Yaxin Chen, Lijiao Yan, Zhao Chen, Ziteng Hu, Fuqiang Zhang, Zhenhong Liu, Luda Feng, Yixiang Li, Xiangwei Dai, Qianzi Che, Huizhen Li, Haili Zhang, Ning Liang, Nannan Shi
Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
Front Psychiatry. 2025 Jan 15;15:1415113. doi: 10.3389/fpsyt.2024.1415113. eCollection 2024.
This study aimed to summarize and assess the certainty of evidence of non-pharmacological interventions (NPIs) on the depressive outcomes in people with mild cognitive impairment (MCI) based on published systematic reviews (SRs).
Databases including PubMed, EMBASE, PsycINFO, the Cochrane Database of Systematic Reviews, CNKI, CBM, Wanfang and VIP database were searched from their inception to June 6, 2023. The methodological quality of the SRs was evaluated using the AMSTAR2 tool, and the quality of evidence was assessed using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) framework.
Twelve eligible SRs were included. Three SRs focused on cognitive interventions (general, computer-based, cognitive stimulation/rehabilitation), six reviews on physical activity (Tai Chi, exercise therapy, dance), three on psychosocial interventions including cognitive behavioral therapy (CBT), mindfulness-based intervention (MBI) and type not specified, one on music therapy, and one on health education; moreover, there were two SRs on multimodal NPIs. One Cochrane SR was rated as moderate quality, while the others were rated as low quality according to AMSTAR2. The overlap between primary studies of included SRs (a total of 51 studies) was 1.8%, indicating slight overlap. General cognitive interventions (SMD=-0.25, 95% CI [-0.46, -0.04], GRADE: moderate) and computer-based cognitive interventions (narrative evidence) showed potential benefits in improving depression. Exercise therapy showed consistency between two SRs in benefiting depressive symptoms of MCI (SMD=-0.33, 95% CI [-0.56, -0.10], GRADE: Low; SMD=-0.37, 95% CI [-0.64, -0.10], GRADE: Low). Dance (SMD=-0.37, 95% CI [-1.11, 0.38], GRADE: Low), CBT (SMD=0.03,95% CI [-0.18, 0.24], GRADE: Moderate), MBI (SMD=0.29, 95% CI [0.00, 0.57], GRADE: Very Low) and health education (SMD=-0.12, 95% CI [-0.44, 0.20], GRADE: Low) did not show significant difference compared to control group in improving depressive symptoms, while the effectiveness of Tai Chi, music therapy and multimodal NPIs showed inconsistency across different studies.
Cognitive interventions (general or computer-based) and exercise therapy (a type of physical activity) show preliminary potential to improve depressive symptoms, while others do not show significant effects or relate to confused effects. Further methodologically rigorous and adequately powered primary studies are necessary for each of these NPIs, with reporting on the components of the interventions clearly in MCI patients.
本研究旨在基于已发表的系统评价（SRs）总结并评估非药物干预（NPIs）对轻度认知障碍（MCI）患者抑郁结局的证据确定性。
检索了包括PubMed、EMBASE、PsycINFO、Cochrane系统评价数据库、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库和维普数据库在内的数据库，检索时间从建库至2023年6月6日。使用AMSTAR2工具评估SRs的方法学质量，并使用推荐分级评估、制定和评价（GRADE）框架评估证据质量。
纳入了12篇合格的SRs。3篇SRs关注认知干预（一般认知干预、基于计算机的认知干预、认知刺激/康复），6篇关于体育活动（太极拳、运动疗法、舞蹈），3篇关于心理社会干预，包括认知行为疗法（CBT）、正念干预（MBI）及未明确类型的干预，1篇关于音乐疗法，1篇关于健康教育；此外，有2篇关于多模式NPIs的SRs。根据AMSTAR2，1篇Cochrane SR被评为中等质量，其他均被评为低质量。纳入的SRs（共51项研究）的原始研究之间的重叠率为1.8%，表明重叠程度较轻。一般认知干预（标准化均数差[SMD]=-0.25，95%置信区间[CI][-0.46, -0.04]，GRADE分级：中等）和基于计算机的认知干预（叙述性证据）在改善抑郁方面显示出潜在益处。运动疗法在两项SRs中均显示对MCI患者的抑郁症状有益（SMD=-0.33，95%CI[-0.56, -0.10]，GRADE分级：低；SMD=-0.37，95%CI[-0.64, -0.10]，GRADE分级：低）。舞蹈（SMD=-0.37，95%CI[-1.11, 0.38]，GRADE分级：低）、CBT（SMD=0.03，95%CI[-0.18, 0.24]，GRADE分级：中等）、MBI（SMD=0.29，95%CI[0.00, 0.57]，GRADE分级：极低）和健康教育（SMD=-0.12，95%CI[-0.44, 0.20]，GRADE分级：低）在改善抑郁症状方面与对照组相比无显著差异，而太极拳、音乐疗法和多模式NPIs的有效性在不同研究中表现不一致。
认知干预（一般或基于计算机的）和运动疗法（一种体育活动）显示出改善抑郁症状的初步潜力，而其他干预未显示出显著效果或效果存在混淆。对于这些NPIs中的每一种，都需要进一步开展方法学严谨且样本量充足的原始研究，并在MCI患者中清晰报告干预的组成部分。
