多领域干预对生理认知衰退综合征的疗效：一项集群随机试验。

Efficacy of Multidomain Intervention Against Physio-cognitive Decline Syndrome: A Cluster-randomized Trial.

机构信息

Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General hospital, Kaohsiung, Taiwan. No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan; Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. No. 155, Sec.2, Linong Street, Taipei 112 Taiwan.

Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. No. 155, Sec.2, Linong Street, Taipei 112 Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan. No.386, Rongguang Rd., Neicheng, Yuanshan Township, Yilan County 264, Taiwan.

出版信息

Arch Gerontol Geriatr. 2021 Jul-Aug;95:104392. doi: 10.1016/j.archger.2021.104392. Epub 2021 Mar 13.

DOI:10.1016/j.archger.2021.104392

PMID:33765656

Abstract

BACKGROUNDS

To investigate the efficacy of a community group-based intervention among community-dwelling older adults with physio-cognitive decline syndrome (PCDS).

METHODS

A prospective cluster randomized controlled trial included 733 community-dwelling older adults with adjusted Montreal Cognitive Assessment (MoCA adj) scores >18 from 40 community-based sites across Taiwan. PCDS was defined as the concomitant presence of physical declines, i.e., slowness and/or weakness plus dysfunction in any cognitive domain. The multidomain intervention integrated physical exercise, cognitive training, nutritional advices and health education lessons. Conventional health education in control group entailed periodic telephone calls to offer participants health education and advice. The primary outcome was the mean differences of MoCA adj total scores and all domains of MoCA adj between baseline and 6- and 12-month follow-up in each group of PCDS, cognitive dysfunction, mobility-type frailty and normal functioning, and the secondary outcomes included the changes of frailty score, handgrip strength, gait speed and physical activity. Intervention effects were analysed using a generalized linear mixed model.

RESULTS

Overall, 18.9% of the study sample had PCDS. Multidomain intervention for 12 months significantly improved cognitive performance in people with PCDS, and those with cognitive dysfunction only. An early benefit on visuo-spatial executive function was seen in older adults with mobility-type frailty. Intervention also improved frailty scores among participants with mobility-type frailty, handgrip strength for participants with PCDS, and gait speed in the normal group.

CONCLUSIONS

PCDS is a potentially reversible condition that may prevent subsequent disability and dementia, which deserves further investigation to confirm the long-term effects.

摘要

背景

调查针对社区居住的有生理认知衰退综合征（PCDS）的老年人的社区为基础的团体干预的疗效。

方法

一项前瞻性的聚类随机对照试验纳入了 733 名来自台湾 40 个社区场所的社区居住的老年人，其经调整的蒙特利尔认知评估（MoCA adj）评分>18。PCDS 的定义是同时存在身体衰退，即任何认知领域的缓慢和/或虚弱加上功能障碍。多领域干预综合了身体锻炼、认知训练、营养建议和健康教育课程。对照组的常规健康教育包括定期打电话给参与者提供健康教育和建议。主要结果是 PCDS、认知功能障碍、移动型虚弱和正常功能的 MoCA adj 总评分和所有领域的 MoCA adj 平均差异，以及次要结果包括虚弱评分、握力、步态速度和身体活动的变化。使用广义线性混合模型分析干预效果。