氧运动能够明显改善心血管病患者的心脏功能、显著降低高血压患者的血压、降低中老年人群糖尿病发病率。结论 运动对各种慢性病均有明显效果，有助于提高患者的生存率和身体机能，降低患病率及死亡风险。建议开展运动治疗慢性病相关知识的宣传推广，充分利用互联网大数据技术对运动治疗全过程进行智能化管理。     

Effects of Nutrition on Cognitive Function in Adults with or without Cognitive Impairment: A Systematic Review of Randomized Controlled Clinical Trials

New dietary approaches for the prevention of cognitive impairment are being investigated. However, evidence from dietary interventions is mainly from food and nutrient supplement interventions, with inconsistent results and high heterogeneity between trials. We conducted a comprehensive systematic search of randomized controlled trials (RCTs) published in MEDLINE-PubMed, from January 2018 to July 2021, investigating the impact of dietary counseling, as well as food-based and dietary supplement interventions on cognitive function in adults with or without cognitive impairment. Based on the search strategy, 197 eligible publications were used for data abstraction. Finally, 61 articles were included in the analysis. There was reasonable evidence that dietary patterns, as well as food and dietary supplements improved cognitive domains or measures of brain integrity. The Mediterranean diet showed promising results, whereas the role of the DASH diet was not clear. Healthy food consumption improved cognitive function, although the quality of these studies was relatively low. The role of dietary supplements was mixed, with strong evidence of the benefits of polyphenols and combinations of nutrients, but with low evidence for PUFAs, vitamin D, specific protein, amino acids, and other types of supplements. Further well-designed RCTs are needed to guide the development of dietary approaches for the prevention of cognitive impairment.     

Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review

ObjectivesWe aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation.DesignSystematic scoping review.Setting and ParticipantsED patients with cognitive impairment and/or their care partners.MethodsInformed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations.ResultsFrom 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage.Conclusions and ImplicationsThis scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.     

Metabolic Syndrome,Cognitive Impairment and the Role of Diet: A Narrative Review

Background: This narrative review presents the association between metabolic syndrome (MetS), along with its components, and cognition-related disorders, as well as the potential reversal role of diet against cognitive impairment by modulating MetS. Methods: An electronic research in Medline (Pubmed) and Scopus was conducted. Results: MetS and cognitive decline share common cardiometabolic pathways as MetS components can trigger cognitive impairment. On the other side, the risk factors for both MetS and cognitive impairment can be reduced by optimizing the nutritional intake. Clinical manifestations such as dyslipidemia, hypertension, diabetes and increased central body adiposity are nutrition-related risk factors present during the prodromal period before cognitive impairment. The Mediterranean dietary pattern stands among the most discussed predominantly plant-based diets in relation to cardiometabolic disorders that may prevent dementia, Alzheimer’s disease and other cognition-related disorders. In addition, accumulating evidence suggests that the consumption of specific dietary food groups as a part of the overall diet can improve cognitive outcomes, maybe due to their involvement in cardiometabolic paths. Conclusions: Early MetS detection may be helpful to prevent or delay cognitive decline. Moreover, this review highlights the importance of healthy nutritional habits to reverse such conditions and the urgency of early lifestyle interventions.     

Impact of aerobic exercise on neurobehavioral outcomes

Numerous studies have examined the relationship between physical activity and cognitive function, demonstrating that greater physical activity is associated with lower incidence of cognitive impairment in later life. Due to an increasingly large number of older adults at risk for cognitive impairment, the relationship between physical activity and cognition has garnered increasing public health relevance and multiple randomized trials have demonstrated that exercise interventions among sedentary adults improve cognitive performance in multiple domains of function. This article will examine the relationship between physical activity and cognitive function by reviewing several different areas of literature, including the prevalence of cognitive impairment, assessment methods, observational studies examining physical activity and cognition, and intervention studies. The present review is intended to provide a historical tutorial of existing literature linking physical activity, exercise, and cognitive function among both healthy and clinical populations.     

绵阳市养老机构老人认知功能现状调查

目的 调查绵阳市养老机构老人的认知功能现状,为开展针对性的认知功能干预措施提供科学依据。方法 采取随机整群抽样法、运用全面衰退量表对主城区6家养老机构的老人进行调查。结果 共调查583名老人,认知功能障碍者210名,患病率为36%,轻度认知障碍者170人,占比为29.2%,认知功能障碍以轻度为主;不同年龄、文化程度、婚姻状况的老人认知功能分级比较,差异有统计学意义(P<0.05)。结论 养老机构老人认知功能减退检出率较高,养老机构应进行积极的早期干预,以提高老人的晚年生活质量。     

A healthy body, a healthy mind: long-term impact of diet on mood and cognitive function

Certain dietary risk factors for physical ill health are also risk factors for depression and cognitive impairment. Although cholesterol lowering has been suggested to increase vulnerability to depression, there is better support for an alternative hypothesis that intake of n-3 long-chain polyunsaturated fatty acids can affect mood (and aggression). Possible mechanisms for such effects include modification of neuronal cell membrane fluidity and consequent impact on neurotransmitter function. Stronger evidence exists concerning a role for diet in influencing cognitive impairment and cognitive decline in older age, in particular through its impact on vascular disease. For example, cognitive impairment is associated with atherosclerosis, type 2 diabetes and hypertension, and findings from a broad range of studies show significant relationships between cognitive function and intakes of various nutrients, including long-chain polyunsaturated fatty acids, antioxidant vitamins, and folate and vitamin B12. Further support is provided by data on nutrient status and cognitive function. Almost all this evidence, however, comes from epidemiological and correlational studies. Given the problem of separating cause and effect from such evidence, and the fact that cognitive impairment and cognitive decline (and depression) are very likely to be significant factors contributing to the consumption of a poor diet, greater emphasis should now be placed on conducting intervention studies. An efficient approach to this problem could be to include assessments of mood and cognitive function as outcome measures in studies designed primarily to investigate the impact of dietary interventions on markers of physical health.     

Are cognitive impairment and depressive mood associated with increased service utilisation in community‐dwelling elderly people?

The healthcare and social services utilisation of elderly people with mental disorders has not been sufficiently described, although such knowledge could indicate directions for preventive and curative interventions, and suggest unmet service needs. The aim of the present study was to examine cognitive impairment and depressive mood as correlates of specific healthcare and social services utilisation of community-dwelling elderly people. A randomly selected population sample of 1134 community-dwelling individuals aged 65 years and over living in a defined area were interviewed at home. Cognitive impairment was measured by the Mini Mental State Examination and depressive mood by the Centre for Epidemiologic Studies -- Depression scale. Cognitive impairment and depressive mood were related to the number of home care services used, and to the utilisaton of every specific healthcare and social service. After controlling for confounding variables (i.e. age, sex, education, co-residence and disabilities), service utilisation was still predicted by depressive mood, but not by cognitive impairment. Interventions to prevent and cure depressive mood should be considered to decrease the service needs of community-dwelling elderly people. Unmet service needs are suggested since cognitive impairment does not result in increased service utilisation.     

Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group

The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on “Cognitive Frailty” was organized by the International Academy on Nutrition and Aging (I.A.N.A) and the International Association of Gerontology and Geriatrics (I.A.G.G) on April 16th, 2013 in Toulouse (France). The present report describes the results of the Consensus Group and provides the first definition of a “Cognitive Frailty” condition in older adults. Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called “cognitive frailty” as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.     

Do nutrition indicators predict death in elderly Canadians with cognitive impairment?

This study describes the independent association between nutritional risk and death in older adults diagnosed with cognitive impairment. Canadian Study of Health and Aging participants who completed a clinical exam and were diagnosed with cognitive impairment and had complete data for regression analyses were included (n = 735). Nutritional risk was defined as the presence of at least one abnormal nutrition indicator identified during the clinical exam (history of weight loss, abnormal serum albumin, poor appetite, body mass index < 20). Other covariates believed to influence mortality were modelled with nutritional risk using logistic regression. There were 373 deaths during the five-year follow-up period in this sample. Nutritional risk was found to independently increase the likelihood of death (OR = 1.6, 95% CI 1.1, 2.2) in these older adults suffering from cognitive impairment. Further work is required to determine if interventions can improve nutritional status and quality of life of these older adults.     

轻度认知障碍老年人不同潜在类别的增长混合模型研究

目的 探讨增长混合模型在识别轻度认知障碍的老年人群中存在的潜在类别及识别不同类别的群体认知功能的发展轨迹的应用。方法 利用65岁以上轻度认知障碍老年人的随访数据构建增长混合模型（growth mixed model，GMM）。利用贝叶斯信息标准（Bayesian information criterion，BIC）进行潜在类别的确定并用后验概率进行模型评价。结果 轻度认知障碍的老年人呈现出了3种不同的认知轨迹:类别1的人群初始认知功能低且短时间内快速下降中间又有反弹，最后下降至一定程度后趋于平缓，称之为"痴呆高危人群"，占全部人群的4.46%。类别2的人群具有较低的认知功能且随着年龄增长认知能力急剧下降，这部分人群称之为"痴呆低危人群"，占全部人群的33.28%。类别3的人群具有较高的认知功能，随着年龄增长认知功能缓慢下降，称之为"正常老化人群"，占全部人群的62.26%。结论 研究揭示了轻度认知障碍的老年人群中认知发展轨迹的异质性，有助于健康促进人员针对高危人群及早制订干预措施从而减少老年痴呆的发生。