Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ontario, Canada.
Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.
JAMA Netw Open. 2022 May 2;5(5):e226744. doi: 10.1001/jamanetworkopen.2022.6744.
Older adults with mild cognitive impairment (MCI) have the highest risk of progressing to dementia. Evidence suggests that nonpharmacological, single-domain interventions can prevent or delay progressive declines, but it is unclear whether greater cognitive benefits arise from multidomain interventions.
To determine whether multidomain interventions, composed of 2 or more interventions, are associated with greater improvements in cognition among older adults with MCI than a single intervention on its own.
MEDLINE, Embase, PsycInfo, AgeLine, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched from database inception to December 20, 2021.
Included studies contained (1) an MCI diagnosis; (2) nonpharmacological, multidomain interventions that were compared with a single active control; (3) older adults aged 65 years and older; and (4) randomized clinical trials.
Data were screened and extracted by 3 independent reviewers. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, random-effects meta-analyses were used to calculate effect sizes from the standardized mean difference (SMD) and 95% CIs.
Postintervention cognitive test scores in 7 cognitive domains were compared between single-domain and multidomain groups. Exposure to the intervention was analyzed.
A total of 28 studies published between 2011 and 2021, including 2711 older adults with MCI, reported greater effect sizes in the multidomain group for global cognition (SMD, 0.41; 95% CI, 0.23-0.59; P < .001), executive function (SMD, 0.20; 95% CI, 0.04-0.36; P = .01), memory (SMD, 0.29; 95% CI, 0.14-0.45; P < .001), and verbal fluency (SMD, 0.30; 95% CI, 0.12-0.49; P = .001). The Mini-Mental State Examination (SMD, 0.40; 95% CI, 0.17-0.64; P < .001), category verbal fluency test (SMD, 0.34; 95% CI, 0.13-0.56; P = .002), Trail Making Test-B (SMD, 0.46; 95% CI, 0.13-0.80; P = .007), and Wechsler Memory Scale-Logical Memory I (SMD, 0.47; 95% CI, 0.15-0.80; P < .001) and II (SMD, 0.26; 95% CI, 0.07-0.45; P < .001) favored the multidomain group. Exposure to the intervention varied between studies: the mean (SD) duration was 71.3 (36.0) minutes for 19.8 (14.6) weeks with sessions taking place 2.5 (1.1) times per week, and all interventions lasted less than 1 year.
In this study, short-term multidomain interventions (<1 year) were associated with improvements in global cognition, executive function, memory, and verbal fluency compared with single interventions in older adults with MCI.
轻度认知障碍 (MCI) 老年人进展为痴呆的风险最高。有证据表明，非药物、单一领域的干预措施可以预防或延缓认知能力下降，但尚不清楚多领域干预是否会带来更大的认知益处。
确定多领域干预措施（由 2 种或更多干预措施组成）是否比单一干预措施更能改善 MCI 老年人的认知能力。
从数据库建立到 2021 年 12 月 20 日，系统地检索了 MEDLINE、Embase、PsycInfo、AgeLine、CINAHL 和 Cochrane 对照试验中心注册库。
纳入的研究包含（1）MCI 诊断；（2）非药物、多领域干预措施，与单一活性对照进行比较；（3）年龄在 65 岁及以上的老年人；以及（4）随机临床试验。
由 3 名独立评审员筛选和提取数据。根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，使用标准化均数差 (SMD) 和 95%置信区间 (CI) 计算随机效应荟萃分析的效应大小。
比较单领域和多领域组之间 7 个认知领域的干预后认知测试分数。分析了对干预的暴露情况。
2011 年至 2021 年期间发表的 28 项研究，包括 2711 名 MCI 老年人，报告了多领域组在总体认知（SMD，0.41；95%CI，0.23-0.59；P<0.001）、执行功能（SMD，0.20；95%CI，0.04-0.36；P=0.01）、记忆（SMD，0.29；95%CI，0.14-0.45；P<0.001）和言语流畅性（SMD，0.30；95%CI，0.12-0.49；P=0.001）方面的效果更大。简易精神状态检查（SMD，0.40；95%CI，0.17-0.64；P<0.001）、类别言语流畅性测试（SMD，0.34；95%CI，0.13-0.56；P=0.002）、连线测试 B（SMD，0.46；95%CI，0.13-0.80；P=0.007）和韦氏记忆量表-逻辑记忆 I（SMD，0.47；95%CI，0.15-0.80；P<0.001）和 II（SMD，0.26；95%CI，0.07-0.45；P<0.001）均有利于多领域组。研究之间的干预暴露情况有所不同：19.8（14.6）周的平均（SD）持续时间为 71.3（36.0）分钟，每周进行 2.5（1.1）次会议，所有干预措施持续时间均不到 1 年。
在这项研究中，与单一干预相比，短期多领域干预措施（<1 年）与 MCI 老年人的总体认知、执行功能、记忆和言语流畅性的改善相关。
