基于ICD-11和ICF主动式音乐疗法改善认知障碍老年人认知功能的系统综述

doi:10.3969/j.issn.1006-9771.2024.01.005

摘要/Abstract

摘要：

目的基于《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF)系统综述主动式音乐疗法对认知障碍老年人认知功能的干预效果。

方法构建PICO架构，采用主题词检索法，在PubMed、Web of Science、Embase、中国知网、维普和万方数据库检索采用主动式音乐疗法对认知障碍老年人认知功能进行干预的相关文献，发表时间为建库至2023年11月5日。筛选文献并提取作者、国家、发表时间、样本特征、研究方法、干预方式、测量工具和干预效果等文献特征，采用物理治疗证据数据库(PEDro)量表进行方法学质量评价，并进行系统综述。

结果最终纳入8篇文献，来自6个国家。研究设计均为随机对照试验，共356例参与者，包括轻度认知障碍和痴呆老年人。文献发表时间集中在2014年至2020年，PEDro量表平均分为7.4分。所采用的干预方式为歌唱和演奏乐器。干预场所涉及医院、疗养院、健康中心。干预时长多数为每次30~60 min，少数为每次120 min。每周多为1~3次，持续8~12周。健康结局集中于认知功能方面，主要表现为改善整体认知功能、执行功能、注意功能和记忆功能。

结论基于ICD-11和ICF构建了主动式音乐疗法对认知障碍老年人认知功能效益的理论架构。主动式音乐疗法有助于改善认知障碍老年人的整体认知功能、执行功能、注意功能和记忆功能。

关键词: 主动式音乐疗法, 老年人, 认知障碍, 认知功能, 系统综述

Abstract:

Objective To conduct a systematic review of the effect of active music therapy on cognitive function for older adults with cognitive impairment based on International Classification of Diseases, the 11th Revision (ICD-11), and International Classification of Functioning, Disability and Health (ICF).

Methods A PICO framework was constructed. Thematic keyword searches were conducted in databases including PubMed, Web of Science, Embase, CNKI, VIP, and Wanfang data, for literature on the effect of active music therapy on cognitive function for older adults with cognitive impairment, published up to November 5th, 2023. Information on authors, countries, publication date, sample characteristics, study designs, intervention methods, measurement tools and outcomes were extracted. The methodological quality of the researches was evaluated using the Physiotherapy Evidence Database (PEDro) scale.

Results Eight researches from six countries were included, which were all randomized controlled trials involving 356 older adults with mild cognitive impairment and dementia. The articles were published from 2014 to 2020, with an average of 7.4 of the PEDro scale. Active music therapy was used by singing and playing instruments. Interventions took place in hospitals, nursing homes, and health centers. The intervention duration ranged from mostly 30 to 60 minutes a time, with a few 120 minutes a time. Interventions were implemented mostly one to three times a week, lasting from eight to twelve weeks. Health outcomes focused on cognitive function, including overall cognitive function, executive function, attention function and memory function.

Conclusion A theoretical framework for the benefits of active music therapy on the cognitive function for older adults with cognitive impairment has been constructed based on ICD-11 and ICF. Active music therapy can improve overall cognitive function, executive function, attention function and memory function for older adults with cognitive impairment.

Key words: active music therapy, older adults, cognitive impairment, cognitive function, systematic review

中图分类号:

R749.1

王航宇, 葛可可, 范永红, 都丽露, 邹敏, 封磊. 基于ICD-11和ICF主动式音乐疗法改善认知障碍老年人认知功能的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 36-43.

WANG Hangyu, GE Keke, FAN Yonghong, DU Lilu, ZOU Min, FENG Lei. Effect of active music therapy on cognitive function for older adults with cognitive impairment: a systematic review based on ICD-11 and ICF[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 36-43.

图/表 4

表1

图1

表2

表3

纳入文献基本特征"

纳入文献	国家	样本特征	干预方式	干预地点	干预方案	比较	结局
Chen等^[12] (2018)	美国	健康状况：轻、中度痴呆对照组：n = 13，平均年龄(77.3±10)岁干预组：n = 15，平均年龄(77.3±9.4)岁	对照组：非音乐认知任务+步行活动干预组：歌唱或演奏乐器+步行活动	医院	每次60 min，每周1次，共2个月	干预组注意力得分变化显著高于对照组	干预组TMT分数显著降低，表明注意功能增强
Han等^[13] (2020)	韩国	健康状况：MCI 对照组：n = 12，平均年龄(73.42±5.96)岁干预组：n = 12，平均年龄(72.83±7.93)岁	对照组：无干预干预组：演奏乐器（数字乐器）	医院	每次60 min，每周2次，共10周	1.干预组干预前后比较：①干预后整体认知功能得分显著高于干预前；②干预后执行功能得分显著高于干预前；③干预后延迟记忆得分显著高于干预前 2.干预组与对照组比较：干预组执行功能得分显著高于对照组	1.干预组干预前后比较：①MoCA总分数提高，表明整体认知功能改善；②MoCA的执行分数提高，表明执行功能提升；③MoCA的延迟记忆分数提高，表明记忆功能中的延迟记忆功能改善 2.干预组与对照组比较：干预组MoCA的执行分数提高，表明执行功能提升
Miyazaki等^[14]a (2020)	日本	健康状况：轻、中、重度痴呆对照组：n = 17，平均年龄(88.89±6.05)岁干预组：n = 22，平均年龄(85.74±6.96)岁	对照组：无干预干预组：演奏乐器（鼓）	疗养院	每次30 min，每周3次，共3个月	①干预组执行功能显著优于对照组；②干预组抑制控制效果显著优于对照组	干预组：①FAB总分数提高，表明执行功能提升；②FAB的Go/No-Go分数提高，表明抑制控制增强
Miyazaki等^[15]b (2020)	日本	健康状况：轻度认知障碍对照组：n = 10，平均年龄(83.58±7.18)岁干预组：n = 13，平均年龄(80.00±7.46)岁	对照组：涂鸦艺术干预组：歌唱	疗养院	每次120 min，每周1次，共12周	①干预组执行功能得分显著高于对照组；②干预组抑制控制得分显著高于对照组	干预组：①FAB总分数提高，表明执行功能提升；②FAB的Go/No-Go分数提高，表明抑制控制增强
Pongan等^[16](2017)	法国	健康状况：轻度AD 对照组：n = 28，平均年龄(80.2±5.71)岁干预组：n = 31，平均年龄(78.8±7.43)岁	对照组：绘画干预组：歌唱	医院	每次120 min，每周1次，共3个月	1.干预组干预前后比较：①干预后工作记忆效果显著优于干预前；②干预后抑制控制效果显著优于干预前 2.干预组与对照组比较：干预组言语记忆效果显著优于对照组	1.干预组干预前后比较：①DST分数提高，表明工作记忆改善；②Stroop测试错误分数降低，表明抑制控制增强 2.干预组与对照组比较：FCRT分数提高，表明记忆功能中的言语记忆功能改善
Shimizu等^[17] (2018)	日本	健康状况：轻度认知障碍对照组：n = 9，平均年龄(73.33±7.31)岁干预组：n = 30，平均年龄(74.90±4.29)岁	对照组：运动干预组：演奏乐器（响板）+运动	健康中心	每次60 min，每周1次，共12周	1.干预组干预前后比较：干预后执行功能得分显著高于干预前 2.干预组与对照组比较：干预组与对照组的执行功能得分差异不显著	1.干预组干预前后比较：FAB总分数提高，表明执行功能提升 2.干预组与对照组比较：两组FAB总分数提高且差异不显著，表明干预组对执行功能没有提升效果
Särkämö等^[18] (2014)	芬兰	健康状况：轻、中度痴呆对照组：n = 28，平均年龄(78.4±11.6)岁干预组1：n = 27，平均年龄(78.5±10.4)岁干预组2：n = 29，平均年龄(79.4±10.1)岁	对照组：无干预干预组1：歌唱干预组2：聆听音乐	医院	每次90 min，每周1次，共10周	①干预组执行功能显著优于对照组；②干预组情景记忆效果优于对照组；③干预组1的工作记忆改善效果显著优于干预组2	干预组：①FAB总分数提高，表明执行功能提升；②AFT分数提高，表明记忆功能中的情景记忆功能改善；③DST分数提高，表明工作记忆改善
Wang等^[19] (2018)	中国	健康状况：轻度AD 对照组：n = 30，平均年龄(69.1±7.2)岁干预组：n = 30，平均年龄(70.4±7.5)岁	对照组：药物治疗干预组：歌唱+药物治疗	医院	每次30~50 min，每天3次，共3个月	干预组整体认知功能得分显著高于对照组	干预组MoCA总分数提高，表明整体认知功能改善

表3

参考文献 35

[1]	JACK C R Jr, BENNETT D A, BLENNOW K, et al. NIA-AA research framework: toward a biological definition of Alzheimer's disease[J]. Alzheimer Dement, 2018, 14(4): 535-562. doi: 10.1016/j.jalz.2018.02.018
[2]	HORNBY-TURNER Y C, PEEL N M, HUBBARD R E. Health assets in older age: a systematic review[J]. BMJ Open, 2017, 7(5): e013226. doi: 10.1136/bmjopen-2016-013226
[3]	JIA L, DU Y, CHU L, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study[J]. Lancet Public Health, 2020, 5(12): e661-e671. doi: 10.1016/S2468-2667(20)30185-7 pmid: 33271079
[4]	WHO. Global status report on the public health response to dementia[EB/OL]. [2021-05-23]. https://www.who.int/publications/i/item/9789240033245.
[5]	CUMMINGS J L, TONG G, BALLARD C. Treatment combinations for Alzheimer's disease: current and future pharmacotherapy options[J]. J Alzheimer's Dis, 2019, 67(3): 779-794.
[6]	SILVERMAN M J. Music therapy in mental health for illness management and recovery[M]. Oxford, UK: Oxford University Press, 2022.
[7]	TSOI K K F, CHAN J Y C, NG Y M, et al. Receptive music therapy is more effective than interactive music therapy to relieve behavioral and psychological symptoms of dementia: a systematic review and meta-analysis[J]. J Am Med Directors Assoc, 2018, 19(7): 568-576.e3. doi: 10.1016/j.jamda.2017.12.009
[8]	GÓMEZ-GALLEGO M, GÓMEZ-GALLEGO J C, GALLEGO-MELLADO M, et al. Comparative efficacy of active group music intervention versus group music listening in Alzheimer's disease[J]. Int J Environ Res Public Health, 2021, 18(15): 8067. doi: 10.3390/ijerph18158067
[9]	World Heath Oranization. International Classification of Diseases 11th Revision[EB/OL]. (2019-10-17)[2021-6-16]. https://int/browse11/1-m/en.
[10]	世界卫生组织. 国际功能、残疾与健康分类(国际中文增补版)[M]. 邱卓英,译. 日内瓦: 世界卫生组织, 2015.
	World Health Organization. International Classification of Functioning, Disability and Health (International Chinese Supplement)[M]. QIU Z Y, trans trans. Geneva: World Health Organization, 2015.
[11]	CASHIN A G, MCAULEY J H. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale[J]. J Physiother, 2020, 66 (1): 59. doi: S1836-9553(19)30092-X pmid: 31521549
[12]	CHEN Y L, PEI Y C. Musical dual-task training in patients with mild-to-moderate dementia: a randomized controlled trial[J]. Neuropsychiatric Dis Treatment, 2018, 14: 1381-1393.
[13]	HAN E, PARK J, KIM H, et al. Cognitive intervention with musical stimuli using digital devices on mild cognitive impairment: a pilot study[J]. Healthcare, 2020, 8(1): 45. doi: 10.3390/healthcare8010045
[14]	MIYAZAKI A, OKUYAMA T, MORI H, et al. Drum communication program intervention in older adults with cognitive impairment and dementia at nursing home: preliminary evidence from pilot randomized controlled trial[J]. Front Aging Neurosci, 2020, 12: 142. doi: 10.3389/fnagi.2020.00142 pmid: 32714176
[15]	MIYAZAKI A, MORI H. Frequent Karaoke training improves frontal executive cognitive skills, tongue pressure, and respiratory function in elderly people: pilot study from a randomized controlled trial[J]. Int J Environ Res Public Health, 2020, 17(4): 1459. doi: 10.3390/ijerph17041459
[16]	PONGAN E, TILLMANN B, LEVEQUE Y, et al. Can musical or painting interventions improve chronic pain, mood, quality of life, and cognition in patients with mild Alzheimer's disease? Evidence from a randomized controlled trial[J]. J Alzheimer's Dis, 2017, 60(2): 663-677.
[17]	SHIMIZU N, UMEMURA T, MATSUNAGA M, et al. Effects of movement music therapy with a percussion instrument on physical and frontal lobe function in older adults with mild cognitive impairment: a randomized controlled trial[J]. Aging Mental Health, 2018, 22(12): 1614-1626. doi: 10.1080/13607863.2017.1379048
[18]	SÄRKÄMÖ T, TERVANIEMI M, LAITINEN S, et al. Cognitive, emotional, and social benefits of regular musical activities in early dementia: randomized controlled study[J]. Gerontologist, 2014, 54(4): 634-650. doi: 10.1093/geront/gnt100 pmid: 24009169
[19]	WANG Z, LI Z, XIE J, et al. Music therapy improves cognitive function and behavior in patients with moderate Alzheimer's disease[J]. Int J Clin Exp Med, 2018, 11(5): 4808-4814.
[20]	RAGLIO A, GALANDRA C, SIBILLA L, et al. Effects of active music therapy on the normal brain: fMRI based evidence[J]. Brain Imaging Behavior, 2016, 10(1): 182-186. doi: 10.1007/s11682-015-9380-x
[21]	SEINFELD S, FIGUEROA H, ORTIZ-GIL J, et al. Effects of music learning and piano practice on cognitive function, mood and quality of life in older adults[J]. Front Psychol, 2013, 4: 810. doi: 10.3389/fpsyg.2013.00810 pmid: 24198804
[22]	KIM S J, YOO G E. Instrument playing as a cognitive intervention task for older adults: a systematic review and meta-analysis[J]. Front Psychol, 2019, 10: 151. doi: 10.3389/fpsyg.2019.00151 pmid: 30833913
[23]	CONWAY C M, PISONI D B, KRONENBERGER W G. The importance of sound for cognitive sequencing abilities: The auditory scaffolding hypothesis[J]. Cur Direct Psychol Sci, 2009, 18(5): 275-279.
[24]	FUSAR-POLI L, BIELENINIK Ł, BRONDINO N, et al. The effect of music therapy on cognitive functions in patients with dementia: a systematic review and meta-analysis[J]. Aging Mental Health, 2018, 22(9): 1103-1112. doi: 10.1080/13607863.2017.1348474
[25]	BUGOS J A, PERLSTEIN W M, MCCRAE C S, et al. Individualized piano instruction enhances executive functioning and working memory in older adults[J]. Aging Mental Health, 2007, 11(4): 464-471. doi: 10.1080/13607860601086504
[26]	BROWN S, MARTINEZ M J, PARSONS L M. Music and language side by side in the brain: a PET study of the generation of melodies and sentences[J]. Eur J Neurosci, 2006, 23(10): 2791-2803. pmid: 16817882
[27]	KLEBER B, VEIT R, BIRBAUMER N, et al. The brain of opera singers: experience-dependent changes in functional activation[J]. Cerebr Cortex, 2010, 20(5): 1144-1152. doi: 10.1093/cercor/bhp177
[28]	BADDELEY A. Working memory[J]. Science, 1992, 255(5044): 556-559. doi: 10.1126/science.1736359 pmid: 1736359
[29]	MORENO S, FARZAN F. Music training and inhibitory control: a multidimensional model[J]. Ann N Y Acad Sci, 2015, 1337(1): 147-152. doi: 10.1111/nyas.2015.1337.issue-1
[30]	STRAIT D L, KRAUS N, PARBERY-CLARK A, et al. Musical experience shapes top-down auditory mechanisms: evidence from masking and auditory attention performance[J]. Hearing Res, 2010, 261(1-2): 22-29. doi: 10.1016/j.heares.2009.12.021 pmid: 20018234
[31]	MEDINA D, BARRAZA P. Efficiency of attentional networks in musicians and non-musicians[J]. Heliyon, 2019, 5(3): e01315. doi: 10.1016/j.heliyon.2019.e01315
[32]	CALLAN D E, TSYTSAREV V, HANAKAWA T, et al. Song and speech: brain regions involved with perception and covert production[J]. Neuroimage, 2006, 31(3): 1327-1342. doi: 10.1016/j.neuroimage.2006.01.036 pmid: 16546406
[33]	CHU H, YANG C Y, LIN Y, et al. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study[J]. Biol Res Nursing, 2014, 16(2): 209-217. doi: 10.1177/1099800413485410
[34]	PALISSON J, ROUSSEL-BACLET C, MAILLET D, et al. Music enhances verbal episodic memory in Alzheimer's disease[J]. J Clin Exp Neuropsychol, 2015, 37(5): 503-517. doi: 10.1080/13803395.2015.1026802 pmid: 25951905
[35]	MOREIRA S V, JUSTI F R R, GOMES C F A, et al. Music therapy enhances episodic memory in Alzheimer's and mixed dementia: a double-blind randomized controlled trial[J]. Healthcare, 2023, 11 (22): 2912. doi: 10.3390/healthcare11222912

人群(Population)		干预 (Intervention)	比较 (Comparison)	结局(Outcome)
健康状况	ICD-11编码	干预 (Intervention)	比较 (Comparison)	结局指标及测量工具	ICF编码
认知障碍轻度认知障碍痴呆年龄≥ 60岁	6D71轻度神经认知障碍 6D80阿尔茨海默病所致痴呆 6E0Y其他特指的神经认知障碍 6E0Z未特指的神经认知障碍	干预方式歌唱演奏乐器干预地点医院疗养院健康中心干预方案活动频率活动强度活动持续时间	干预前后比较干预组与对照组比较	整体认知功能：MoCA 注意功能：TMT 记忆功能：MoCA、FCRT、AFT 执行功能：MoCA、FAB、DST、Stroop测试	b139其他特指和未特指的整体精神功能 b140注意功能 b144记忆功能 b164执行功能

纳入文献	资格标准	随机分配	分配隐藏	基线相似	被试施盲	治疗师施盲	评定者施盲	被试流失率≤ 15%	意向治疗分析	组间统计比较	点估计和变异性测量	总分
Chen等^[12](2018)	√	√	√		√		√	√	√	√	√	8
Han等^[13](2020)	√	√		√					√	√	√	5
Miyazaki等^[14](2020)	√	√		√				√	√	√	√	6
Miyazaki等^[15](2020)	√	√	√	√		√	√	√	√	√	√	9
Pongan等^[16](2017)	√	√	√	√			√	√	√	√	√	8
Shimizu等^[17](2018)	√	√	√	√	√		√	√	√	√	√	9
Särkämö等^[18](2014)	√	√		√			√	√	√	√	√	7
Wang等^[19](2018)	√	√	√	√				√	√	√	√	7