Meng Xiangfei, Fang Shuyan, Zhang Shuang, Li Huanhuan, Ma Dongfei, Ye Yaodong, Su Jianping, Sun Jiao
School of Nursing, Jilin University, Changchun, Jilin, China.
School of Nursing, Jilin University, Changchun, Jilin, China; School of Nursing, Xinjiang Medical University, Urumqi Municipality, Xinjiang, China.
Int J Nurs Stud. 2022 Jun;130:104236. doi: 10.1016/j.ijnurstu.2022.104236. Epub 2022 Mar 17.
Cognitive impairment and dementia have emerged as one of the greatest global challenges for health and social care. Multidomain interventions that target several risk factors simultaneously may achieve optimal preventive effects for dementia.
This systematic review aimed to evaluate the effectiveness of multidomain lifestyle interventions for improving cognition and reducing the risk of dementia.
Systematic review and meta-analysis.
Five electronic databases, PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO, were systematically searched from inception to April 17, 2021. Randomised controlled trials (RCTs) that assessed multidomain lifestyle interventions on the outcomes of cognition or dementia risk were included. The standardized mean difference (Hedges' g) was calculated using random-effects models. Risk of bias was assessed using the Revised Cochrane risk-of-bias assessment tool for randomised trials (RoB2), and the certainty of evidence was assessed using the five Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Seventeen RCTs involving 12,312 participants were included. The meta-analysis indicated that multidomain lifestyle interventions showed small but significant effects on both the risk of dementia (SMD = -0.11; 95%CI, -0.18 to -0.05; P <0.001; I = 0%; 6RCTs, 1981 participants) and the cognitive composite score (SMD = 0.10; 95%CI, 0.02 to 0.17; P = 0.012; I = 27.5%; 7 RCTs, 2643 participants). No significant improvements were found in global cognition (SMD = -0.04; 95% CI, -0.12 to 0.04; P = 0.330; I = 38.3%; 9 RCTs, 3740 participants).
Multidomain lifestyle interventions have the potential to reduce the risk of dementia (high-certainty evidence) and improve the cognitive composite score (moderate-certainty evidence). There is no moderate- or high-certainty evidence that multidomain interventions improve global cognition. Future large-scale, high-quality studies are required to determine the effects of multidomain interventions on global cognition or other cognitive domains.
The systematic review and meta-analysis have been registered in PROSPERO (CRD42021260122).
认知障碍和痴呆已成为全球卫生与社会保健面临的最大挑战之一。同时针对多种风险因素的多领域干预措施可能对痴呆症产生最佳预防效果。
本系统评价旨在评估多领域生活方式干预对改善认知和降低痴呆风险的有效性。
系统评价和荟萃分析。
从数据库建库至2021年4月17日，对五个电子数据库PubMed、Embase、Cochrane图书馆、CINAHL和PsycINFO进行系统检索。纳入评估多领域生活方式干预对认知或痴呆风险结局影响的随机对照试验（RCT）。使用随机效应模型计算标准化均数差（Hedges' g）。采用修订后的Cochrane随机试验偏倚风险评估工具（RoB2）评估偏倚风险，并使用推荐分级的评估、制定和评价（GRADE）五项标准评估证据的确定性。
纳入17项RCT，共12312名参与者。荟萃分析表明，多领域生活方式干预对痴呆风险（标准化均数差= -0.11；95%置信区间，-0.18至-0.05；P <0.001；I² = 0%；6项RCT，1981名参与者）和认知综合评分（标准化均数差= 0.10；95%置信区间，0.02至0.17；P = 0.012；I² = 27.5%；7项RCT，2643名参与者）均有微小但显著的影响。在整体认知方面未发现显著改善（标准化均数差= -0.04；95%置信区间，-0.12至0.04；P = 0.330；I² = 38.3%；9项RCT，3740名参与者）。
多领域生活方式干预有可能降低痴呆风险（高确定性证据）并改善认知综合评分（中等确定性证据）。没有中等或高确定性证据表明多领域干预能改善整体认知。未来需要大规模、高质量的研究来确定多领域干预对整体认知或其他认知领域的影响。
该系统评价和荟萃分析已在PROSPERO注册（CRD42021260122）。
