双语训练改善老年人认知功能的系统综述

doi:10.3969/j.issn.1006-9771.2022.05.013

摘要/Abstract

摘要：

目的系统评价双语训练对于老年人认知功能的改善情况。方法检索PubMed、Web of science、ScienceDirect、SpringerLink、万方、中国知网的相关文献,时限为2011年至2021年5月,并辅以参考文献回溯和手工检索,提取相关数据。结果共获得有效文献21篇,来自12个国家,主要来源于医学、神经病学、心理学、生物学等相关的期刊,发表时间集中在2017年和2019年。研究包括前瞻性研究和回顾性研究,目标群体包括健康人群、痴呆患者和阿尔茨海默病(AD)患者,主要涉及双语对老年人认知功能的影响、双语训练对认知功能改善的作用途径及其效果、老年人双语训练的局限性等。结论双语训练能改善老年人的认知功能,提高与记忆、注意和执行功能相关的脑功能连接性,延迟AD或痴呆的发病时间。脑结构和脑功能的改善是认知功能改善的主要原因,包括脑区连接增加、改变皮质回路激活水平和保持大脑结构的完整性和可塑性等;训练效果主要表现为执行功能和知觉功能的改善,延缓认知功能减退速度,并能在短期内起效。双语训练的最终结果可能是促进语言功能,保持大脑结构完整性,使用更多神经回路补偿。相关研究缺乏统一的受试人群标准和合理的控制条件,实验设计缺乏统一范式,还需要更多研究。

关键词: 老年, 双语训练, 认知, 脑功能, 系统综述

Abstract:

Objective To systematically review the effects of bilingual training on cognition for older adults. Methods Researches about bilingual training for cognition for the older adults were retrieved from PubMed, Web of Science, ScienceDirect, SpringerLink, Wanfang Data, and CNKI from 2011 to May, 2021, supplemented by references backtracking and manual retrieval. The data was extracted for analysis. Results A total of 21 researches were included from twelve countries, which published mainly on journals of medicine, neurology, psychology, biology, etc., in 2017 and 2019. Most of the researches were prospective researches and retrospective researches, and the targeted groups including healthy people, people with dementia and people with Alzheimer's disease (AD). The objects mainly involved the effects of bilingualism on cognition, the pathways and the limitations. Conclusion Bilingual training may improve the cognition for older adults, through the brain connection related with memory, attention and execution, to delay the onset of AD or dementia; which may associate with the improvement of brain structure and function, including connectivity among regions, activation of cortical circuits, and structural integrity and plasticity. The effects are mainly on execution and perception, and delaying the cognitive decline, which appear in a short term. Bilingual training may finally promote language function, maintain the integrity of the brain structures, and compensate cognitive decline using more potential neural circuits. However, these researches need more uniform criteria for subjects, more reasonable control conditions, and more uniform paradigms.

Key words: aged, bilingual training, cognition, brain function, systematic review

中图分类号:

R493

轩文如,沈雨晴,周淼,封世文. 双语训练改善老年人认知功能的系统综述[J]. 《中国康复理论与实践》, 2022, 28(5): 578-584.

XUAN Wenru,SHEN Yuqing,ZHOU Miao,FENG Shiwen. Bilingual training for cognition of older adults: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 578-584.

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主要文献分析"

纳入文献	国家	研究对象	干预策略	评估方法	研究结果	局限性
Vails等^[6](2019)	捷克	认知障碍的年长者	英语教学和学习	标准化测试的认知评估	试验组认知功能略有改善	试验组与对照组的分数差异较小
Bellander等^[7](2016)	瑞典	健康参与者	语言学习	磁共振成像、认知测试	与主动对照相比,试验组右侧海马的灰质结构发生更大变化	研究只包括两个测试时间点,可能会模糊大脑变化和行为之间的关系
Hofstetter等^[8](2017)	以色列	成人右利手志愿者	语言学习任务	弥散张力成像	额下回、颞中回和顶下小叶的扩散率改变	仅观察左半球选定区域,可能忽视其他区域的功能
Bubbico等^[9](2019)	意大利	健康老年人	英语课程学习、家庭作业练习	母语教师定性评估、神经心理学评估、功能性磁共振成像	干预组整体认知功能提高,右侧额下回、右侧额上回和左侧顶上小叶功能连接增加	样本量相对较小
Wong等^[10](2019)	中国	健康老年人	外语学习、游戏、音乐欣赏、计算机程序训练	行为试验、测试分析	整体认知功能提高	需进行随机对照研究
Bak等^[11](2016)	英国	各年龄段健康人	苏格兰盖尔语课程学习	听觉注意测验	每周练习盖尔语超过5 h的人认知功能有所提高	课程开始和结束时进行测试的时间很短,限制了所用测试的数量
Berggren等^[12](2020)	瑞典	健康老年人	语言学习或放松训练	认知评估	在认知改善方面,组间差异不明显	没有全面评估语言功能;参与者的受教育程度高于平均水平
Ware等^[13](2017)	法国	认知健康、没有视听觉障碍的老年人	英语学习	问卷调查	外语课程方案对认知正常的法国老年人可行	项目对缺乏英语经验的参与者相当困难
Bak等^[14](2014)	英国	老年人	双语学习	双语问卷调查、认知测试	双语者的表现明显好于基线认知功能的预测,对一般智力和阅读的影响最大	语言知识是由问卷来定义的,而不是熟练程度
Craik等^[15](2010)	加拿大	AD患者	使用双语	发病时间	双语患者比单语患者的确诊时间晚4.3年,报告发病时间晚5.1年	组间比较是横向的,应谨慎对待这些发现
Bialystok等^[16](2007)	加拿大	痴呆患者	使用双语	发病时间	双语患者比单语患者痴呆症状延迟4.1年	研究存在一定程度的主观性
Legault等^[17](2019)	美国	母语为英语的学习者	使用双语	MRI	第二语言词汇的发展与认知控制和语义处理的重要脑区的功能和结构变化有关	没有观察到尾状核对语言经验的作用
Rieker等^[18](2020)	西班牙	老年人	使用双语	在显性任务提示和记忆转换条件下进行任务转换	双语者无变化,单语者响应延迟、错误率增加	样本量小,应谨慎对待结果
Gold等^[19](2013)	美国	老年人	使用双语	感知任务切换、fMRI	双语老年人的表现优于单语同龄人,同时左侧额叶皮质和扣带回皮质的激活减少	没有解决习得年龄对双语优势的影响等问题
Ljungberg等^[20](2013)	瑞典	单语和双语参与者	使用双语	情景记忆回忆任务、语言流利性任务	双语者比单语者在情景回忆和字母流畅性方面的表现更好	双语者无法在日常生活中练习他们的第二语言
Bialystok等^[21](2004)	加拿大	年轻人和老年人	使用双语	西蒙任务	双语者对一致和不一致试验的反应更快,但也产生较小的西蒙效应	不确定能否将结果扩展到双语经验更有限的双语者
Jylkkä等^[22](2018)	芬兰	使用芬兰语和英语的健康人	-	图片命名和语义分类任务	第一语言(L1)比第二语言(L2)具有更高的基础水平激活,并且在L2生产过程中需要更多地抑制L1	结果与现有的理论框架不兼容,需要进一步的调查和检验
Martensson等^[23](2012)	瑞典	口译人员	强化训练	MRI	被试者的大脑皮质厚度和海马体积增加	样本代表性不高
Stein等^[24](2012)	瑞士	母语为英语的交换生	密集德语课程	多项选择测试和词汇测试、MRI	德语水平提高与左额下回结构变化有关	样本量小
Ramos等^[25](2017)	西班牙	健康老年人	巴斯克语培训	行为试验	双语老年人没有任何特定的认知优势	没有一个较好的对照组
Anderson等^[26](2017)	英国	健康老年人、MCI患者、疑似AD患者	使用双语	简易精神状态检查、Delis-Kaplan执行功能系统、蒙特利尔认知评估	在不同的诊断类别中,双语者的表现比单语同龄人好	神经心理学测试在用于双语参与者时可能会产生偏差

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