由照料者实施的认知刺激治疗对阿尔茨海默病病人及照料者的影响

摘要

目的 探讨由家庭照料者实施的认知刺激训练对早中期阿尔茨海默病(AD)病人及照料者的影响.方法 采用单盲(评定者)随机对照研究,入选50例AD病人及照料者随机分为认知刺激训练组(CST组,25例)和对照组(25例),分别在治疗师指导下由家庭照料者对病人进行认知刺激训练或支持治疗,每周2次共24周.干预前后以简易智能状态检查量表(MMSE)、日常生活能力量表(ADL)和神经精神科问卷(NPI)对AD病人进行评价;以中文版压力知觉量表(CPSS)、抑郁自评量表(SDS)和照料者积极感受量表(PAC)对照料者状况进行评价.结果 入选AD病人基线资料差异均无统计学意义(P>0.05),以影响分析结果的基线评定分值为协变量进行协方差分析.治疗24周后,CST组病人的NPI评分与对照组相比差异无统计学意义(P=0.960),部分病人日常生活能力虽出现一定改善,但MMSE、ADL评分与对照组比较,差异亦无统计学意义.CST组家庭照料者的主观知觉压力与对照组相比差异无统计学意义(P=0.646),但积极感受显著增加(P=0.005),同时照料者抑郁评分显著下降(P=0.001),差异具有统计学意义.结论 由居家照料者实施的认知刺激训练未增加早中期AD病人的神经精神症状,同时照料者的积极感受显著增加,抑郁症状有所减轻,该方法可作为居家AD病人的辅助治疗应用于临床.%Objective To investigate the efficacy of home-based cognitive stimulation therapy ( CST) by family caregivers in improving cognitive and neuropsychiatric symptoms for the patients with mild to moderate Alzheimer disease ( AD) and in improving mental and perceived stress for the caregiver. Methods A randomized, controlled, rater-blind clinical trial enrolled 50 patients with AD. All patients were assigned to CST group (n=25) or control group (CG group, n=25),and the study was carried out for 24 weeks. The cognitive status was evaluated by the mini mental state examination ( MMSE) and activities of daily living ( ADL) . The psychological and behavioral disorders were evaluated by the neuropsychiatry inventory ( NPI ) . The pressure on caregivers was evaluated by the Chinese perceived stress scale (CPSS), positive aspects of caregiving (PAC) and self-rating depression scale ( SDS) . ANCOVA was used to estimate the differences between CST group and CG group. Results The characteristics of the patients at baseline were well balanced between the two treatment groups ( P>0. 05) . After a 24-day treatment, caregivers participating in CST showed a greater improvement in the total score of PAC(F=8. 817,P=0. 005) and SDS(F=13. 43,P=0. 001)compared to control group. There was no statistically significant difference in MMSE, NPI and ADL score in patients, and no significant difference in perceived stress in caregivers between control group and CST group. Conclusions CST could alleviate the depression symptoms and increase the positive aspects of caregivers.