Gräßel Elmar, Donath Carolin, Pendergrass Anna, Luttenberger Katharina
Zentrum für Medizinische Versorgungsforschung, Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Gesundheitswesen. 2022 Dec;84(12):1154-1157. doi: 10.1055/a-1531-4636. Epub 2021 Sep 24.
Study of the long-term effects of a psychosocial intervention in dementia including its implementation under real world conditions in day care centers. In the present study this was investigated for the MAKS intervention - Motor, Activities of daily living, (K)Cognitive and Social-communicative component.
At the end of a 6-month, cluster-randomised, controlled study, professional caregivers in all 32 day care centers (DCC) were trained in MAKS. From then on, all centers were free to carry out the intervention or not (open phase). In the 18-month follow-up phase, after 6 and 18 months the heads of the DCC were asked whether MAKS was carried out regularly in the trained form. After 6 months in the open phase, the cognitive abilities of the study participants with mild cognitive impairment, mild to moderate dementia were again assessed using Mini-Mental Status Examination (MMSE). Multiple linear regression analysis was used to investigate whether the MMSE score was predicted by carrying out MAKS or not. Other adjustment variables were MMST score at t6, age, sex, frequency of visits to TP, antidementia medication use, and depressiveness.
In the first 6 months of the open phase, 22 DCC (69%) stated that they performed MAKS. In months 7 to 18, this proportion increased up to 81%. For the 287 study participants in the 32 DCC, the fact whether they were guests in a DCC with or without MAKS was a significant predictor of the course of cognitive abilities (p=0.019). The average MMSE score in DCC without MAKS decreased; in DCC with MAKS it stayed approximately the same. Other significant predictors were baseline score and use of antidementia medications (individuals on antidementia medications scored worse).
The multimodal, psychosocial MAKS intervention for people with cognitive impairment that has been trained in a structured way can be implemented in day care centers on a long-term basis. MAKS has a positive effect on cognitive abilities also in a real world scenario.
研究心理社会干预对痴呆症的长期影响，包括在日托中心的实际条件下实施该干预。在本研究中，针对MAKS干预——运动、日常生活活动、（K）认知和社会交流组成部分进行了调查。
在一项为期6个月的整群随机对照研究结束时，对所有32个日托中心（DCC）的专业护理人员进行了MAKS培训。从那时起，所有中心可自行决定是否开展干预（开放阶段）。在18个月的随访阶段，在6个月和18个月后，询问DCC的负责人MAKS是否以培训的形式定期开展。在开放阶段6个月后，再次使用简易精神状态检查表（MMSE）对患有轻度认知障碍、轻度至中度痴呆症的研究参与者的认知能力进行评估。使用多元线性回归分析来研究MMSE评分是否由开展MAKS来预测。其他调整变量包括t6时的MMST评分、年龄、性别、到TP的就诊频率、抗痴呆药物的使用情况以及抑郁程度。
在开放阶段的前6个月，22个DCC（69%）表示他们开展了MAKS。在第7至18个月，这一比例上升至81%。对于32个DCC中的287名研究参与者而言，他们所在的DCC是否开展MAKS是认知能力变化过程的一个显著预测因素（p = 0.019）。未开展MAKS的DCC中，MMSE平均评分下降；开展MAKS的DCC中，该评分大致保持不变。其他显著预测因素为基线评分和抗痴呆药物的使用情况（服用抗痴呆药物的个体得分更低）。
以结构化方式培训的针对认知障碍患者的多模式心理社会MAKS干预可在日托中心长期实施。在实际场景中，MAKS对认知能力也有积极影响。
