| Objectives:(1) To understand the situation of patients with mild cognitive impairment (MCI) in the elderly in communities in Jilin area, as well as the awareness on the knowledge related to MCI and the needs for it.(2) To analyze factors affecting MCI in the elderly in communities, to construct a structural equation model of factors affecting MCI in the elderly in communities for revealing the relationship among the various factors and the role of them in the development of MCI.(3) To study an effective cognition training method for the elderly with MCI by Meta analysis.(4) To construct a cognitive intervention model for the elderly with MCI based on the results from the Meta analysis and the structural equation model of factors affecting elderly MCI in communities.(5) To verify the application effect of the cognitive intervention model in the elderly with MCI in communities by taking the elderly with MCI in communities as the object of study and using a randomized controlled trial.Methods:(1) A stratified sampling method was used in this study. First,5 administrative regions (Fengman District, Changyi District Chuanying District, Longtan District and High-tech area) were selected in Jilin area, and then 2 community in each district were randomly selected and all the elderly in all the selected health service centers in the 10 communities. The collection of data was accomplished by the researchers and investigators who had received a unified training, and the contents included the questionnaires and the measurement of physiological and biochemical indexes.(2) Amos7.0 software was used to construct a structural equation model of factors affecting the MCI in the elderly.(3) RevMan5.2 statistical software was used to analyze effective cognition training methods for the elderly with MCI.(4) Based on the social cognitive theory, the cognitive behavioral therapy and the stage behavior change model, a cognitive intervention model suitable for the elderly with MCI was constructed.(5) Using a random sampling method and based on the early screening for MCI in the elderly in Jilin area,6 district health service center were randomly selected, in which 3 of them were randomly selected as intervention group and the other 3 districts were taken as control group, and then 25 people in each district health service center were randomly selected as the object of study according to the random number table and a total of 150 people were selected,75 in the intervention group and 75 in the control group, respectively.Results:(1) A total of 2,920 community elders were investigated in this study,1148 males and 1172 females, with an average age of 69.07±7.28. There were 560 elders with MCI in the population investigated, accounting for 19.2%; only 10.9% of the elderly with MCI who could know the knowledge related to MCI; 70.9% of the elderly who needed the knowledge on the clinical manifestation of MCI,53.4% of them who needed the knowledge on the clinical diagnosis of MCI, and 79.6% of them who needed the knowledge on the treatment of MCI.(2) The results of the structural equation model showed that the primary factors affecting MCI in the elderly included age, sex, marital status, occupation, smoking, drinking, sleeping, exercise, depression, DBP, FPG and TC, in which depression was an important intermediary variable in MCI-affected paths. Whether the direct effect, indirect effect or total effect showed that the effect of depression on the MCI in the elderly in communities was largest, and their path coefficient was 0.53,0.04 and 0.66, respectively.(3) The Meta analysis showed that the cognitive training could improve the overall cognition level of the elderly with MCI. Intervention methods used for the knowledge training, such as the memory training, operational training, reminiscence therapy training, language ability training and digital method training, were effective on the improvement of the cognitive function in the elderly with MCI.(4) According to the results of structural equation model of factors affecting MCI and meta analysis, a comprehensive intervention framework and model for the cognitive function in the elderly, which was integrated community health education, lifestyle guidance, psychological therapy, chronic disease management and cognitive training, was constructed in his study.(5) After the intervention for 6 months, there was a significantly statistical difference in changes in the depression score (8.67±1.23,13.60±2.18) between the intervention group and the control group (p<0.05); in the lifestyle, there was a significantly statistical difference in the number of the elderly who took part in exercise (60,24) between the intervention group and the control group (p<0.05); there was a significantly statistical difference in the sleep score (6.21±1.30,11.31±1.99) between the intervention group and the control group (p<0.05); there was a significantly statistical difference who smoke (20,24) between the intervention group and the control group (p<0.05);the results from the measurement of physiological and biochemical indexes showed that there were great differences in changes in SBP(125.80±10.33,146.10±15.69), DBP (77.31±6.59,88.59±9.10), and FPG (7.09±1.48,8.54±1.91) between the intervention group and the control group (p<0.05), and only TC (5.10±1.09,5.68±1.24) in the detection of blood lipids presented a significant difference (p<0.05), in the cognitive function, scores in the visual network and implementation function (3.93±0.40,3.37±0.76), name (2.83±0.49,2.26±0.86), attention (4.37±0.39,3.07±0.37), language (1.95±1.08,1.30±0.97), abstract (1.05±0.67,0.58±0.49), delay memory(3.50±1.25,2.81±1.22), and the total score of the elderly (24.83±1.90,20.53±2.39) in the intervention group all were significantly higher than those in the control group (p<0.05).(6) After the intervention, in the total score of MoCA, and scores in the visual network and implementation function, name, attention, language, abstract, delay memory in the intervention group, the intervention for 3months> the intervention for 6 months> before the intervention (26.17±1.86> 24.83±1.90> 20.53±2.39) could be found, with statistically significant differences (p<0.01); in the depression, the intervention for 3months< the intervention for 6 months< before the intervention (8.15±1.86<8.67±1.23<14.30±2.57), with statistically significant differences (p<0.05); in the sleep, the intervention for 6 monthes< the intervention for 3months< before the intervention (6.21±1.30<7.20±1.89<11.09±2.14) with statistically significant differences (p<0.05); in the number of the elderly who took part in exercise in the lifestyle, the intervention for 3months> the intervention for 6 months> before the intervention (61>60>36), with statistically significant differences (p<0.05); in the number of the elderly who smoken in the lifestyle, the intervention for 6 monthes< the intervention for 3months< before the intervention (18<24<26) with statistically significant differences (p<0.05);in the physiological and biochemical indexes SBP, DBP, FPG and TC, the intervention for 6 months> the intervention for 3 months>before the intervention (125.80±10.33<130.11±10.50< 145.85±16.50,77.31±6.59< 85.69±7.31< 93.89±8.50, 7.09±1.48< 7.64±1.50< 8.44±1.29,5.10±1.09< 5.21±1.03< 5.89±1.20), with statistically significant differences (p<0.05).Conclusions:1 The cognition of elderly in communities in Jilin area was lower and the elderly with MCI was 19.2%, indicating that Jilin area should be a high-prevalence area of MCI.2 The awareness rate of MCI in the elderly in communities in Jilin area was lower and the demand for the knowledge on MCI was high.3 It can be concluded from the analysis of overall effects that the depression has a greatest effect on MCI and its action paths should be most. The analysis of indirect effects indicates that lifestyle, sleep and depression in chronic diseases can affect MCI in the elderly, and the maximum impact is still depression.4 A comprehensive intervention model, which was integrated community health education, lifestyle guidance, psychological therapy, chronic disease management and cognitive training, can significantly improve the cognition, lifestyle, depression, sleep, and physiological and biochemical indexes of the elderly with MCI in this area. |
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