Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia.
Gold Coast Health, Clinical Governance, Education and Research (Allied Health), Southport, Queensland, Australia.
Am J Speech Lang Pathol. 2018 May 3;27(2):836-852. doi: 10.1044/2017_AJSLP-17-0043.
The purpose of this study is to evaluate the evidence for direct and indirect interventions for communication in people with moderate-severe dementia.
A systematic search of the literature was conducted, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysed guidelines, across 8 electronic databases. Studies were included if they included direct or indirect interventions, which could be administered by a speech-language pathologist to people with moderate-severe dementia (defined as having Mini-Mental State Examination of ≤ 15; Folstein, Folstein, & McHugh, 1975). Studies also were required to include outcome measures, which reported on communication function or participation and/or well-being related to communication. Included studies were evaluated for methodological quality using the McMaster critical appraisal tool (Law et al., 1998).
Eleven studies met the inclusion criteria. Ten of these studies related to direct interventions and included cognitive stimulation approaches using group (n = 5) or individual therapy (n = 1); cognitive training, including naming therapy (n = 1) and spaced retrieval training (n = 1); and cognitive rehabilitation approaches using augmentative and alternative communication (n = 2). One study reported an indirect intervention: conversation partner training. Due to the heterogeneity of studies, a meta-analysis was unable to be conducted. A descriptive synthesis of results indicated that interventions generally resulted in positive changes to communication and related quality-of-life outcomes compared with baseline or control groups.
Preliminary evidence was found to support communication interventions for people with moderate-severe dementia. The use of cognitive stimulation approaches, which use a group treatment model and conversation, as a therapy medium show promise as direct intervention options. Implications for clinical practice for speech-language pathologists and future research are discussed.
本研究旨在评估针对中重度痴呆患者的沟通进行直接和间接干预的证据。
根据系统评价和荟萃分析的首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analysed guidelines），对 8 个电子数据库进行了系统检索。如果研究包括直接或间接干预措施，则将其纳入研究，这些干预措施可以由言语-语言病理学家对中重度痴呆患者（定义为 Mini-Mental State Examination 得分≤15；Folstein、Folstein 和 McHugh，1975）进行干预。研究还需要包括报告沟通功能或参与度以及/或与沟通相关的幸福感的结果测量。使用 McMaster 批判性评估工具（Law 等人，1998）评估纳入研究的方法学质量。
符合纳入标准的研究有 11 项。其中 10 项研究涉及直接干预，包括使用小组（n=5）或个体治疗（n=1）的认知刺激方法；认知训练，包括命名疗法（n=1）和间隔检索训练（n=1）；以及使用辅助和替代沟通的认知康复方法（n=2）。一项研究报告了间接干预：对话伙伴培训。由于研究的异质性，无法进行荟萃分析。结果的描述性综合表明，与基线或对照组相比，干预通常会导致沟通和相关生活质量结果的积极变化。
初步证据支持针对中重度痴呆患者的沟通干预措施。使用认知刺激方法，这种方法使用小组治疗模式和对话作为治疗媒介，作为直接干预选择具有潜力。讨论了对言语-语言病理学家的临床实践意义和未来研究的启示。
