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

Abstract

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

CLC Number:

R749.1

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.

Figures/Tables 4

Table 1

Figure 1

Table 2

Table 3

Basic features of the included literatures"

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

Table 3

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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

Effect of active music therapy on cognitive function for older adults with cognitive impairment: a systematic review based on ICD-11 and ICF

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