电子游戏对痴呆症患者认知和社交功能的影响：一项随机对照试验。

Effects of Exergaming on Cognitive and Social Functioning of People with Dementia: A Randomized Controlled Trial.

机构信息

Department of Psychiatry, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.

出版信息

J Am Med Dir Assoc. 2020 Dec;21(12):1958-1967.e5. doi: 10.1016/j.jamda.2020.04.018. Epub 2020 Jul 7.

DOI:10.1016/j.jamda.2020.04.018

PMID:32651132

Abstract

OBJECTIVES: Physical activity in people with dementia (PwD) may enhance physical and mental functioning. Exergaming, which combines physical exercise with cognitive stimulation in a gaming environment, was developed to overcome barriers in performing physical activities. We evaluated the effects of exergaming in day care centers (DCCs) for PwD and informal caregivers (ICs). DESIGN: A randomized controlled trial among 23 DCCs across the Netherlands randomized to exergaming (interactive cycling during 6 months) or a care-as-usual control group. SETTING AND PARTICIPANTS: A total of 112 (73 exergaming, 39 control) community-dwelling dyads (PwD, IC), with the PwD visiting a DCC at least twice per week. METHODS: All outcomes were assessed using structured questionnaires during interviews with PwD and ICs at baseline (T0), 3 months (T1), and 6 months (T2). Primary outcomes: physical activity and mobility of the PwD. SECONDARY OUTCOMES: physical, cognitive, emotional and social functioning, and quality of life for PwD. For ICs: experienced burden, quality of life, and positive care experiences. RESULTS: Mixed-model analyses showed no statistically significant effects on primary outcomes. There were statistically significant positive effects on PwD's secondary outcomes at T2 on cognition [Mini-Mental State Examination (MMSE): r = 2.30, 95% confidence interval (CI): 0.65, 3.96, P = .007; and Trail Making Test part A (TMT-A): r = -28.98, 95% CI: -54.89, -3.08, P = .029], social functioning (Behavior Observation Scale for Intramural Psychogeriatrics subscale 1 (GIP): r = -1.86, 95% CI: -3.56, -0.17, P = .031), and positive post-test effects in ICs on distress caused by the PwD's neuropsychiatric symptoms (NPI-Q total distress: r = -3.30, 95% CI: -6.57, -0.03, P = .048) and on sense of competence (SSCQ: r = 2.78, 95% CI: 0.85, 4.71, P = .005). CONCLUSIONS AND IMPLICATIONS: Exergaming appeared not effective on the primary outcomes. Despite the study being underpowered, we found positive effects on secondary outcomes for PwD and ICs, and no negative effects. We therefore recommend further study, dissemination, and implementation.

摘要

目的：体力活动可增强痴呆症患者（PwD）的身心功能。健身游戏将身体活动与游戏环境中的认知刺激相结合，旨在克服进行身体活动的障碍。我们评估了健身游戏在痴呆症日间护理中心（DCC）中对 PwD 和非正式照护者（IC）的影响。

设计：在荷兰的 23 个 DCC 中进行了一项随机对照试验，将参与者随机分为健身游戏组（6 个月内进行互动式骑行）或常规护理对照组。

地点和参与者：共有 112 对（73 名健身游戏组，39 名对照组）社区居住的 PwD 和 IC，其中 PwD 每周至少两次到 DCC 访问。

方法：所有结果均通过对 PwD 和 IC 在基线（T0）、3 个月（T1）和 6 个月（T2）时进行的访谈使用结构化问卷进行评估。主要结果：PwD 的体力活动和移动能力。

次要结果：PwD 的身体、认知、情绪和社会功能以及生活质量。对 IC 而言：体验负担、生活质量和积极的照护体验。

结果：混合模型分析显示，主要结果无统计学意义。在 T2 时，PwD 的次要结果显示出统计学上的积极影响，包括认知[简易精神状态检查（MMSE）：r=2.30，95%置信区间（CI）：0.65，3.96，P=0.007；和连线测试 A（TMT-A）：r=-28.98，95%CI：-54.89，-3.08，P=0.029]、社会功能[院内精神老化行为观察量表（GIP）子量表 1（GIP）：r=-1.86，95%CI：-3.56，-0.17，P=0.031]和积极的后测效应，在 IC 中对 PwD 的神经精神症状（NPI-Q 总困扰：r=-3.30，95%CI：-6.57，-0.03，P=0.048）和对胜任感（SSCQ：r=2.78，95%CI：0.85，4.71，P=0.005）造成的困扰。

结论和意义：健身游戏对主要结果似乎没有效果。尽管研究力度不足，但我们发现 PwD 和 IC 的次要结果有积极影响，且没有负面效果。因此，我们建议进一步研究、传播和实施。