Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia; Department of Health Sciences, Alma Mater Europaea-ECM, Maribor, Slovenia.
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
J Am Med Dir Assoc. 2018 Jun;19(6):484-491.e3. doi: 10.1016/j.jamda.2018.02.002. Epub 2018 Apr 19.
A strong relation between cognition and mobility has been identified in aging, supporting a role for enhancement mobility through cognitive-based interventions. However, a critical evaluation of the consistency of treatment effects of cognitive-based interventions is currently lacking. The objective of this study was 2-fold: (1) to review the existing literature on cognitive-based interventions aimed at improving mobility in older adults and (2) to assess the clinical effectiveness of cognitive interventions on gait performance.
A systematic review of randomized controlled trials (RCT) of cognitive training interventions for improving simple (normal walking) and complex (dual task walking) gait was conducted in February 2018.
Older adults without major cognitive, psychiatric, neurologic, and/or sensory impairments were included.
Random effect meta-analyses and a subsequent meta-regression were performed to generate overall cognitive intervention effects on single- and dual-task walking conditions.
Ten RCTs met inclusion criteria, with a total of 351 participants included in this meta-analysis. Cognitive training interventions revealed a small effect of intervention on complex gait [effect size (ES) = 0.47, 95% confidence interval (CI) 0.13 to 0.81, P = .007, I = 15.85%], but not simple gait (ES = 0.35, 95% CI -0.01 to 0.71, P = .057, I = 57.32%). Moreover, a meta-regression analysis revealed that intervention duration, training frequency, total number of sessions, and total minutes spent in intervention were not significant predictors of improvement in dual-task walking speed, though there was a suggestive trend toward a negative association between dual-task walking speed improvements and individual training session duration (P = .067).
CONCLUSIONS/IMPLICATIONS: This meta-analysis provides support for the fact that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions. Additional evidence from well-designed large-scale randomized clinical trials is warranted to confirm the observed effects.
认知与移动能力之间存在很强的关系，这在衰老中得到了证实，这支持了通过基于认知的干预措施来提高移动能力的作用。然而，目前缺乏对基于认知的干预措施治疗效果一致性的批判性评估。本研究的目的有两个：（1）综述旨在提高老年人移动能力的基于认知的干预措施的现有文献；（2）评估认知干预对步态表现的临床效果。
2018 年 2 月，对旨在改善简单（正常行走）和复杂（双重任务行走）步态的认知训练干预的随机对照试验（RCT）进行了系统综述。
没有严重认知、精神、神经和/或感觉障碍的老年人被纳入研究。
采用随机效应荟萃分析和随后的荟萃回归，以生成认知干预对单一和双重任务行走条件的总体影响。
10 项 RCT 符合纳入标准，共有 351 名参与者纳入荟萃分析。认知训练干预对复杂步态有较小的干预效果[效应量（ES）=0.47，95%置信区间（CI）0.13 至 0.81，P=0.007，I=15.85%]，但对简单步态没有影响（ES=0.35，95%CI -0.01 至 0.71，P=0.057，I=57.32%）。此外，元回归分析显示，干预持续时间、训练频率、总训练次数和干预总时长并不是改善双重任务行走速度的显著预测因素，尽管双重任务行走速度改善与个体训练课程时长之间存在负相关的趋势（P=0.067）。
结论/意义：这项荟萃分析为认知训练干预可以改善与移动能力相关的结果提供了支持，特别是在需要更高阶执行功能的具有挑战性的行走条件下。需要更多来自精心设计的大规模随机临床试验的证据来证实观察到的效果。
