老年人轻度认知障碍社区识别-干预工具包的研制

doi:10.3969/j.issn.1006-9771.2025.06.010

Abstract

Abstract:

Objective To develop a toolkit suitable for assisting community health institutions in the early identification and intervention of mild cognitive impairment (MCI) among older adults.

Methods A literature review was conducted to construct a draft of the identification and intervention toolkit. Tools with an expert approval rate above 70% were included after expert consultation. The final version of the toolkit was developed by integrating these tools with officially recommended tools in China.

Results The expert consultation yielded an authority coefficient of 0.84. The finalized toolkit included the assessment tools of Mini-Mental State Examination, Montreal Cognitive Assessment, General Practitioner Assessment of Cognition, Cognitive Abilities Screening Instrument and Clock Drawing Test, and 18 intervention measures including pharmacological treatment, cognitive training and psychological interventions, etc.

Conclusion The MCI Identification-Intervention Toolkit may serve as a reference for guiding the identification and intervention of MCI among older adults for community health institutions.

Key words: older adults, mild cognitive impairment, identification, intervention, community

CLC Number:

R749.1

CHEN Junli, ZHANG Han, SHI Zhixue, LIU Ya, ZHAO Yingzhe, DONG Zhiwei, JI Lihong, LI Haiyan, CHEN Fangfang, WANG Chunping, MA Anning, JING Qi. Development of a community toolkit for identifying and managing mild cognitive impairment among older adults[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(6): 692-702.

Figures/Tables 9

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Table 7

MCI intervention toolkits"

编号	干预措施	内涵
管理认知功能损失的干预措施
1	药物治疗	使用改善认知障碍的药物，如促智药、胆碱酯酶抑制剂、离子型谷氨酸受体拮抗剂、麦角生物碱类制剂、钙离子拮抗剂、银杏叶提取物等；同时给予药物服用指导
2	认知训练	借助系统设计的任务，针对注意、记忆、逻辑推理等认知域进行难度自适应训练，提升个体认知功能，包括感官刺激、记忆力训练、智力训练、言语训练、定向力训练、认知-行为训练、注意力训练、计算力训练、逻辑训练
3	心理干预	为MCI患者提供心理支持，改善患者不良情绪。具体方法验证疗法、动物辅助疗法、园艺疗法、玩偶工具移情疗法等
4	日常活动和运动能力训练	通过规律运动、体育锻炼、肢体活动改善患者的基础运动能力和日常生活活动能力。具体方法有氧运动(散步、游泳)、无氧运动(举重)等
5	饮食干预	通过饮食结构和营养搭配，降低认知功能损失。具体方法地中海饮食等
家庭社会关怀和环境支持
6	社会支持	帮助患者进行室外活动，比如晒太阳，开展游戏、社交，参与社区活动等，使其保持社会参与，增强社会支持
7	环境支持	打造友好环境，为患者营造良好的睡眠、生活环境；同时为患者提供声音、灯光、香薰、震动等模拟大自然的物理刺激，以延缓认知功能衰退
8	家庭照护与关怀	在患者行为不便时，照护者需为患者提供家庭照护，如餐饮、排泄、更衣、清洁、活动照护等。由于MCI的特殊性，要求家庭成员和照护者需充分落实家庭监护员职责，同时尊重患者意愿，满足患者需求
基础管理
9	睡眠障碍管理	老年人睡眠障碍风险较高，应采取措施缓解患者睡眠障碍。如洗热水澡或播放舒缓的音乐；同时，尽可能避免白天小睡和定期适度运动也有助于促进良好睡眠
10	营养管理	老年人易发生营养不良，应监测患者营养状况，根据不同患者设计营养支持方案，及时干预管理，避免由于营养不良造成认知功能减退
11	慢性疾病管理	慢性疾病是危害老年人健康的主要危险因素，并造成严重的疾病负担。应积极采取措施管理慢性疾病的发展，包括控制血压和糖尿病、治疗高脂血症，以降低心血管疾病等事件的风险
12	体检管理	老年人机体功能较弱，易发生健康风险事件，因此家庭成员及照护者应定期陪同就医体检，包括测量血压、体温、脉搏和呼吸，检查听力和视力，监测血糖等
13	听力与视力管理	听力损失和视力损失是老年综合征的组成部分，不仅影响患者的正常生活，还对患者的认知功能产生了负面影响。应采取措施管理老年MCI患者听力和视力功能
安全问题干预
14	环境安全	生活环境问题，如忘记关煤气或生活用水、用火不安全等
15	预防走失	老年认知障碍患者由于记忆力下降，走出家门后易迷路
16	预防跌倒	老年认知障碍患者身体衰弱，活动能力下降，易发生跌倒，而跌倒可能对其造成严重伤害
支持自我照护和自我管理
17	鼓励维持爱好	维持爱好能够为患者提供积极治疗和乐观生活的动力，家庭成员及照护者鼓励患者维持爱好，对于患者进行自我管理和照护具有重要意义
18	辅具选择支持	帮助患者选择适合的辅具，如为听力障碍患者配备助听器，提高其自我照护能力

Table 7

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序号	工具名称
1	简易智力状态检查量表(Mini-Mental State Examination, MMSE)
2	蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)
3	认知能力自评表(Ascertain Dementia 8, AD8)
4	迷你认知评估量表(Mini-Cog)
5	全科医生认知功能评估量表(General Practitioner Assessment of Cognition, GPCOG)
6	老年人认知功能减退知情者调查问卷(Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE)
7	改良版长谷川痴呆量表(Revised Hasegawa Dementia Scale, HDS-R)
8	Addenbrooke改良认知评估量表(Addenbrooke's Cognitive Examination-Revised, ACE-R)
9	ICOPE简易测试(Integrated Care for Older People Screening Tool)

序号	工具名称	同意纳入工具包		社区可行性		社区推荐性
序号	工具名称	人数/n	比例/%	均值	标准差	均值	标准差
1	MMSE	21	84.00	4.52	0.94	4.48	0.81
2	MoCA	18	72.00	4.16	1.12	4.00	1.10
3	AD8	14	56.00	3.80	1.50	3.24	1.45
4	Mini-Cog	14	56.00	4.08	1.02	3.76	0.99
5	GPCOG	20	80.00	4.16	0.97	3.80	1.26
6	IQCODE	14	56.00	3.68	1.38	3.32	1.38
7	HDS	14	56.00	3.76	1.30	3.32	1.49
8	ACE-R	13	52.00	3.28	1.43	3.16	1.43
9	ICOPE	11	44.00	3.56	1.50	2.80	1.47

编号	干预措施	同意纳入人数/n(%)	必要性	可行性
管理认知功能损失的干预措施
1	药物治疗	18 (94.7)	4.47	4.42
2	认知训练	19 (100.0)	4.95	4.05
3	心理干预	18 (94.7)	4.58	3.79
4	日常活动及运动能力训练	18 (94.7)	4.63	4.37
5	饮食干预	17 (89.5)	4.21	4.32
家庭社会关怀和环境支持
6	社会支持	19 (100.0)	4.68	4.58
7	环境支持	17 (89.5)	4.00	3.42
8	家庭照护	19 (100.0)	4.89	4.42
9	家庭关怀	15 (78.9)	4.42	3.79
基础管理
10	睡眠障碍管理	19 (100.0)	4.74	4.05
11	营养管理	17 (89.5)	4.21	4.00
12	口腔健康管理	13 (68.4)	3.89	3.84
13	慢性病管理	19 (100.0)	4.84	4.58
14	皮肤卫生管理	13 (68.4)	4.00	4.00
15	体检管理	19 (100.0)	4.68	4.58
16	听力与视力管理	19 (100.0)	4.68	4.53
安全问题干预
17	环境安全	18 (94.7)	4.63	4.63
18	预防走失	18 (94.7)	4.63	4.68
19	预防跌倒	19 (100.0)	4.74	4.42
支持自我照护和自我管理
20	鼓励维持爱好	19 (100.0)	4.79	4.79
21	辅具选择支持	17 (89.5)	4.58	4.11

政策指南	识别工具	干预措施
国家基本公共卫生服务规范	MMSE	药物治疗
疾病预防控制推荐工具	MoCA、CASI	心理支持、家庭支持
“健康中国2030”规划纲要	—	生活方式干预、药物干预
应对老年期痴呆国家行动计划(2024-2030年)	画钟测验	认知训练、社区支持

工具信息	MMSE	MoCA	GPCOG	CASI	画钟测验
评估内容	定向力、记忆力、语言功能、注意力、计算力	注意与集中、执行功能、记忆、语言、视结构技能、抽象思维、计算和定向力	定向力、记忆力、语言功能、视空间功能、执行功能及其他日常生活活动能力	定向力、注意力、记忆力、语言能力、视觉空间能力、抽象思维、列表生成	视觉空间能力、执行功能、计划能力、注意力
题目数量	共30个项目，满分30分	共30个项目，满分30分	受试者：9个项目知情者：6个项目	共20个项目，满分100分	共1个项目(画钟任务)，10分制
评分标准	< 27分考虑为认知障碍	< 26分考虑为认知障碍	受试者< 4分，提示显著认知障碍；知情者≥ 4分，提示认知功能下降	< 50分可能提示认知障碍	≤ 3分可能提示异常
测试时间	7~10min	10~15min	受试者：2~5 min 知情者：1~3 min	15~20 min	2~5 min
敏感性	80%~85%	67%~90%	70.05%~98.08%	80%~90%	60%~85%
特异性	76%~80%	50%~95%	69.52%~91.94%	70%~85%	75%~90%
优点	简单、易操作，广泛应用和研究	测试的认知域较全面	可靠，高效，可预测早期MCI，受性别，年龄，受教育程度和抑郁症状影响较小	全面评估多个认知领域，适用于不同教育水平人群，标准化程度高	快速、简便，不受语言和文化限制
缺点	受年龄和文化偏差影响，部分题目有天花板效应	存在教育和文化误差	数据获取有一定挑战	耗时较长，对极轻度认知损害可能不敏感	可能受绘画能力影响

Development of a community toolkit for identifying and managing mild cognitive impairment among older adults

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