多模式干预对轻度认知障碍个体的影响：上海的一项随机临床试验。

Effect of Multimodal Intervention in Individuals with Mild Cognitive Impairment: A Randomized Clinical Trial in Shanghai.

机构信息

Department of General Medicine, Huashan Hospital, Fudan University, Shanghai, China.

National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.

出版信息

J Alzheimers Dis. 2024;101(1):235-248. doi: 10.3233/JAD-231370.

DOI:10.3233/JAD-231370

PMID:39031354

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11380217/

Abstract

BACKGROUND

Previous trials have indicated that multimodal training could improve cognitive functions and moods in individuals with mild cognitive impairment (MCI). However, evidence was mainly obtained from studies in high-income countries.

OBJECTIVE

This trial aims to investigate the efficacy, safety, and potential mechanism of a multimodal intervention on cognitive function in individuals with MCI living in a community.

METHODS

In this single-blind, randomized controlled trial, 120 participants with MCI were randomly assigned to either the intervention group or the control group. The intervention group received the multimodal intervention, while the control group received regular health education. Neuropsychological tests and magnetic resonance imaging (MRI) were conducted at baseline and after the 12-week intervention.

RESULTS

Fifty-nine and fifty-seven participants respectively in the intervention and control groups completed the trial. The intervention group shown improvements in primary outcome, Mini-Mental State Exam (MMSE) total score (mean difference -0.96, 95% CI [-1.58, -0.34], p = 0.003), and secondary outcomes: MMSE recall (-0.39, 95% CI [-0.71, -0.07], p = 0.019), MMSE language (-0.26, 95% CI [-0.44, -0.07], p = 0.007), Auditory Verbal Learning Test instantaneous memory (-3.30, 95% CI [-5.70, -0.89], p = 0.008), Digit Symbol Substitution Test total score (-2.91, 95% CI [-5.67, -0.15], p = 0.039), digit span forwards (-1.25, 95% CI [-1.93, -0.56], p < 0.001), and Digit Span Test (-1.33, 95% CI [-2.33, -0.34], p = 0.009) compared to the control group. Improvements were observed in structural and functional connectivity related to language, concentration, executive function, memory, and recall functioning via MRI in the intervention group.

CONCLUSIONS

The multimodal intervention improved cognitive function in individuals with MCI in cognitive performance and neuroimaging.

摘要

背景

先前的试验表明，多模式训练可以改善轻度认知障碍（MCI）患者的认知功能和情绪。然而，证据主要来自高收入国家的研究。

目的

本试验旨在研究社区中 MCI 个体的多模式干预对认知功能的疗效、安全性和潜在机制。

方法

在这项单盲、随机对照试验中，将 120 名 MCI 患者随机分为干预组和对照组。干预组接受多模式干预，对照组接受常规健康教育。在基线和 12 周干预后进行神经心理学测试和磁共振成像（MRI）。

结果

干预组和对照组各有 59 名和 57 名患者完成了试验。干预组在主要结局、简易精神状态检查（MMSE）总分（平均差值-0.96，95%置信区间[-1.58，-0.34]，p=0.003）和次要结局方面均有改善：MMSE 回忆（-0.39，95%置信区间[-0.71，-0.07]，p=0.019）、MMSE 语言（-0.26，95%置信区间[-0.44，-0.07]，p=0.007）、听觉词语学习测试即时记忆（-3.30，95%置信区间[-5.70，-0.89]，p=0.008）、数字符号替代测试总分（-2.91，95%置信区间[-5.67，-0.15]，p=0.039）、数字符号向前（-1.25，95%置信区间[-1.93，-0.56]，p<0.001）和数字跨度测试（-1.33，95%置信区间[-2.33，-0.34]，p=0.009），与对照组相比。通过 MRI，干预组在与语言、注意力、执行功能、记忆和回忆功能相关的结构和功能连接方面也观察到了改善。