老年期痴呆患者的认知促进治疗
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摘要
认知促进治疗(Cognitive Stimulation Therapy,CST)是一种针对轻中度老年期痴呆患者的非药物治疗方法。CST的治疗原则是从精神活动方面对患者进行刺激,从而使患者的精神活动更加活跃和集中。CST的治疗目标是通过组织参与者开展活动,全面改善患者的认知能力并通过在小组中不断对其引导以提高其社会功能。CST由经过培训的治疗师提供,每5-8名患者组成一个小组进行训练,分为7周每周2次的强化期训练和16至24周每周1次的维持期训练。最新进展为由照料者对老年期痴呆患者实施一对一的25周每周3次的个体认知促进训练。国内研究证实CST适合中国国情,对患者的语言能力、沟通能力以及情绪改善有一定效果。CST成本低,效果好,组织实施容易,值得在我国推广。
Cognitive stimulation therapy(CST) is a non-pharmacological treatment for patients with mild to moderate dementia. The key principle of CST is to mentally stimulate, in other words to get patients' minds active and engaged. The aim of CST is to generally enhance cognitive and social functioning of patients by a range of activities and discussions. CST is usually provided by trained facilitators in a group of five to eight patients. Standard CST is finished in seven weeks, twice a week, and maintenance CST is performed in 16 to 24 weeks, once a week. A new tendency of CST is to be carried out at home, delivered to patients face-to-face by their caregivers in 25 weeks at a frequency of three times a week. Current evidences of CST in China showed clear improvements of language,communication and mood disturbance of patients. CST is suggested to be scaled up in China due to its low cost and high feasibility.
Cognitive stimulation therapy(CST) is a non-pharmacological treatment for patients with mild to moderate dementia. The key principle of CST is to mentally stimulate, in other words to get patients' minds active and engaged. The aim of CST is to generally enhance cognitive and social functioning of patients by a range of activities and discussions. CST is usually provided by trained facilitators in a group of five to eight patients. Standard CST is finished in seven weeks, twice a week, and maintenance CST is performed in 16 to 24 weeks, once a week. A new tendency of CST is to be carried out at home, delivered to patients face-to-face by their caregivers in 25 weeks at a frequency of three times a week. Current evidences of CST in China showed clear improvements of language,communication and mood disturbance of patients. CST is suggested to be scaled up in China due to its low cost and high feasibility.
引文
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[2]Swaab D.Brain aging and Alzheimer’s disease,“wear and tear”versus“use it or lose it”.Neurobiol Aging.1991;12(4):317-24.
[3]Breuil V,Derotrou J,Forette F,et al.Cognitive Stimulation of Patients with Dementia-Preliminary-Results.Int J Geriatr Psychiatry.1994;9(3):211-7.
[4]Small G.What we need to know about age related memory loss.Brit Med J.2002;324(7352):1502-5.
[5]NICE.National Institute of Clinical Excellence(NICE)guidance 2006.Available from:http://www.nice.org.uk/.
[6]Spector A,Orrell M,Davies S,et al.Can reality orientation be rehabilitated?Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia.NeuropsycholRehabil.2001;11(3-4):377-97.
[7]Woods R.Non-pharmacological techniques.In:Qizilbash N,editor.Evidence-based dementia practice.Oxford:Blackwell;2002.p.428-46.
[8]Spector A,Thorgrimsen L,Woods B,et al.Making a difference.London:Hawker Publications;2006.
[9]Spector A,Thorgrimsen L,Woods B,et al.Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia:randomised controlled trial.Br J Psychiatry.2003;183:248-54.
[10]Coen R,Flynn B,Rigney E,et al.Efficacy of a cognitive stimulation therapy programme for people with dementia.Ir J Psychol Med.2011;28(3):145-7.
[11]Yamanaka K,Kawano Y,Noguchi D,et al.Effects of cognitive stimulation therapy Japanese version(CST-J)for people with dementia:a single-blind,controlled clinical trial.Aging Ment Health.2013;17(5):579-86.
[12]Orrell M,Spector A,Thorgrimsen L,et al.A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy(MCST)for people with dementia.Int J Geriatr Psychiatry.2005;20(5):446-51.
[13]Aguirre E,Spector A,Streater A,et al.Making a difference 2.London:Hawker Publications;2012.
[14]Aguirre E,Spector A,Streater A,et al.Service users’involvement in the development of a maintenance cognitive stimulation therapy(CST)programme:A comparison of the views of people with dementia,staff and family carers.Dementia-London.2011;10(4):459-73.
[15]Aguirre E,Spector A,Hoe J,et al.Maintenance Cognitive Stimulation Therapy(CST)for dementia:A single-blind,multi-centre,randomized controlled trial of Maintenance CST vs.CST for dementia.Trials,2010;11.
[16]Orrell M,Aguirre E,Spector A,et al.Maintenance cognitive stimulation therapy for dementia:single-blind,multicentre,pragmatic randomised controlled trial.Br JPsychiatry.2014;204(6):454-61.
[17]Yates L,Leung P,Orgeta V,et al.The development of individual cognitive stimulation therapy(iCST)for dementia.ClinInterv Aging.2015;10:95-104.
[18]Yates L,Orrell M,Leung P,et al.Making a difference 3.London:Hawker Publications;2015.
[19]Orgeta V,Leung P,Yates L,et al.Individual cognitive stimulation therapy for dementia:a clinical effectiveness and cost-effectiveness pragmatic,multicentre,randomised controlled trial.Health Technol Assess.2015;19(64):1-108.
[20]Liu Z,Huang Y,Li T,et al.China.In:Yates L,Yates J,Orrell M,et al,editor.Cognitive Stimulation Therapy for Dementia:History,Evolution and Internationalism.Oxon:Routledge;2018.p.227-36.
[2]Swaab D.Brain aging and Alzheimer’s disease,“wear and tear”versus“use it or lose it”.Neurobiol Aging.1991;12(4):317-24.
[3]Breuil V,Derotrou J,Forette F,et al.Cognitive Stimulation of Patients with Dementia-Preliminary-Results.Int J Geriatr Psychiatry.1994;9(3):211-7.
[4]Small G.What we need to know about age related memory loss.Brit Med J.2002;324(7352):1502-5.
[5]NICE.National Institute of Clinical Excellence(NICE)guidance 2006.Available from:http://www.nice.org.uk/.
[6]Spector A,Orrell M,Davies S,et al.Can reality orientation be rehabilitated?Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia.NeuropsycholRehabil.2001;11(3-4):377-97.
[7]Woods R.Non-pharmacological techniques.In:Qizilbash N,editor.Evidence-based dementia practice.Oxford:Blackwell;2002.p.428-46.
[8]Spector A,Thorgrimsen L,Woods B,et al.Making a difference.London:Hawker Publications;2006.
[9]Spector A,Thorgrimsen L,Woods B,et al.Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia:randomised controlled trial.Br J Psychiatry.2003;183:248-54.
[10]Coen R,Flynn B,Rigney E,et al.Efficacy of a cognitive stimulation therapy programme for people with dementia.Ir J Psychol Med.2011;28(3):145-7.
[11]Yamanaka K,Kawano Y,Noguchi D,et al.Effects of cognitive stimulation therapy Japanese version(CST-J)for people with dementia:a single-blind,controlled clinical trial.Aging Ment Health.2013;17(5):579-86.
[12]Orrell M,Spector A,Thorgrimsen L,et al.A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy(MCST)for people with dementia.Int J Geriatr Psychiatry.2005;20(5):446-51.
[13]Aguirre E,Spector A,Streater A,et al.Making a difference 2.London:Hawker Publications;2012.
[14]Aguirre E,Spector A,Streater A,et al.Service users’involvement in the development of a maintenance cognitive stimulation therapy(CST)programme:A comparison of the views of people with dementia,staff and family carers.Dementia-London.2011;10(4):459-73.
[15]Aguirre E,Spector A,Hoe J,et al.Maintenance Cognitive Stimulation Therapy(CST)for dementia:A single-blind,multi-centre,randomized controlled trial of Maintenance CST vs.CST for dementia.Trials,2010;11.
[16]Orrell M,Aguirre E,Spector A,et al.Maintenance cognitive stimulation therapy for dementia:single-blind,multicentre,pragmatic randomised controlled trial.Br JPsychiatry.2014;204(6):454-61.
[17]Yates L,Leung P,Orgeta V,et al.The development of individual cognitive stimulation therapy(iCST)for dementia.ClinInterv Aging.2015;10:95-104.
[18]Yates L,Orrell M,Leung P,et al.Making a difference 3.London:Hawker Publications;2015.
[19]Orgeta V,Leung P,Yates L,et al.Individual cognitive stimulation therapy for dementia:a clinical effectiveness and cost-effectiveness pragmatic,multicentre,randomised controlled trial.Health Technol Assess.2015;19(64):1-108.
[20]Liu Z,Huang Y,Li T,et al.China.In:Yates L,Yates J,Orrell M,et al,editor.Cognitive Stimulation Therapy for Dementia:History,Evolution and Internationalism.Oxon:Routledge;2018.p.227-36.