Korean Journal of Occupational Therapy (대한작업치료학회지)

Korean Society of Occupational Therapy (대한작업치료학회)
권호 표지
DOI QR코드

DOI QR Code

A Systematic Review of the Application Nonpharmacological Cognitive Interventions in Patients With Dementia

치매 환자에게 적용된 비약물적 인지중재방법에 대한 체계적 고찰

  • Kwak, Ho-Soung (Dept. of Occupational Therapy, Woosong University) ;
  • Park, Ji-Hyuk (Dept. of Occupational Therapy, College of Health Science, Yonsei University)
  • 곽호성 (우송대학교 작업치료학과) ;
  • 박지혁 (연세대학교 보건과학대학 작업치료학과)
  • Received : 2018.04.20
  • Accepted : 2018.12.04
  • Published : 2018.12.30
⟨ Previous Next ⟩

Abstract

Objective : The aim of the study was to investigate the application of nonpharmacological cognitive interventions in patients with dementia. Methods : We searched published studies in KISS, PubMed, and Sciencedirect databases from January 2013 to December 2017. The main keywords used were "Dementia" AND "Cognitive stimulation OR Cognitive rehabilitation OR Cognitive training" and a total of ten studies were selected for analysis from 753 searched articles. Results : Seven of the ten selected studies showed significant improvements in cognitive function after intervention, whereas three studies showed no improvement in cognitive function; however, activation of brain waves, improvement in the relationship between care givers and patients, improvement in the quality of life of care givers, and improvements in visual motor skills were shown. Mini-Mental State Examination(MMSE) was used as the assessment tool for identifying the effects of the cognitive function improvement, and in four studies the quality of life of dementia patients was measured as an intervention effect. The main subject of the cognitive intervention is patients with mild to moderate dementia. Conclusion : The results of this study can be used as a basis for the selection of intervention methods, as well as their duration and assessment, according to the characteristics of dementia patients.

목적 : 본 연구에서는 체계적 고찰을 통해 치매 환자를 대상으로 사용된 비약물적 인지중재방법에 대해 알아봄으로써 임상영역에서 치매 환자 중재 시 기초자료를 삼고자 한다. 연구방법 : 2013년 1월부터 2017년 12월까지 국내 국외학회지에 게재된 논문을 KISS, PubMed와 Sciencedirect을 통하여 검색하였으며, 주요검색 용어로는 '치매 OR dementia', '인지 자극 OR cognitive stimulation', '인지재활 OR cognitive rehabilitation', '인지 훈련 OR cognitive training'을 사용하였다. 최종적으로 10개의 논문을 선정하여 분석하였다. 결과 : 선정된 10편의 논문 중 7편에서 중재 후 인지기능에 유의한 향상이 나타났으며, 3편의 연구에서는 인지기능의 향상은 나타나지 않았으나 뇌파의 활성화, 간병인과 환자와의 관계 및 간병인의 삶의 질 향상, 시각적 운동 기술 향상이 나타났다. 인지기능 개선효과를 확인을 위한 평가도구는 Mini-Mental State Examination(MMSE)가 가장 많았으며, 4편의 논문에서는 치매환자의 삶의 질을 중재 효과로 측정하였다. 인지중재의 주 대상자는 경도에서 중등도 사이의 치매환자를 대상으로 사용된 것으로 확인되었다. 결론 : 본 연구를 토대로 임상에서 치료사들이 치매환자를 대상으로 치료할 때 치매환자의 특성에 따라 중재방법, 기간, 평가도구 등을 선정하는데 필요한 근거로 활용될 수 있을 것으로 사료된다.

Keywords

References

  1. 김상우, 이채정. (2014). 치매관리사업의 현황과 개선과제. 서울, 한국: 국회예산정책처.
  2. 보건복지부. (2012). 2012년 치매 유병률 조사. 서울, 한국: 보건복지부.
  3. 홍정민. (2012). 치매와 경도인지장애에 대한 고찰. 한국컨텐츠학회논문지, 10(2), 25-30.
  4. Arbesman, M., Scheer, J., & Lieberman, D. (2008). Using AOTA's Critically Appraised Topic (CAT) and Critically Appraised Paper (CAP) series to link evidence to practice. OT Practice, 13(5), 18-22.
  5. Buschert, V., Bokde, A. L., & Hampel, H. (2010). Cognitive intervention in Alzheimer disease. Nature Reviews Neurology, 6, 508-517.
  6. Carrion, C., Aymerich, M., Bailles, E., & Lopez-Bermejo, A. (2013). Cognitive psychosocial intervention in dementia: A systematic review. Dementia and Geriatric Cognitive Disorders, 36, 363-375. doi:10.1159/000354365
  7. Cho, S. H., & Yang, Y. A. (2017). The effect of occupational therapy based multimodal cognitive rehabilitation therapy on cognitive function in elderly people with mild dementia: A randomized controlled trial. Journal of Korean Society of Occupational Therapy, 25(3), 71-86. doi:10.14519/jksot.2017.25.3.06
  8. Chong, B. H. (2013). The effect of cognitive occupational therapy in community living elders with mild cognitive impairment and dementia. Journal of Digital Convergence, 11, 317-325. doi:10.14400/JDPM.2013.11.3.317
  9. Chong, B. H. (2016). The effect of a complex rehabilitation intervention program on cognitive and hand functions in patients with mild cognitive impairment and dementia. Journal of The Korean Society of Integrative Medicine, 4(3), 49-59.
  10. Clare, L., & Woods, R. T. (2004). Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: A review. Neuropsychological Rehabilitation, 14, 385-401. doi:10.1080/09602010443000074
  11. Clark, C. M., Sheppard, L., Fillenbaum, G. G., Galasko, D., Morris, J. C., Koss, E., ... Heyman, A. (1999). Variability in annual mini-mental state examination score in patients with probable Alzheimer disease: A clinical perspective of data from the consortium to establish a registry for Alzheimer's disease. Archives of Neurology, 56, 857-862. doi:10.10 01/archneur.56.7.857 https://doi.org/10.1001/archneur.56.7.857
  12. Depoy, E., & Gitlow, L. (2001). A model of evidence-based practice of occupational therapy. In L. W. Pedretti, & M. B. Early (Eds.). Occupational therapy: Practice skills for physical dysfunction (5th ed., pp. 58-68). St. Louis, MO: Mosby.
  13. Frank Lopresti, E., Mihailidis, A., & Kirsch, N. (2004). Assistive technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation, 14(1), 5-39. doi:10.1080/09602010343000101
  14. Galasko, D., Klauber, M. R., Hofstetter, C. R., Salmon, D. P., Lasker, B., & Thal, L. J. (1990). The mini-mental state examination in the early diagnosis of Alzheimer's disease. Archives of Neurology, 47(1), 49-52. doi:10.1001/archneur.1990.00530010061020
  15. Gates, N. J., Sachdev, P. S., Singh, M. A. F., & Valenzuela, M. (2011). Cognitive and memory training in adults at risk of dementia: A systematic review. BMC Geriatrics, 11(1), 55. doi:10.1 186/1471-2318-11-55 https://doi.org/10.1186/1471-2318-11-55
  16. Ha, E. H. (2010). The influencing factors on cognitive impairment of the elderly with dementia at home (Doctorate dissertation). Chungang University. Seoul.
  17. Hwang, Y. J., & Jung, W. M. (2009). Effects of a home environmental skill-building program on dementia patients based on community: Evidence based practice (a single subject research design). Journal of Society of Occupational Therapy for the Aged and Dementia, 3(2), 45-57.
  18. Jeon, M. S. (2017). A study on the effects of an integrative cognitive training program on the aged with mild dementia: Targeting elders in day-care. Korean Journal of Gerontological Social Welfare, 72(1), 209-232. https://doi.org/10.21194/kjgsw.72.1.201703.209
  19. Kang, J. H. (2016). Effect of computerized cognitive training on cognitive function, instrumental activities of daily living and quality of life in patients with mild dementia. Journal of Korea Aging Friendly Industry Association, 8(2), 71-83.
  20. Kapur, N., Glisky, E. L., & Wilson, B. A. (2004). Technological memory aids for people with memory deficits. Neuropsychological Rehabilitation, 14(1), 41-60. doi:10.1080/09602010343000138
  21. Kim, H. J., Moon, S. Y., Kim, S. Y., & Han, S. H. (2008). Assessment of the quality of life in patients with Alzheimer's disease. Journal of Korean Neurological Association, 26, 308-313.
  22. Kim, H. J., Yang, Y., Oh, J. G., Oh, S., Choi, H., Kim, K. H., & Kim, S. H. (2016). Effectiveness of a community‐based multidomain cognitive intervention program in patients with Alzheimer's disease. Geriatrics & Gerontology International, 16, 191-199. doi:10.1111/ggi.12453
  23. Kim, J. M., Shin, I. S., Kim, S. W., Yang, S. J., Jeong, S. K., Park, K. H., & Yoon, J. S. (2005). Correlates of activities of daily living in demented and non-demented elderly. Journal of Korean Neurological Association, 23, 199-205.
  24. Kim, J. M., Shin, I. S., Yoon, J. S., & Lee, H. Y. (2003). Comparison of diagnostic validities between MMSE-K and K-MMSE for screening of dementia. Journal of Korean Neurological Association, 42(1), 124-130.
  25. Kim, Y. R. (2015). The effects of the reminiscence therapy program on the perception of the elderly suffering from dementia. Journal of the Korean Academy of Health and Welfare for Elderly, 7(1), 19-36.
  26. Kwon, Y. C., & Park, J. H. (1989). Korean version of Mini-Mental State Examination (MMSE-K) part I : Development of the test for the elderly. Journal of Korean Neuropsychiatric Association, 28(1), 125-135.
  27. Lee, D. K. (2013). Clinical approach to dementia. Korean Journal Clinical Geriatrics, 14(1), 11-19.
  28. Lee, G. H. (2017). Effects of a virtual reality exercise program (Wii) on cognitive function of elderly people with Alzheimer dementia. Official Journal of the Korean Academy of Kinesiology, 19(1), 35-44. doi:10.15758/jkak.2017.19.1.35
  29. Lee, K. S., Cheong, H. K., Oh, B. G., & Hong C. H.. (2009). Comparison of the validity of screening tests for dementia and mild cognitive impairment of the elderly in a community: K-MMSE, MMSE-K, MMSE-KC, and K-HDS, Journal of Korean Neuropsychiatric Association, 48(2), 61-69.
  30. Lee, S. B., & Kim, K. W. (2009). Nonpharmacological interventions for Alzheimer's disease. Journal of the Korean Medical Association, 52, 1069-1076. https://doi.org/10.5124/jkma.2009.52.11.1069
  31. Lee, Y. J., & Shin, S. M. (2003). The effect of physical activity program on cognition and ADL of demented elderly. Journal of the Korea Gerontological Society, 23(4), 17-31.
  32. Luijpen, M. W., Scherder, E. J., Van Sortieren, E. J., Swaab, D. F., & Sergeant, J. A. (2003). Non-pharmacological interventions in cognitively impaired and demented patients a comparison with cholinesterase inhibitors. Reviews in the Neurosciences, 14, 343-368. doi:10.1515/REVNEURO.2003.14.4.343
  33. MacNeill, S. E., & Lichtenberg, P. A. (1997). Home alone: The role of cognition in return to independent living. Archives of Physical Medicine and Rehabilitation, 78, 755-758. doi:10.1016/S0003-9993(97)90085-X
  34. Metternich, B., Kosch, D., Kriston, L., Harter, M., & Hull, M. (2010). The effects of nonpharmacological interventions on subjective memory complaints: A systematic review and meta-analysis. Psychotherapy and Psychosomatics, 79(1), 6-19. doi:10.1159/000254901
  35. Ohman, H., Savikko, N., Strandberg, T. E., & Pitkala, K. H. (2014). Effect of physical exercise on cognitive performance in older adults with mild cognitive impairment or dementia: A systematic review. Dementia and Geriatric Cognitive Disorders, 38, 347-365. doi:10.1159/000365388
  36. Orrell, M., Yates, L., Leung, P., Kang, S., Hoare, Z., Whitaker, C., ... Pearson, S. (2017). The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial. PLoS Medicine, 14, e1002269. doi:10.1371/journal.pmed.1002269
  37. Park, J. Y. (2009). The effectiveness of interventions for individuals with dementia: A qualitative meta-analysis. Journal of Occupational Therapy for the Aged and Dementia, 3(2), 23-32.
  38. Park, S. H., Yoo. J. Y., Park, S. J., & Yang, Y. A. (2009). A systematic review about evaluating screening instruments of dementia patient of cognitive. Journal of Society of Occupational Therapy for the Aged and Dementia, 3(2), 73-82.
  39. Park, S. M., Lee, J. S., Lee, K. W., Choi, W. S., & Kim, J. R. (2017). A systematic review of effects of cognitive rehabilitation therapy for community dwelling adults with early dementia or mild cognitive impairment. Journal of Korean Society of Cognitive Rehabilitation, 6(1), 39-63.
  40. Park, Y. S., & Jee, Y. J. (2015). Effects of intervention program on cognitive function, depression, activity of daily living and psycho-behavioral function among patients with dementia. Asia-pacific Journal of Multimedia Services Convergent With Art, Humanities, and Sociology, 5, 187-196.
  41. Sackett, D. L., Rosenberg, W. M., Cray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. Britich Medical Journal, 312, 71-72. https://doi.org/10.1136/bmj.312.7023.71
  42. Scarpini, E., Bruno, G., Zappala, G., Adami, M., Richarz, U., Gaudig, M., ... Schäuble, B. (2011). Cessation versus continuation of galantamine treatment after 12 months of therapy in patients with Alzheimer's disease: A randomized, double blind, placebo controlled withdrawal trial. Journal of Alzheimer's Disease, 26, 211-220. doi:10.3233/JAD-2011-110134
  43. Shin, H. Y., Jung, E. K., Lee, J. A., Yoon, J. S., & Kim, J. M. (2005). Prevalence and related factors of dementia in an urban elderly population using a new screening method. Journal of Preventive Medicine and Public Health, 38, 351-358.
  44. Shin, S. H., Kim, H. N., & Jeon, Y. (2016). The effects of art and craft program on cognition and visual motor of the mild dementia. Korean Aging Friendly Industry Association, 8(1), 19-25.
  45. Sim, S. Y., Baek, J. Y., Jung, H. S., & Cha, T. H. (2015). Effects of physical activities and cognitive activities on EEG and occupational performance in mild dementia. Institute of Special Education & Rehabilitation Science, 54, 453-469.
  46. Yamanaka, K., Kawano, Y., Noguchi, D., Nakaaki, S., Watanabe, N., Amano, T., & Spector, A. (2013). Effects of Cognitive Stimulation Therapy Japanese version (CST-J) for people with dementia: A single-blind, controlled clinical trial. Aging & Mental Health, 17, 579-586. doi:10.1 080/13607863.2013.777395 https://doi.org/10.1080/13607863.2013.777395

Cited by

  1. 도구적 일상생활에 초점을 둔 복합인지중재 프로그램이 치매고위험군 노인에게 미치는 영향 : 예비연구 vol.9, pp.5, 2019, https://doi.org/10.22156/cs4smb.2019.9.5.210
  2. 노인 대상 ICT 기반 융합연구: 무작위 대조군 실험연구의 체계적 고찰 vol.11, pp.3, 2018, https://doi.org/10.15207/jkcs.2020.11.3.085