| Mild cognitive impairment (MCI) is a transitional state between normal aging anddementia. Patients of MCI with conversion rate of10～40%/year for Alzheimer’s disease, itwas10times higher than healthy seniors. There is a lack of effective methods for thetreatment of Alzheimer’s disease. Therefore, through the intervention of this particular stageto reduce the incidence of dementia is of great significance. A growing number of studiesshow that the existence of cognitive plasticity in healthy older persons, whose cognitivefunctioning can be maintained or improved by training, and even reversed. In recent years,there is increased interest in research of nonpharmacological approaches for patients withMCI. At present, some developed countries have already started sevices for preventingcognitive decline based on public health service. However, community-based researches onthe effectiveness of cognitive intervention are very insufficient in China. The aim of thisstudy is to develop a localized comprehensive cognitive intervention program which couldbe suitable for community-dwelling elderly patients with MCI, and to evaluate the effect ofthis program on overall cognitive function, memory function and quality of life for thispopulation.Methods：In this study, the adults aged60years and older, who attended annual health check inTongjiaqiao Community Health Service Center, from convenience sampling wereface-to-face interviewed with cognitive function screening. To select paticipants with MCIwho accorded with research criteria and were randomly divided into control group andexperimental group. Based on conventional health services, participants in the experimentalgroup received structured comprehensive cognitive intervention whereas participants in thecontrol group received relevant health education. Respectively in two time points of beforeand after intervention to assess all participants’ overall cognitive function, memory function and quality of life by using five instruments including the montreal cognitive assessmentscale (MoCA), the auditory verbal learning test (AVLT), the logical memory test (LMT), therivermead behavioural memory test second edition (RBMT-II) and the short-form36-itemhealth survey scale (SF-36). Using SPSS software version19.0, data are summarized asmeans (standard error) for the quantitative variables or numbers (proportions) for thequalitative variables. Differences between groups were compared using chi aquare (χ2),Fisher exact probability tests or Mann-Whitney for2independent samples tests whereappropriate. The Wilcoxon test for2related samples was used to examine within-groupdifferences with comparisons performed between pre-and post-test assessment. UsingSpearman rank correlation analysis to test the correlation between cognitive function andquality of life. Repetitive measures analysis of variance (ANOVA) was used to assessBetween-Subject Effects, With-Subject Effects and Interaction Effects.Results：The designed cases was72, excluding16cases, the final effective cases was56, thetotal effective rate was approximately78%, the control group is26cases and theexperimental group is30cases.1. The status of cognitive function and quality of life in the patients with MCIBaseline results showed that56patients with MCI whose the mean score of MoCAwas21.730.35, the low mean scores of the four cognitive domain of MoCA: visuospatialexecutive, language, abstraction and delayed recall were3.000.13,1.820.09,0.770.11,2.710.19; the low mean scores of both short-term memory and long-term delayed recall ofAVLT were19.790.66,5.720.40; the low mean scores of both short form andcomplexity form of LMT were7.380.29,11.240.45; the mean score of RBMT-II was15.640.41, the low mean scores of the three dimensions of RBMT-II: remembering a firstname and a surname, remembering to ask about an appointment, and delayed recall of ashort story were0.890.12,0.890.11,0.660.11; the low mean scores of general healthdimension of SF-36was54.023.25. The Spearman rank correlation analysis showed thatthe score of complexity form of LMT and role physical dimension of SF-36had positivecorrelation, the total score of RBMT-II and physical functioning, role emotional hadpositive correlation.2. The effect of cognitive intervention on cognitive function in patients with MCI The result of Mann-Whitney for2independent samples tests showed that the scores ofvisuospatial executive (MoCA), total score of RBMT-II and faces recognition, immediateand delayed recall of a short story (RBMT-II) in experimental group were increasedsignificantly (P＜0.05) than control group after intervention. The result of Wilcoxon test for2related samples showed that the scores of total and delayed recall (MoCA), short-termmemory (AVLT), complexity form (LMT), remembering a first name and a surname,remembering to ask about an appointment and pictures recognition (RBMT-II) in controlgroup were increased significantly (P＜0.05), but the scores of faces recognition anddelayed recall of a short story (RBMT-II) in control group were declined significantly (P＜0.05) before and after intervention, and the scores of total and visuospatial executive,attention, language, abstraction and delayed recall five cognitive domain (MoCA), bothshort-term memory and long-term delayed recall (AVLT), both short form and complexityform (LMT), RBMT-IItotal score and remembering to ask about an appointment, immediateand delayed recall of a short story, immediate recall of a new route (RBMT-II) inexperimental group were increased significantly (P＜0.05) before and after intervention.The result of repetitive measures ANOVA revealed that time main effect had significanteffect on the scores of MoCA, AVLT, LMT and RBMT-II(P＜0.01),interaction betweentime and interverntion had significant effect on the total score of RBMT-II(P＜0.05).3. The effect of cognitive intervention on quality of life in patients with MCIThe result of Mann-Whitney for2independent samples tests showed that the scores ofsocial functioning and vitality two dimensions and mental component summary inexperimental group were increased significantly (P＜0.05) than control group afterintervention. The result of Wilcoxon test for2related samples showed that the scores ofeight dimensions and two component summary (SF-36) in control group were no significantdifference (P＞0.05) before and after intervention, and the scores of social functioning,vitality and general health three dimensions, physical and mental component summary(SF-36) in experimental group were increased significantly (P＜0.05) before and afterintervention. The result of repetitive measures ANOVA revealed that time main effect hadsignificant effect on the score of general health dimension (P＜0.01),interaction betweentime and interverntion had significant effect on the scores of social functioning and vitalitytwo dimensions (P＜0.05). Conclusions：1. The status of cognitive function and quality of life in the patients with MCI in thepresent study shows the following features: overall cognitive function reveal severelyimpaired cognitive domain including visuospatial executive, executive function, language,abstraction and delayed recall; memory performance is characterized by episodic memoryare integrally damaged both immediate and delayed recall; self-reported general health ofpatients was poor; there are significant positive correlation between cognitive function andphysical functioning, role physical and role emotional.2. The results of this study indicate that comprehensive cognitive intervention caneffectively improve MCI patients’ visuospatial executive and memory performance,especially for news stories immediate and delayed recall function has improvedsignificantly.3. The results of present study suggest that comprehensive cognitive intervention caneffectively improve MCI patients’ social functioning, vitality and mental health, thusimproving the quality of life. |
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