Research On The Traditional Chinese Medicine Nursing Intervention Of Mild Cognitive Impairment In Community

Objective:Tosystematically review the efficacy of acupoint massage and Taiji exercise on cognitive function of the elderly,and provide references for empirical research.Assessing the role ofcomprehensivetraditionalChinesemedicine(TCM)nursing intervention on the mild cognitive impairment(MCI)of the elderly in community by empirical study,in order to provide a basis for establishingtheeffective,comprehensive TCMnursing interventionprogramsofMCI,block and delay the progress of cognitive impairment,improving cognition of MCI,and reducing the incidence of dementia.Method:We searched databases including CNKI,WANFANG DATA,Chongqing VIP,CBM,PubMed,MEDLINE from January 2006 to December2016 to collect randomized controlled trials(RCTs)about acupoint Massage/Tai Chi for the elderly.Two reviewers independently screened the literature and extracted the data which meet the inclusion criteria.Meta-analysis was performed by using RevMan5.3 software.On the basis of literature research and evidence-based research,acupoint massage and Taijiquan were included in the intervention program.75 old peoplewith MCI who meet the research requirements in the community of Zhangjiawan street,Wuhan City were randomly selected,and randomly assigned to the intervention group and control group.The intervention group received health education,and at the same time,received the comprehensive TCM nursing intervention by trained nurses for 6 months,while the control group received health education only.The two groups were assessedbyMini-mentalStateExamination(MMSE)before intervention and 6 months after intervention respectively.Confirmatory factor analysis(CFA)was conducted to evaluate the measurement properties of MMSE.Second,Model constraint test was used to measure the constancy of cognitive function before and after intervention.Structural equation modeling(SEM)was conducted to analyze the effect of intervention.Bayesian estimation was applied to the CFA,Model constraintand SEM.All the analysis and modeling were performed using Mplus 7.4.Results:1.A total of 9 randomized controlled clinical trials studying the effects of acupressure on cognitive function in the elderly were included.All studies were described as randomized.Six studies described randomized trials.All studies did not mention blind method and intentional analysis,theOverall methodological quality is low.The results of Meta-analysis showed that in the evaluation of cognitive function in elderly with cognitive impairment,the acupressure group had a significant difference in global cognitive function[MD=0.91,95%CI(0.37,1.46),I~2=0,P=.001]and social function evaluation[MD=2.17,95%CI(0.88,3.45),I~2=0,P<0.001]were significantly better than the control group.In the outcome evaluation of healthy elderly,the acupoint massage group was significantly better than the control group in the global cognitive function[MD=2.46,95%CI(1.65,3.26),I~2=24%,P<0.00001].Recall assessments[MD=2.86,95%CI(-0.22,5.95),I~2=91%,P=0.07]showed no statistically significant difference,but there was a potential advantage in associative memory[MD=2.17,95%CI(1.32,3.02),I~2=41%,P<0.00001],Understanding Memory[MD=2.86,95%CI(1.90,3.82),I~2=0%,P<0.00001]and Back Numbers[MD=3.20,95%CI(2.56,3.84),I~2=0%,P<0.00001]is superior to the control group.There was no significant difference in cognitive function between interventions at 3 and 6 months(P=0.08).2.A total of 9 randomized controlled clinical trials studying the effects of Tai Chi exercise on cognitive function in the elderly were included.All studies were described as randomized,2 studies described randomized methods,2 studies conducted blind method for data gatherers and statistical evaluators,and the overall quality of the literature was not good.Meta-analysis showed:In the evaluation of cognitive function in the elderly with MCI,the experimental group was significantly better than the control group in global cognitive function[MD=0.92,95%CI(0.37,1.46),P<0.01],theWordFluencyTestScale[MD=2.17,95%CI(0.88,3.45),I~2=0%,P<0.001]and the Delayed recall test scale[MD=0.70,95%CI(0.29,1.11),I~2=0%,P<0.001].The improvement of memory span was not significant[MD=0.19,95%CI(-0.09,0.47),I~2=31%,P=0.18].In the outcome evaluation of healthy elderly people,the test group was significantly better than the control group in the global cognitive function[MD=0.70,95%CI(0.11,1.29),P<0.05].Tai Chi did not improve the TMT test.TMT-A[MD=-3.43,95%CI(-14.69,7.83),I~2=99%,P=0.55],TMT-B[MD=-5.48,95%CI(-26.72,15.76),I~2=99%,P=0.61].The experimental group with?6 months of intervention and>6 months of study had statistically significant differences in the MMSE total score compared with the control group,but there was no significant difference between the groups with different intervention time(P=0.60).3.Confirmatory factor analysis showed that measurements of cognitive function at baseline and after 6 months of intervention measured well in this study,which well fit the data,posterior predictive P-values ppp)=.476.4.In Bayesian estimation,the"Model Constraints"command is used for testing.The results showed that all of the new parameters set were insignificant,and therefore,the factors of cognitive function that were measured twice before and after the change over time were constant.5.Bayesian structural equation model analysis revealed that the final model included interventions as independent variable,age,and hobby as a covariate.The final model fits well,ppp=.27.The effects of grouping variables(experimental and control)were?=.30,p<.05,95%CI[.01,.54].These parameters indicate that after controlling for pretest,age,and hobbies,the test group was30 units higher than the control group in the dimension of the six month posttest latent variable.Since each parameter estimated by Bayes is a probability distribution,.30 is the median of this effectprobabilitydistributionwitha95%probability distribution between.01 and.54.6.In addition,age and hobby as covariates for post-test effectwere?=-.16,p<.05,95%CI[-.30,-.04]and?=.23,p<.05,95%CI[.01,.45].Finally,the correlation between age and hobby and pretest was?=-.15,p>.05,95%CI[-.42,.13],?=.07,p>.05,95%CI[.21,.37].Conclusion:1.Acupoint massage/Tai Chi exercise is superior to conventional therapy in the treatment of cognitive function in the elderly,but is limited by the quantity and quality of the study.The conclusion of this study also depends on the large sample,multicenter,high-quality RCT verification.2.After 6 months comprehensive TCM nursing intervention,including acupressure massage and Taijiquan training,can effectively improve the overall cognitive function ofMCI in community,and improve significantly better than simple health education group.In addition,age and hobby affect the global cognitive function of the elderly,with the increase of age,the worse the cognitive function;the more interests and hobbies,the better cognitive function.3.Through evidence-based and empirical studies,a set of comprehensive TCM nursing intervension programs for the elderly in the community are validated to improve the cognitive ability of MCI elderly,prevent dementia,reduce the social and family burden,and enhance the level of Chinese community nursing services significance.