自适应认知训练对非痴呆型血管性认知障碍患者认知能力和生活质量的影响

目的 探讨自适应认知训练对非痴呆型血管性认知障碍(VCIND)患者认知能力和生活质量的影响.方法 选取2013年8月至2016年8月入住海口某三级甲等综合医院老年病科病房的VCIND患者235例,根据患者入组顺序按随机数表编号,1:1分配到两组,观察组118例,对照组117例,两组患者均给予丁苯酞、多奈哌齐常规药物基础治疗,观察组接受六六脑?脑康复系统的自适应认知训练(包括感知觉、注意力、记忆力、灵活性、计算推理能力五项脑功能训练),对照组只给予初级感知觉、注意力训练,两组患者每日均训练一次,每次30 min,持续训练12周后(第1～2周在医院训练;第3～12周在家中训练,由研究人员经网络监督),采用蒙特利尔认知评估量表(MoCa)、欧洲五维健康量表(EQ-5D-5L)评价两组患者的认知能力和生活质量并进行比较.结果 研究过程中,观察组有14例患者退出,对照组12例患者退出,最终209例患者完成研究.治疗前,两组患者的MoCa、EQ-5D-5L评分比较,差异均无统计学意义(P>0.05);干预12周后,两组患者的MoCA总分、视空间与执行功能、注意力、语言、抽象、延迟记忆、定向能力评分均较治疗前有不同程度的改善,且观察组比对照组得分更高,差异均有统计学意义(P<0.05);干预12周后,两组患者的自我照顾、日常活动、疼痛/不适、焦虑/沮丧、EQ-5D指数和自我EQ-VAS评分均较治疗前有不同程度的改善,观察组患者在自我照顾、日常活动和焦虑/沮丧三个维度异常报告人数的比例较对照组降低更为明显,差异均有统计学意义(P<0.05).结论 基于六六脑?脑康复系统的自适应认知训练可以有效提高VCIND患者的认知能力,改善患者生活质量.

Effect of adaptive cognitive training on the cognitive level and quality of life in patients with vascular cognitive impairment-no dementia

Objective To explore the effect of adaptive cognitive training on the cognitive function and quality of life in patients with vascular cognitive impairment-no dementia (VCIND). Methods From August 2013 to August 2016, a total of 235 patients with VCIND, who admitted to Department of Geriatrics a three-level general hospital in Haikou, were enrolled and randomly divided into the observation group (118 cases) and control group (117 cases) accord-ing to random number table method. Both of the two groups were given butylphthalide and donepezil as routine treat-ment. The observation group received adaptive cognitive training based on 66nao brain training system (including per-ception, attention, memory, flexibility and computational reasoning capability), while the control group was conducted primary perception and attention training. Both of the two groups were trained once a day for 30 minutes, with continu-ous training after 12 weeks (the first 1～2 weeks in hospital;the following 3～12 week at home supervised by the research-ers through the network). The Montreal cognitive assessment scale (MoCa) and EuroQol (EQ-5D-5L) were performed to evaluate the patients' cognitive level and quality of life. Results During the course of the study, 14 cases were re-moved from the observation group and 12 cases from the control group, and 209 cases were finally completed. There was no significant difference in general conditions (e.g. age, gender, education), MoCa and EQ-5D-5L scores between the two groups before treatment (P>0.05). After 12 weeks' training, the scores of MoCA, visual space, executive func-tion, attention, language, abstraction, delayed memory and orientation ability of the two groups were improved in differ-ent degrees than before treatment, and the scores of the observation group was higher than those of the control group (P<0.05). The self-care, daily activities, pain/discomfort, anxiety/depression, EQ-5D index and self-EQ-VAS score of the two groups were improved in different degrees than before treatment, and the proportion of abnormal reports in the three groups of self-care, daily activities and anxiety/depression in the observation group were significantly lower than those in the control group (P<0.05). Conclusion The adaptive cognitive training based on 66nao brain training system can improve the cognitive level and the quality of life of VCIND patients effectively.