發(fā)布時(shí)間：2018-01-18 13:27

  本文關(guān)鍵詞：輕度認(rèn)知障礙老年人認(rèn)知功能干預(yù)模式的構(gòu)建及其干預(yù)效果評(píng)價(jià)　出處：《延邊大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 老年人 輕度認(rèn)知障礙 患病情況 結(jié)構(gòu)方程模型 meta分析 認(rèn)知功能干預(yù)模式

【摘要】：目的：(1)了解吉林地區(qū)社區(qū)老年人輕度認(rèn)知障礙患病情況,以及輕度認(rèn)知障礙相關(guān)知識(shí)知曉和需求情況。(2)分析社區(qū)老年人輕度認(rèn)知障礙的影響因素,構(gòu)建社區(qū)老年人輕度認(rèn)知障礙影響因素的結(jié)構(gòu)方程模型,揭示各影響因素之間的關(guān)系,及其在輕度認(rèn)知障礙患病中發(fā)揮的作用。(3)通過(guò)Meta分析,探討輕度認(rèn)知障礙老年人有效的認(rèn)知訓(xùn)練方法。(4)結(jié)合Meta分析結(jié)果,以及社區(qū)老年人輕度認(rèn)知障礙影響因素的結(jié)構(gòu)方程模型,初步構(gòu)建輕度認(rèn)知障礙老年人認(rèn)知功能干預(yù)模式。(5)以社區(qū)輕度認(rèn)知障礙老年人為研究對(duì)象,通過(guò)隨機(jī)對(duì)照試驗(yàn),驗(yàn)證輕度認(rèn)知障礙老年人認(rèn)知功能干預(yù)模式的應(yīng)用效果。方法：(1)采用整群分層抽樣的方法,首先選取吉林地區(qū)5個(gè)行政區(qū)(昌邑區(qū)、船營(yíng)區(qū)、豐滿區(qū)、龍?zhí)秴^(qū)、高新區(qū)),然后在每個(gè)區(qū)隨機(jī)抽取2個(gè)社區(qū)衛(wèi)生服務(wù)中心,并選取10個(gè)社區(qū)衛(wèi)生服務(wù)中心內(nèi)全部老年人。由研究者及經(jīng)過(guò)統(tǒng)一培訓(xùn)的調(diào)查員進(jìn)行現(xiàn)場(chǎng)流行病學(xué)調(diào)查,其內(nèi)容包括問(wèn)卷調(diào)查和生理生化指標(biāo)測(cè)量。(2)運(yùn)用Amos7.0統(tǒng)計(jì)軟件構(gòu)建老年輕度認(rèn)知障礙影響因素的結(jié)構(gòu)方程模型。(3)運(yùn)用RevMan5.2統(tǒng)計(jì)軟件分析輕度認(rèn)知障礙老年人有效的認(rèn)知訓(xùn)練方法。(4)以社會(huì)認(rèn)知理論、認(rèn)知行為療法及階段性行為改變模式為基礎(chǔ),構(gòu)建適合輕度認(rèn)知障礙老年人的認(rèn)知功能干預(yù)模式。(5)采用隨機(jī)抽樣的方法,以前期篩查的吉林地區(qū)輕度認(rèn)知障礙老年人為基礎(chǔ),隨機(jī)抽取6個(gè)社區(qū)衛(wèi)生服務(wù)中心,其中隨機(jī)抽取3個(gè)社區(qū)衛(wèi)生服務(wù)中心作為干預(yù)組,另外3個(gè)社區(qū)衛(wèi)生服務(wù)中心作為對(duì)照組。隨后在每個(gè)社區(qū)衛(wèi)生服務(wù)中心按照隨機(jī)數(shù)字表法隨機(jī)抽取25人,共抽取150人作為研究對(duì)象,即干預(yù)組75人,對(duì)照組75人。結(jié)果：(1)本次研究共調(diào)查2920名社區(qū)老年人,其中男性1148名,女性1172名,平均年齡為69.07±7.28歲。在調(diào)查的人群中,患有輕度認(rèn)知障礙的老年人560名,占19.2%；在輕度認(rèn)知障礙疾病知識(shí)知曉方面,僅有10.9%的老年人了解輕度認(rèn)知障礙疾病相關(guān)知識(shí)；在輕度認(rèn)知障礙疾病知識(shí)需求方面,有70.9%的老年人需要輕度認(rèn)知障礙疾病臨床表現(xiàn)知識(shí),有53.4%的老年人需要輕度認(rèn)知障礙疾病臨床診斷知識(shí),有79.6%的老年人需要輕度認(rèn)知障礙疾病治療知識(shí)。(2)結(jié)構(gòu)方程模型結(jié)果顯示：影響老年人輕度認(rèn)知障礙主要因素包括年齡、性別、婚姻、職業(yè)、吸煙、喝酒、睡眠、運(yùn)動(dòng)、抑郁、DBP、FPG、TC。其中抑郁是輕度認(rèn)知障礙影響路徑中重要的中介變量,無(wú)論是直接效果、間接效果還是總效果,都顯示抑郁對(duì)社區(qū)老年人MCI影響作用最大,路徑系數(shù)分別為0.53、0.04、0.66。(3)Meta分析結(jié)果顯示,認(rèn)知訓(xùn)練能夠提高輕度認(rèn)知障礙老年人認(rèn)知功能總體水平。認(rèn)知訓(xùn)練中的記憶力訓(xùn)練、運(yùn)算法訓(xùn)練、回憶療法訓(xùn)練、語(yǔ)言能力訓(xùn)練及數(shù)字法訓(xùn)練等干預(yù)方法對(duì)提高輕度認(rèn)知障礙老年人認(rèn)知功能有效。(4)根據(jù)MCI影響因素結(jié)構(gòu)方程模型及其meta分析結(jié)果,本研究構(gòu)建了社區(qū)健康教育、生活方式指導(dǎo)、心理療法、慢性病管理和認(rèn)知訓(xùn)練為一體的MCI老年人認(rèn)知功能綜合干預(yù)框架和模式。(5)干預(yù)6個(gè)月后,干預(yù)組與對(duì)照組在抑郁得分(8.67±1.23、13.60±2.18)變化方面差異有統(tǒng)計(jì)學(xué)意義(p0.05)：在生活方式方面,干預(yù)組與對(duì)照組在運(yùn)動(dòng)人數(shù)(60、24)變化方面差異有統(tǒng)計(jì)學(xué)意義(p0.05),在睡眠得分(6.21±1.30、11.31±1.99)變化方面差異有統(tǒng)計(jì)學(xué)意義(p0.05),在吸煙人數(shù)(18、24)變化方面差異有統(tǒng)計(jì)學(xué)意義(p0.05)；在生理生化指標(biāo)方面,干預(yù)組與對(duì)照組在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)指標(biāo)變化方面有顯著性差異(p0.05),而血脂中僅TC(5.10±1.09、5.68±1.24)指標(biāo)變化有顯著性差異(p0.05)；在認(rèn)知功能方面,干預(yù)組在視覺網(wǎng)與執(zhí)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)、語(yǔ)言(1.95±1.08、1.30±0.97)、抽象(1.05±0.67、0.58±0.49)、延遲記憶(3.50±1.25、2.81±1.22)及總分(24.83±1.90、20.53±2.39)均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。(6)干預(yù)后,干預(yù)組在MoCA總分及其維度中的視覺網(wǎng)與執(zhí)行功能、命名、注意力、語(yǔ)言、抽象、延遲記憶方面,干預(yù)3個(gè)月干預(yù)6個(gè)月干預(yù)前(26.17±1.8624.83±1.9020.53±2.39),差異有統(tǒng)計(jì)學(xué)意義(p0.01)；在抑郁得分方面,干預(yù)3個(gè)月干預(yù)6個(gè)月干預(yù)前(8.15±1.868.67±1.2314.30±2.57),差異有統(tǒng)計(jì)學(xué)意義(p0.05)；在睡眠方面,干預(yù)6個(gè)月干預(yù)3個(gè)月干預(yù)前(6.21±1.307.20±1.8911.09±2.14),差異有統(tǒng)計(jì)學(xué)意義(p0.05)；在生活方式中,運(yùn)動(dòng)人數(shù)變化方面,干預(yù)3個(gè)月干預(yù)6個(gè)月干預(yù)前(616036),差異有統(tǒng)計(jì)學(xué)意義(p0.05),吸煙人數(shù)變化方面,干預(yù)6個(gè)月干預(yù)3個(gè)月干預(yù)前(182426),差異有統(tǒng)計(jì)學(xué)意義(p0.05)；在生理生化指標(biāo)方面,SBP、DBP、FPG、血脂中的TC,干預(yù)6個(gè)月干預(yù)3個(gè)月干預(yù)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),差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論1吉林地區(qū)社區(qū)老年人總體認(rèn)知功能較低,其輕度認(rèn)知障礙患病情況為19.2%,屬較高發(fā)地區(qū)。2吉林地區(qū)社區(qū)老年人輕度認(rèn)知障礙知曉率低,但對(duì)輕度認(rèn)知障礙相關(guān)疾病知識(shí)需求大。3從總體效果和直接效果分析,抑郁對(duì)老年人輕度認(rèn)知障礙影響最大,作用路徑最多。從間接作用效果分析,生活方式、睡眠、抑郁作用于慢性病后,對(duì)老年人輕度認(rèn)知障礙產(chǎn)生影響,而影響最大仍然是抑郁。4社區(qū)健康教育、生活方式指導(dǎo)、心理療法、慢性病管理和認(rèn)知訓(xùn)練為一體的MCI老年人認(rèn)知功能綜合干預(yù)模式明顯改善本地區(qū)輕度認(rèn)知障礙老年人的認(rèn)知功能、生活方式、抑郁情緒、睡眠狀況和生理生化指標(biāo)。
[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鹵10.33, 146.10鹵15.69),DBP (77.31鹵6.59,88.59鹵9.10),FPG (7.09鹵1.48,8.54鹵1.91)鎸囨爣鍙樺寲鏂歸潰鏈夋樉钁楁，

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