系统回顾和Meta分析 | Int J Nurs Stud

Abstract

BACKGROUND

Cognitive impairment and dementia have emerged as one of the greatest global challenges for health and social care Multidomain interventions that target several risk factors simultaneously may achieve optimal preventive effects for dementia.

OBJECTIVE

This systematic review aimed to evaluate the effectiveness of multidomain lifestyle interventions for improving cognition and reducing the risk of dementia.

DESIGN

Systematic review and meta-analysis.

METHODS

Five electronic databases, PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO, were systematically searched from inception to April 17, 2021. Randomised controlled trials that assessed multidomain lifestyle interventions on the outcomes of cognition or dementia risk were included. The standardized mean difference (Hedges’ g) was calculated using random-effects models. Risk of bias was assessed using the Revised Cochrane risk-of-bias assessment tool for randomised trials (RoB2), and the certainty of evidence assessed using the five Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

RESULTS

Seventeen Randomised controlled trials (RCTs) involving 12,312 participants were included. The meta-analysis indicated that multidomain lifestyle interventions showed small but significant effects on both the risk of dementia (SMD = -0.11; 95%CI, -0.18 to -0.05; P <0.001; I2 = 0%; 6RCTs, 1981 participants) and the cognitive composite score (SMD = 0.10; 95%CI, 0.02 to 0.17; P=0.012; I2 = 27.5%; 7 RCTs, 2643 participants). No significant improvements were found in global cognition (SMD = -0.04; 95% CI, -0.12 to 0.04; P=0.330; I2 = 38.3%; 9 RCTs, 3740 participants).

CONCLUSIONS

Multidomain lifestyle interventions have the potential to reduce the risk of dementia (high-certainty evidence) and improve the cognitive composite score (moderate-certainty evidence). There is no moderate- or high-certainty evidence that multidomain interventions improve global cognition. Future large-scale, high-quality studies are required to determine the effects of multidomain interventions on global cognition or other cognitive domains.

REGISTRATION

The systematic review and meta-analysis have been registered in PROSPERO (CRD42021260122)

摘要翻译（仅供参考）

背景介绍

认知障碍和痴呆症已经成为健康和社会护理方面最大的全球性挑战之一。同时针对几个风险因素的多领域干预措施可能会达到预防痴呆症的最佳效果。

目的

本系统综述旨在评估多领域生活方式干预对改善认知能力和降低痴呆风险的有效性。

设计

系统回顾和荟萃分析。

方法

从建库到2021年4月17日，系统地检索了五个电子数据库，即PubMed、Embase、Cochrane图书馆、CINAHL和PsycinFO。评估多领域生活方式干预对认知或痴呆风险结果的随机对照试验被纳入。使用随机效应模型计算标准化的平均差异（Hedges' g）。使用修订的Cochrane随机试验偏倚风险评估工具（RoB2）评估偏倚风险，并使用建议评估、发展和评价（GRADE）的五个分级标准评估证据的确定性。

结果

纳入了17项随机对照试验（RCTs），涉及12 312名参与者。荟萃分析表明，多领域生活方式干预对痴呆风险（SMD=-0.11；95%CI，-0.18至-0.05；P<0.001；I2=0%；6项RCTs，1981名参与者）和认知综合评分（SMD=0.10；95%CI，0.02至0.17；P=0.012；I2=27.5%；7项RCTs，2643名参与者）有小而明显的影响。在全球认知方面没有发现明显的改善（SMD=-0.04；95%CI，-0.12到0.04；P=0.330；I2=38.3%；9项RCTs，3740名参与者）。

结论

多领域的生活方式干预有可能降低痴呆症的风险（高确定性证据）并改善认知综合评分（中等确定性证据）。没有中度或高度确定的证据表明多领域干预措施可以改善全球认知能力。未来需要大规模、高质量的研究来确定多领域干预对全球认知或其他认知领域的影响。