新型冠状病毒性肺炎疫情封闭管理期间正念减压疗法对阿尔茨海默病患者情绪障碍及睡眠状况的影响分析

doi:10.16150/j.1671-2870.2022.01.010

摘要/Abstract

摘要：

目的： 探讨因新型冠状病毒性肺炎疫情封闭管理期间基于正念减压疗法（mindfulness-based stress reduction, MBSR）的心理康复干预,对长期住院轻中度阿尔茨海默病（Alzheimer disease,AD）患者情绪障碍及睡眠状况的影响。目的： 入组2020年1月前收治入院的轻中度AD患者70例,所有入选患者均接受为期8周的基于MBSR心理康复干预,干预时间为2020年2月11日至2020年4月30日。在干预开始前,进行患者一般资料收集,并使用汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）、老年抑郁量表（The 15-item Geriatric Depression Scale,GDS-15）及匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index,PSQI）等评估量表对每位入选患者进行初次评估,为期8周的MBSR干预结束时进行再次评估。在初次评估后,对患者一般资料与初次评估结果进行相关性分析。结果： 根据入组轻中度AD患者的焦虑、抑郁程度、睡眠状况评分与其受教育程度呈负相关（r<-0.4;P≤0.01）;而患者的睡眠状况评分与其焦虑、抑郁程度呈正相关（r>0.4;P≤0.01）。在接受了8周的MBSR干预后,患者的GDS、HAMA、PSQI评分较初次评估时有明显改善（P<0.05）。结论： 在因疫情封闭管理期间,基于MBSR的心理康复干预有助于改善长期住院轻中度AD患者的焦虑、抑郁等情绪障碍和睡眠状况。

关键词: 正念减压疗法, 轻中度阿尔茨海默病, 情绪障碍, 睡眠

Abstract:

Objective: To investigate the effects of MBSR(mindfulness-based stress reduction)-based mental rehabilitation intervention on mood disorders and sleep status of patients with mild to moderate Alzheimer′s disease (AD) in long-term hospital during closed management of COVID-19 pandemic. Methods: A total of 70 patients with mild to moderate AD who were admitted to hospital before January 2020 were enrolled. All patients received an 8-week psychological rehabilitation intervention based on MBSR from February 11, 2020 to April 30, 2020. Prior to the intervention, general patient data were collected, including Hamilton Anxiety Scale(HAMA), The 15-item Geriatric Depression Scale(GDS-15) and Pittsburgh Sleep Quality Index(PSQI) and other assessment scales were used for initial assessment of each enrolled patient, and re-assessment was performed at the end of the 8-week intervention. After the initial assessment, correlation analysis was conducted between general patient data and the results of the initial assessment in patients. Results: It revealed that anxiety, depression, sleep status of patients were negatively correlated with their education level (R<-0.4; P≤0.01); the sleep status score of patients was positively correlated with the degree of anxiety and depression (R>0.4; P≤0.01); GDS, HAMA and PSQI scores of the patients were significantly improved after 8 weeks of intervention compared with the initial evaluation(P<0.05). Conclusions: Mental rehabilitation intervention based on MBSR during closed management due to COVID-19 can improve anxiety, depression and other mood disorders and sleep status of patients with long-term inpatient mild to moderate AD.

Key words: Mindfulness-based stress reduction, Mild to moderate Alzheimer′s disease, Mood disorders, Sleep

中图分类号:

R541.7

付丛会, 徐英, 苏巍, 文静, 刘志芳, 朱倩, 张静怡, 熊泽民, 陈兰兰, 贾杰. 新型冠状病毒性肺炎疫情封闭管理期间正念减压疗法对阿尔茨海默病患者情绪障碍及睡眠状况的影响分析[J]. 诊断学理论与实践, 2022, 21(01): 46-51.

FU Conghui, XU Ying, SU Wei, WEN Jing, LIU Zhifang, ZHU Qian, ZHANG Jingyi, XIONG Zemin, CHEN Lanlan, JIA Jie. Effects of mindfulness-based stress reduction on mood disorders and sleep in patients with Alzheimer′s disease in the context of COVID-19[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(01): 46-51.

图/表 5

表1

图1

表2

表3

表4

参考文献 36

[1]	World Health Organization. Mental health of older adults[EB/OL]. [2022-01-15]. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults.
[2]	Zhai K, Dilawar A, Yousef MS, et al. Virtual Reality Therapy for Depression and Mood in Long-Term Care Facilities[J]. Geriatrics (Basel), 2021, 6(2):58.
[3]	Mukhtar S. Psychological health during the coronavirus disease 2019 pandemic outbreak[J]. Int J Soc Psychiatry, 2020, 66(5):512-516. doi: 10.1177/0020764020925835 pmid: 32434402
[4]	Tanoue Y, Nomura S, Yoneoka D, et al. Mental health of family, friends, and co-workers of COVID-19 patients in Japan[J]. Psychiatry Res, 2020, 291:113067. doi: 10.1016/j.psychres.2020.113067 URL
[5]	岳晶丽, 苏思贞, 钱英, 等. 新型冠状病毒肺炎疫情的心理危机干预及应对策略[J]. 中华精神科杂志, 2020, 53(3):176-180.
	Yue JL, Su SZ, Qian Y, et al. Psychological crisis intervention and coping strategies for the COVID-19 pandemic[J]. Chinese Journal of Psychiatry, 2020, 53(3):176-180.
[6]	刘冯铂, 张忠秋, 邱服冰, 等. 正念干预改善运动员心理康复效果的系统综述和Meta分析[J]. 中国康复理论与实践, 2020, 26(12):1390-1400.
	Liu FB, Zhang ZQ, Qiu FB, et al. Effect of Mindfulness on Psychological Rehabilitation of Athletes: A Systematic Review and Meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2020, 26(12):1390-1400.
[7]	Larouche E, Hudon C, Goulet S. Potential benefits of mindfulness-based interventions in mild cognitive impairment and Alzheimer′s disease: an interdisciplinary perspective[J]. Behav Brain Res, 2015, 276:199-212. doi: 10.1016/j.bbr.2014.05.058 pmid: 24893317
[8]	Creswell JD. Mindfulness Interventions[J]. Annu Rev Psychol, 2017, 68:491-516. doi: 10.1146/annurev-psych-042716-051139 pmid: 27687118
[9]	Moss AS, Reibel DK, Greeson JM, et al. An adapted mindfulness-based stress reduction program for elders in a continuing care retirement community: quantitative and qualitative results from a pilot randomized controlled trial[J]. J Appl Gerontol, 2015, 34(4):518-538. doi: 10.1177/0733464814559411 URL
[10]	张倩, 张宁, 刘金凤, 等. 正念干预治疗脑卒中患者抑郁效果的Meta分析[J]. 中国康复理论与实践, 2018, 24(12):1479-1484.
	Zhang Q, Zhang N, Liu JF, et al. Effect of Mindfulness-based Therapy on Depression for Stroke Patients:A Meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2018, 24(12):1479-1484.
[11]	Larouche E, Hudon C, Goulet S. Potential benefits of mindfulness-based interventions in mild cognitive impairment and Alzheimer′s disease: an interdisciplinary perspective[J]. Behav Brain Res, 2015, 276:199-212. doi: 10.1016/j.bbr.2014.05.058 pmid: 24893317
[12]	Vespa A, Fabbietti P, Giulietti MV. Study of the effects of mindfulness training on quality of life of patients with Alzheimer′s disease and their caregivers (Dyad Mindfulness Project)[J]. Aging Clin Exp Res, 2022, 34(1):65-71. doi: 10.1007/s40520-021-01907-x URL
[13]	Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria[J]. Lancet Neurol, 2007, 6(8):734-746. doi: 10.1016/S1474-4422(07)70178-3 pmid: 17616482
[14]	王刚. 痴呆及认知障碍神经心理测评量表手册[M]. 2版. 北京: 科学出版社, 2021:60-61.
	Wang G. Handbook of Rating scales for neuropsycholo-gical Assessment of Dementia and Associated cognitive disorders[M]. 2nd edition. Beijing: Science Press, 2021:60-61.
[15]	Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living[J]. Gerontologist, 1969, 9(3):179-186. pmid: 5349366
[16]	Thompson E. Hamilton Rating Scale for Anxiety (HAM-A)[J]. Occup Med (Lond), 2015, 65(7):601. doi: 10.1093/occmed/kqv054 pmid: 26370845
[17]	Gurevich A, Guller V, Berner YN, et al. Are atypical antipsychotics safer than typical antipsychotics for treating behavioral and psychological symptoms of dementia?[J]. J Nutr Health Aging, 2012, 16(6):557-561. pmid: 22659997
[18]	Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28(2):193-213. doi: 10.1016/0165-1781(89)90047-4 URL
[19]	Dos Santos Picanco LC, Ozela PF, et al. Alzheimer′s Disease: A Review from the Pathophysiology to Diagnosis, New Perspectives for Pharmacological Treatment[J]. Curr Med Chem, 2018, 25(26):3141-3159. doi: 10.2174/0929867323666161213101126 URL
[20]	Jensen-Dahm C, Waldemar G, Staehelin Jensen T, et al. Autonomic Dysfunction in Patients with Mild to Moderate Alzheimer′s Disease[J]. J Alzheimers Dis, 2015, 47(3):681-689. doi: 10.3233/JAD-150169 pmid: 26401703
[21]	Lima S, Garrett C, Machado JC, et al. Quality of life in patients with mild Alzheimer disease: the mediator role of mindfulness and spirituality[J]. Aging Ment Health, 2020, 24(12):2103-2110.
[22]	陈梅, 付丛会, 沈志强, 等. 互动式歌唱表演对轻中度阿尔茨海默病患者抑郁、精神行为和运动训练参与率的影响[J]. 临床荟萃, 2020, 35(4):357-361.
	Chen M, Fu CH, Shen ZQ, et al. Impact of interactive singing performance on depression,psychobehavioral symptoms and rate of participation in exercise training in patients with mild to moderate Alzheimer′s disease[J]. Clinical Focus, 2020, 35(4):357-361.
[23]	Creighton AS, Davison TE, Kissane DW. The correlates of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review[J]. Int J Geriatr Psychiatry, 2017, 32(2):141-154. doi: 10.1002/gps.4604 URL
[24]	朱荣彦, 郭鹏, 张巍. 阿尔茨海默病与睡眠障碍[J]. 中华老年医学杂志, 2017, 36(1):1-4.
	Zhu RY, Guo P, Zhang W. Alzheimer′s disease and sleep disorders[J]. Chinese Journal of Geriatrics, 2017, 36(1):1-4.
[25]	Mehra A, Rani S, Sahoo S, et al. A crisis for elderly with mental disorders: Relapse of symptoms due to heightened anxiety due to COVID-19[J]. Asian J Psychiatr, 2020, 51:102114. doi: 10.1016/j.ajp.2020.102114 URL
[26]	Voitsidis P, Nikopoulou VA, Holeva V, et al. The mediating role of fear of COVID-19 in the relationship between intolerance of uncertainty and depression[J]. Psychol Psychother, 2021, 94(3):884-893. doi: 10.1111/papt.12315 URL
[27]	Quintana Hernández DJ, Miró Barrachina MT, Ibáñez Fernández I, et al. Effects of a neuropsychology program based on mindfulness on Alzheimer′s disease: randomized double-blind clinical study[J]. Rev Esp Geriatr Gerontol, 2014, 49(4):165-172. doi: 10.1016/j.regg.2014.03.002 pmid: 24880524
[28]	Black DS, O′Reilly GA, Olmstead R, et al. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial[J]. JAMA Intern Med, 2015, 175(4):494-501. doi: 10.1001/jamainternmed.2014.8081 URL
[29]	Kahl KG, Winter L, Schweiger U. The third wave of cognitive behavioural therapies: what is new and what is effective?[J]. Curr Opin Psychiatry, 2012, 25(6):522-528. doi: 10.1097/YCO.0b013e328358e531 URL
[30]	Gao L, Xie J, Huang T, et al. Effects of mindfulness decompression therapy combined with transcranial magnetic stimulation in generalized anxiety disorder[J]. Am J Transl Res, 2021, 13(6):6827-6836.
[31]	Goldin PR, Gross JJ. Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder[J]. Emotion, 2010, 10(1):83-91. doi: 10.1037/a0018441 URL
[32]	Black DS, Milam J, Sussman S. Sitting-meditation interventions among youth: a review of treatment efficacy[J]. Pediatrics, 2009, 124(3):e532-e541. doi: 10.1542/peds.2008-3434 URL
[33]	Harvey AG. A cognitive model of insomnia[J]. Behav Res Ther, 2002, 40(8):869-893. pmid: 12186352
[34]	Hofmann SG, Sawyer AT, Witt AA, et al. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review[J]. J Consult Clin Psychol, 2010, 78(2):169-183. doi: 10.1037/a0018555 pmid: 20350028
[35]	Kemper KJ, Mo X, Khayat R. Are Mindfulness and Self-Compassion Associated with Sleep and Resilience in Health Professionals?[J]. J Altern Complement Med, 2015, 21(8):496-503. doi: 10.1089/acm.2014.0281 URL
[36]	Tseng TJ, Wu YS, Tang JH, et al. Association between health behaviors and mood disorders among the elderly: a community-based cohort study[J]. BMC Geriatr, 2019, 19(1):60. doi: 10.1186/s12877-019-1079-1 URL

项目	特征	统计值
年龄（岁）^a）		82.0（75,87）
性别（男/女）（%）	男	27（39.7）
	女	41（60.3）
受教育程度（年）	文盲	12（17.6）
	小学	16（23.5）
	初中	16（23.5）
	高中	12（17.6）
	大学及以上	12（17.6）
MMSE评分（分）^a）		15.5（14,19）
ADL评分（分）^a）		55.0（40.0,78.8）
婚姻状况（%）	健在	26（38.2）
	离异/丧偶	42（61.8）
吸烟（%）	有	15（22.1）
	无	53（77.9）
高血压（%）	有	30（44.1）
	无	38（55.9）
糖尿病（%）	有	21（30.9）
	无	47（69.1）
听力障碍（%）	有	25（36.8）
	无	43（63.2）

变量	r值
变量	HAMA	GDS-15	PSQI
受教育程度	-0.497	-0.487	-0.416

变量	r值
变量	HAMA	GDS-15
PSQI	0.460^*	0.484

分组	HAMA	GDS	PSQI
干预前	8（5,11）	8（5,9）	10（7,13）
干预后	5（4,8）	6（4,7.75）	8（6,10.75）
Z值	-3.243	-3.051	-2.464
P值	0.001	0.002	0.014