中度至重度痴呆非药物干预的系统评价与荟萃分析
A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia.
作者信息
Na Riyoung, Yang Ji-Hye, Yeom Yusung, Kim You Joung, Byun Seonjeong, Kim Kiwon, Kim Ki Woong
机构信息
National Institute of Dementia, Seongnam, Republic of Korea.
Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
出版信息
Psychiatry Investig. 2019 May;16(5):325-335. doi: 10.30773/pi.2019.02.11.2. Epub 2019 May 23.
OBJECTIVE
Due to limited efficacy of medications, non-pharmacological interventions (NPI) are frequently co-administered to people with moderate to severe dementia (PWMSD). This systematic review and meta-analysis investigated the effects of NPI on activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD), and cognition and quality of life (QoL) of PWMSD.
METHODS
A literature search was conducted in the following databases: Cochrane CENTRAL, EMBASE, Medline, CIHNAL, PsycINFO, KoreaMED, KMbase, and KISS. We conducted a meta-analysis on randomized controlled trials and used the generic inverse variance method with a fixed-effects model to calculate the standardized mean difference (SMD). The protocol had been registered (CRD42017058020).
RESULTS
Ten randomized controlled trials met the inclusion criteria of the current meta-analysis. NPI were effective in improving ADL [SMD=0.28, 95% confidence interval (CI)=0.11-0.45] and reducing depression (SMD=-0.44, 95% CI=-0.70- -0.19). However, NPI were not effective in reducing agitation, anxiety, or overall, or improving cognitive function. In a subgroup analysis, music therapy was effective in reducing overall BPSD (SMD=-0.52, 95% CI=-0.90- -0.13).
CONCLUSION
Albeit the number of studies was limited, NPI improved ADL and depression in PWMSD.
目的
由于药物疗效有限，非药物干预措施（NPI）常与中重度痴呆患者（PWMSD）联合使用。本系统评价和荟萃分析调查了NPI对PWMSD日常生活活动（ADL）、痴呆行为和心理症状（BPSD）以及认知和生活质量（QoL）的影响。
方法
在以下数据库中进行文献检索：Cochrane CENTRAL、EMBASE、Medline、CIHNAL、PsycINFO、KoreaMED、KMbase和KISS。我们对随机对照试验进行了荟萃分析，并使用固定效应模型的通用逆方差法计算标准化平均差（SMD）。该方案已注册（CRD42017058020）。
结果
10项随机对照试验符合当前荟萃分析的纳入标准。NPI在改善ADL方面有效[SMD=0.28，95%置信区间（CI）=0.11-0.45]，在减轻抑郁方面有效（SMD=-0.44，95%CI=-0.70--0.19）。然而，NPI在减少激越、焦虑或总体症状或改善认知功能方面无效。在亚组分析中，音乐疗法在减少总体BPSD方面有效（SMD=-0.52，95%CI=-0.90--0.13）。
结论
尽管研究数量有限，但NPI改善了PWMSD的ADL和抑郁症状。
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