轻度认知功能损害认知训练内容体系的构建
|
摘要
背景循证医学证据显示轻度认知功能损害(MCI)目前尚无有效的长期治疗药物,通过早期认知干预可延缓或阻止MCI的病情发展。然而国内外的认知训练内容多是根据各自的研究目的和实际情况制定相应的干预方案,目前正处于探索及发展阶段,尚无统一标准,干预效果的评价也受到争议。目的构建MCI认知训练内容体系,为MCI认知干预的标准化和规范化提供理论依据;通过在社区MCI人群的认知干预中应用并进一步完善该体系,编制出适合中国国情的MCI认知训练内容体系,为进一步开展认知干预提供支持。方法 2018年12月——2017年3月,在大脑可塑性理论和文献研究基础上,拟定MCI认知训练内容体系的初步框架,通过两轮改良的德尔菲专家咨询法对MCI认知训练内容体系框架进行论证和完善。结果共纳入13名咨询专家,经过两轮咨询,最终形成了由8个一级指标、25个二级指标、42个三级指标构成的MCI认知训练内容体系。两轮咨询的专家积极系数分别为86.7%、100.0%,有效问卷回收率分别为92.3%、100.0%;专家对认知训练内容体系构建的判断依据系数为0.92、熟悉程度为0.54、权威程度为0.73;两轮专家咨询一级指标的协调系数(W)分别为0.15、0.40,有统计学意义(P<0.05)。结论采用德尔菲专家咨询法初步构建了MCI认知训练内容体系;选取的专家具有较好的代表性,权威程度较高,专家意见协调一致,指标体系建立的方法学具有合理性、可靠性。
Background Evidence-based medical evidence shows that there is no effective long-term treatment for mild cognitive impairment(MCI).MCI patients can delay or prevent the progression of the disease through early cognitive intervention.However,the content of cognitive training at home and abroad is based on their respective research purposes and actual conditions.The program is currently in the stage of exploration and development,there is no uniform standard,and the evaluation of the intervention effect is therefore controversial.Objective To construct a cognitive training system of MCI and provide a theoretical basis for the standardization of MCI cognitive interventions.We aim to build a system of MCI cognitive training suitable for China's national condition by further improving the application of cognitive intervention in patients with MCI in communities and providing support and reference for cognitive intervention training in China.Methods From December 2015 to March 2017,based on the theory and literature research of brain plasticity,MCI cognitive training system was preliminarily constructed and further improved by two rounds of modified Delphi expert consultation method.Results After two rounds of consultation,a MCI cognitive training system consisting of 8 first-level indicators,25 second-level indicators and 42 thirdlevel indicators was formed.The active coefficients of experts in two rounds were 86.7% and 100.0%,respectively,the effective rates of the questionnaire were 92.3% and 100.0%,respectively.The judgment coefficient of experts in training system was 0.92,the degree of familiarity was 0.54 and the authority degree was 0.73.The coordination coefficients(W) of two rounds of expert consultation were 0.15 and 0.40,respectively,with statistical significance(P<0.05).Conclusion The MCI cognitive training system is preliminarily constructed by Delphi expert consultation method.The selected experts have a good representativeness,a high degree of authority,and the opinions of them are coordinated.From the methodology established by the indicator system,the results of this study are reasonable and reliable.
Background Evidence-based medical evidence shows that there is no effective long-term treatment for mild cognitive impairment(MCI).MCI patients can delay or prevent the progression of the disease through early cognitive intervention.However,the content of cognitive training at home and abroad is based on their respective research purposes and actual conditions.The program is currently in the stage of exploration and development,there is no uniform standard,and the evaluation of the intervention effect is therefore controversial.Objective To construct a cognitive training system of MCI and provide a theoretical basis for the standardization of MCI cognitive interventions.We aim to build a system of MCI cognitive training suitable for China's national condition by further improving the application of cognitive intervention in patients with MCI in communities and providing support and reference for cognitive intervention training in China.Methods From December 2015 to March 2017,based on the theory and literature research of brain plasticity,MCI cognitive training system was preliminarily constructed and further improved by two rounds of modified Delphi expert consultation method.Results After two rounds of consultation,a MCI cognitive training system consisting of 8 first-level indicators,25 second-level indicators and 42 thirdlevel indicators was formed.The active coefficients of experts in two rounds were 86.7% and 100.0%,respectively,the effective rates of the questionnaire were 92.3% and 100.0%,respectively.The judgment coefficient of experts in training system was 0.92,the degree of familiarity was 0.54 and the authority degree was 0.73.The coordination coefficients(W) of two rounds of expert consultation were 0.15 and 0.40,respectively,with statistical significance(P<0.05).Conclusion The MCI cognitive training system is preliminarily constructed by Delphi expert consultation method.The selected experts have a good representativeness,a high degree of authority,and the opinions of them are coordinated.From the methodology established by the indicator system,the results of this study are reasonable and reliable.
引文
[1]马菲,曲成毅.老年轻度认知功能障碍流行病学研究进展[J].中国公共卫生,2008(10):1174-1176.DOI:10.3321/j.issn:1001-0580.2008.10.015.MA F,QU C Y.Advances in epidemiology of mild cognitive dysfunction elderly[J].Chin J Public Health,2008(10):1174-1176.DOI:10.3321/j.issn:1001-0580.2008.10.015.
[2]丁玎,洪震.老年性痴呆和轻度认知功能障碍的流行病学研究进展[J].中国临床神经科学,2013,21(1):101-108.DOI:10.3969/j.issn.1008-0678.2013.01.019.DING D,HONG Z.Progression of epidemiological studies of dementia and mild cognitive impairment among elderly[J].Chin J Clin Neurosci,2013,21(1):101-108.DOI:10.3969/j.issn.1008-0678.2013.01.019.
[3]PETERSEN R C,SMITH G E,WARNING S C,et al.Mild cognitive impairment clinical characterization and outcome[J].Arch Neurol,1999,56(3):303-308.DOI:10.1001/archneur.56.3.303.
[4]MORRIS J C,STORANDT M,MILLER J P,et al.Mild cognitive impairment representsearly-stage Alzheimer disease[J].Arch Neurol,2001,58(3):397-405.DOI:10.1001/archneur.58.3.397.
[5]VISSER P J.Mild cognitive impairment[J].Medicine in Old Age,2006,2:94.
[6]田金洲.中国痴呆诊疗指南[M].北京:人民卫生出版社,2012.
[7]LIN Y,LI B,TANG H,et al.Shanghai cognitive intervention of mild cognitive impairment for delaying progress with longitudinal evaluation--a prospective,randomized controlled study(SIMPLE):rationale,design,and methodology[J].BMC Neurol,2018,18(1):103.DOI:10.1186/s12883-018-1100-x.
[8]HORR T,MESSINGER-RAPPORT B,PILLAI J A.Systematic review of strengths and limitations of Randomized Controlled Trials for non-pharmacological interventions in mild cognitive impairment:focus on Alzheimer's disease[J].J Nutr Health Aging,2015,19(2):141-153.DOI:10.1007/s12603-014-0565-6.
[9]CUMMINGS J,CHO W,WARD M,et al.A randomized,double-blind,placebo-controlled phase 2 study to evaluate the efficacy and safety of Crenezumab in patients with mild to moderate Alzheimer's disease[J].Alzheimers Dement,2014,10(4):275.DOI:10.1016/j.jalz.2014.04.450
[10]王亚鹏,董奇.脑的可塑性研究:现状与进展[J].北京师范大学学报,2007,3:39-43.DOI:10.3969/j.issn.1002-0209.2007.03.006.WANG Y P,DONG Q.Brain plasticity research:current status and progress[J].Journal of Beijing Normal University,2007,3:39-43.DOI:10.3969/j.issn.1002-0209.2007.03.006.
[11]世界卫生组织.ICD-10精神与行为障碍分类[M].范肖冬,汪向东,于欣,等,译.北京:人民卫生出版社,1993:3-10.
[12]BARBAN F,MANCINI M,CERCIGNANI M,et al.A Pilot study on brain plasticity of functional connectivity modulated by cognitive training in mild Alzheimer's disease and mild cognitive impairment[J].Brain Sci,2017,7(50):1-22.DOI:10.3390/brainsci7050050.
[13]张群.认知训练对社区老年人认知功能的影响研究[D].湖南:中南大学,2009.
[14]许少英,刘婧,黄艾,等.怀旧治疗对老年轻度认知障碍患者认知功能的影响[J].中华现代护理杂志,2011,17(17):2036-2038.DOI:10.3760/cma.j.issn.1674-2907.2011.17.016.XU S Y,LIU J,HUANG A,et al.Effect of reminiscence therapy on cognitive function of elderly patients with mild cognitive impairment[J].China J Mod Nurs,2011,17(17):2036-2038.DOI:10.3760/cma.j.issn.1674-2907.2011.17.016.
[15]BUSCHERT V C,FRIESE U,TEIPEL S J,et al.Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer's disease:a pilot study[J].J Alzheimer's Dis,2011,25(4):679-694.DOI:10.3233/JAD-2011-100999.
[16]张建,魏秀红,田敏,等.联想记忆训练对轻度认知功能障碍老人认知功能的影响[J].中国老年学杂志,2012,32(23):5109-5111.DOI:10.3969/j.issn.1005-9202.2012.23.002.ZHANG J,WEI X H,TIAN M,et al.Effect of associative memory training on cognitive function of elderly patients with mild cognitive dysfunction[J].Chinese Journal of Gerontology,2012,32(23):5109-5111.DOI:10.3969/j.issn.1005-9202.2012.23.002.
[17]刘风兰.认知干预对轻度认知障碍患者认知功能和生活质量的影响研究[D].湖南:中南大学,2012.
[18]TAOLASI M,KOUNTI F,AGOGIATOU C,et al.Effectiveness of nonpharmacological approaches in patients with mild cognitive impairment[J].Neurodegener Dis,2011,8(3):138-145.DOI:10.1159/000320575.
[19]GREENAWAY M C,DUNCAN N L,SMITH G E.The memory support system for mild cognitive impairment:randomized trial of a cognition rehabilitation intervention[J].Int J Geriatr Psychiatry,2013,28(4):402-409.DOI:10.1002/gps.3838.
[20]成燕,冯威,张旭,等.多领域认知训练对社区轻度认知障碍老年人影响的随机对照研究[J].中华精神科杂志,2012,45(4):228-231.DOI:10.3760/cma.j.issn.1006-7884.2012.04.011.CHENG Y,FENG W,ZHANG X,et al.A randomized controlled trial of multi-domain cognitive training for community older adults with mild cognitive impairment[J].Chinese Journal of Psychiatry,2012,45(4):228-231.DOI:10.3760/cma.j.issn.1006-7884.2012.04.011.
[21]邓兰兰.结构化综合认知干预对社区轻度认知功能障碍患者的影响研究[D].重庆:第三军医大学,2014.DENG L L.The effect of structured comprehensive cognitive intervention on community-dwelling elderly people with mild cognitive impairment[D].Chongqing:Third Military Medical University,2014.
[22]BROWN B.Delphi Process:a methodology using for the elici-tation of opinions of experts[J].The Rand Corporation,1987,9:3925.
[23]PAQUETTE-WARREN J,TYLER M,FOURNIE M,et al.The diabetes evaluation framework for innovative national evaluations(define):construct and content validation using a modified delphi method[J].Can J Diabetes,2017,41(3):281-296.DOI:10.1016/j.jcjd.2016.10.011.
[24]孙景贤,曾慧,潘露.认知训练和穴位按摩对轻度认知功能障碍老年患者认知功能的影响研究[J].中国全科医学,2016,19(25):3108-3111.DOI:10.3969/j.issn.1007-9572.2016.25.023.SUN J X,ZENG H,PAN L.Effects of cognitive training and acupoint massage on cognitive function of elderly patients with mild cognitive impairment[J].Chinese General Practice,2016,19(25):3108-3111.DOI:10.3969/j.issn.1007-9572.2016.25.023.
[25]万佳佳,徐梅松,随瑞斌,等.重复经颅磁刺激和计算机辅助认知训练改善轻度认知功能障碍患者认知的临床研究[J].中华老年心脑血管病杂志,2016,18(4):356-362.DOI:10.3969/j.issn.1009-0126.2016.04.006.WAN J J,XU M S,SUI R B,et al.rTMS and computer-based cognitive training improve cognitive function in patients with mild cognitive impairment[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2016,18(4):356-362.DOI:10.3969/j.issn.1009-0126.2016.04.006.
[26]霍丽娟,郑志伟,李瑾,等.老年人的脑可塑性:来自认知训练的证据[J].心理科学进展,2018,26(5):846-858.DOI:10.3724/SP.J.1042.2018.00846.HUO L J,ZHENG Z W,LI J,et al.Brain plasticity in the elderly:evidence from cognitive training[J].Advances in Psychological Science,2018,26(5):846-858.DOI:10.3724/SP.J.1042.2018.00846.
[27]董新秀,胡慧,石义容.轻度认知损害病人认知干预研究进展[J].护理研究,2016,30(2):144-146.DOI:10.3969/j.issn.1009-6493.2016.02.006.DONG X X,HU H,SHI Y R.Research progress on cognitive intervention for patients with mild cognitive impairment[J].Chinese Nursing Research,2016,30(2):144-146.DOI:10.3969/j.issn.1009-6493.2016.02.006.
[28]张立,唐强.头穴丛刺改善脑卒中后认知功能障碍[J].针灸临床研究,2007,23(6):27-28.DOI:10.3969/j.issn.1005-0779.2007.06.022.ZHANG L,TANG Q.Clinical observation on the promotion of cognitive impairment after apoplexy by cluster acupuncture on the head points[J].Journal of Clinical Acupuncture and Moxibustion,2007,23(6):27-28.DOI:10.3969/j.issn.1005-0779.2007.06.022.
[29]李国辉,赖莹莹.针刺结合认知康复训练治疗轻度认知功能障碍临床观察[J].山东中医药大学学报,2009,33(2):124-125.DOI:1007-659X(2009)02-0124-02.LI G H,LAI Y Y.Treatment of mild cognitive impairment with acupuncture and cognitive training[J].Journal of Shandong University of Traditional Chinese Medicine,2009,33(2):124-125.DOI:1007-659X(2009)02-0124-02.
[30]施利军.“治未病”思想在防治老年性痴呆中的指导作用[D].沈阳:辽宁中医药大学,2012.
[31]黄帝内经素问[M].北京:人民卫生出版社,1956:78.
[32]林珮琴.类证治裁[M].太原:山西科学技术出版社,2010:356.
[33]黄金,胡进,朱熊兆,等.社区2型糖尿病患者认知功能现状及其影响因素研究[J].中国全科医学,2016,19(2):135-141.DOI:10.3969/j.issn.1007-9572.2016.02.003.HUANG J,HU J,ZHU X Z,et al.Status and influencing factors for the cognitive function of patients with type 2 diabetes mellitus[J].Chinese General Practice,2016,19(2):135-141.DOI:10.3969/j.issn.1007-9572.2016.02.003.
[34]周媛媛,周香莲,王杰,等.轻度认知功能障碍向痴呆进展的危险因素及保护因素研究[J].中国全科医学,2018,21(33):4149-4156.DOI:10.3969/j.issn.1007-9572.2018.00.204.ZHOU Y Y,ZHOU X L,WANG J,et al.Risk Factors and protective factors for the progression of mild cognitive impairment towards dementia[J].Chinese General Practice,2018,21(33):4149-4156.DOI:10.3969/j.issn.1007-9572.2018.00.204.
[2]丁玎,洪震.老年性痴呆和轻度认知功能障碍的流行病学研究进展[J].中国临床神经科学,2013,21(1):101-108.DOI:10.3969/j.issn.1008-0678.2013.01.019.DING D,HONG Z.Progression of epidemiological studies of dementia and mild cognitive impairment among elderly[J].Chin J Clin Neurosci,2013,21(1):101-108.DOI:10.3969/j.issn.1008-0678.2013.01.019.
[3]PETERSEN R C,SMITH G E,WARNING S C,et al.Mild cognitive impairment clinical characterization and outcome[J].Arch Neurol,1999,56(3):303-308.DOI:10.1001/archneur.56.3.303.
[4]MORRIS J C,STORANDT M,MILLER J P,et al.Mild cognitive impairment representsearly-stage Alzheimer disease[J].Arch Neurol,2001,58(3):397-405.DOI:10.1001/archneur.58.3.397.
[5]VISSER P J.Mild cognitive impairment[J].Medicine in Old Age,2006,2:94.
[6]田金洲.中国痴呆诊疗指南[M].北京:人民卫生出版社,2012.
[7]LIN Y,LI B,TANG H,et al.Shanghai cognitive intervention of mild cognitive impairment for delaying progress with longitudinal evaluation--a prospective,randomized controlled study(SIMPLE):rationale,design,and methodology[J].BMC Neurol,2018,18(1):103.DOI:10.1186/s12883-018-1100-x.
[8]HORR T,MESSINGER-RAPPORT B,PILLAI J A.Systematic review of strengths and limitations of Randomized Controlled Trials for non-pharmacological interventions in mild cognitive impairment:focus on Alzheimer's disease[J].J Nutr Health Aging,2015,19(2):141-153.DOI:10.1007/s12603-014-0565-6.
[9]CUMMINGS J,CHO W,WARD M,et al.A randomized,double-blind,placebo-controlled phase 2 study to evaluate the efficacy and safety of Crenezumab in patients with mild to moderate Alzheimer's disease[J].Alzheimers Dement,2014,10(4):275.DOI:10.1016/j.jalz.2014.04.450
[10]王亚鹏,董奇.脑的可塑性研究:现状与进展[J].北京师范大学学报,2007,3:39-43.DOI:10.3969/j.issn.1002-0209.2007.03.006.WANG Y P,DONG Q.Brain plasticity research:current status and progress[J].Journal of Beijing Normal University,2007,3:39-43.DOI:10.3969/j.issn.1002-0209.2007.03.006.
[11]世界卫生组织.ICD-10精神与行为障碍分类[M].范肖冬,汪向东,于欣,等,译.北京:人民卫生出版社,1993:3-10.
[12]BARBAN F,MANCINI M,CERCIGNANI M,et al.A Pilot study on brain plasticity of functional connectivity modulated by cognitive training in mild Alzheimer's disease and mild cognitive impairment[J].Brain Sci,2017,7(50):1-22.DOI:10.3390/brainsci7050050.
[13]张群.认知训练对社区老年人认知功能的影响研究[D].湖南:中南大学,2009.
[14]许少英,刘婧,黄艾,等.怀旧治疗对老年轻度认知障碍患者认知功能的影响[J].中华现代护理杂志,2011,17(17):2036-2038.DOI:10.3760/cma.j.issn.1674-2907.2011.17.016.XU S Y,LIU J,HUANG A,et al.Effect of reminiscence therapy on cognitive function of elderly patients with mild cognitive impairment[J].China J Mod Nurs,2011,17(17):2036-2038.DOI:10.3760/cma.j.issn.1674-2907.2011.17.016.
[15]BUSCHERT V C,FRIESE U,TEIPEL S J,et al.Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer's disease:a pilot study[J].J Alzheimer's Dis,2011,25(4):679-694.DOI:10.3233/JAD-2011-100999.
[16]张建,魏秀红,田敏,等.联想记忆训练对轻度认知功能障碍老人认知功能的影响[J].中国老年学杂志,2012,32(23):5109-5111.DOI:10.3969/j.issn.1005-9202.2012.23.002.ZHANG J,WEI X H,TIAN M,et al.Effect of associative memory training on cognitive function of elderly patients with mild cognitive dysfunction[J].Chinese Journal of Gerontology,2012,32(23):5109-5111.DOI:10.3969/j.issn.1005-9202.2012.23.002.
[17]刘风兰.认知干预对轻度认知障碍患者认知功能和生活质量的影响研究[D].湖南:中南大学,2012.
[18]TAOLASI M,KOUNTI F,AGOGIATOU C,et al.Effectiveness of nonpharmacological approaches in patients with mild cognitive impairment[J].Neurodegener Dis,2011,8(3):138-145.DOI:10.1159/000320575.
[19]GREENAWAY M C,DUNCAN N L,SMITH G E.The memory support system for mild cognitive impairment:randomized trial of a cognition rehabilitation intervention[J].Int J Geriatr Psychiatry,2013,28(4):402-409.DOI:10.1002/gps.3838.
[20]成燕,冯威,张旭,等.多领域认知训练对社区轻度认知障碍老年人影响的随机对照研究[J].中华精神科杂志,2012,45(4):228-231.DOI:10.3760/cma.j.issn.1006-7884.2012.04.011.CHENG Y,FENG W,ZHANG X,et al.A randomized controlled trial of multi-domain cognitive training for community older adults with mild cognitive impairment[J].Chinese Journal of Psychiatry,2012,45(4):228-231.DOI:10.3760/cma.j.issn.1006-7884.2012.04.011.
[21]邓兰兰.结构化综合认知干预对社区轻度认知功能障碍患者的影响研究[D].重庆:第三军医大学,2014.DENG L L.The effect of structured comprehensive cognitive intervention on community-dwelling elderly people with mild cognitive impairment[D].Chongqing:Third Military Medical University,2014.
[22]BROWN B.Delphi Process:a methodology using for the elici-tation of opinions of experts[J].The Rand Corporation,1987,9:3925.
[23]PAQUETTE-WARREN J,TYLER M,FOURNIE M,et al.The diabetes evaluation framework for innovative national evaluations(define):construct and content validation using a modified delphi method[J].Can J Diabetes,2017,41(3):281-296.DOI:10.1016/j.jcjd.2016.10.011.
[24]孙景贤,曾慧,潘露.认知训练和穴位按摩对轻度认知功能障碍老年患者认知功能的影响研究[J].中国全科医学,2016,19(25):3108-3111.DOI:10.3969/j.issn.1007-9572.2016.25.023.SUN J X,ZENG H,PAN L.Effects of cognitive training and acupoint massage on cognitive function of elderly patients with mild cognitive impairment[J].Chinese General Practice,2016,19(25):3108-3111.DOI:10.3969/j.issn.1007-9572.2016.25.023.
[25]万佳佳,徐梅松,随瑞斌,等.重复经颅磁刺激和计算机辅助认知训练改善轻度认知功能障碍患者认知的临床研究[J].中华老年心脑血管病杂志,2016,18(4):356-362.DOI:10.3969/j.issn.1009-0126.2016.04.006.WAN J J,XU M S,SUI R B,et al.rTMS and computer-based cognitive training improve cognitive function in patients with mild cognitive impairment[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2016,18(4):356-362.DOI:10.3969/j.issn.1009-0126.2016.04.006.
[26]霍丽娟,郑志伟,李瑾,等.老年人的脑可塑性:来自认知训练的证据[J].心理科学进展,2018,26(5):846-858.DOI:10.3724/SP.J.1042.2018.00846.HUO L J,ZHENG Z W,LI J,et al.Brain plasticity in the elderly:evidence from cognitive training[J].Advances in Psychological Science,2018,26(5):846-858.DOI:10.3724/SP.J.1042.2018.00846.
[27]董新秀,胡慧,石义容.轻度认知损害病人认知干预研究进展[J].护理研究,2016,30(2):144-146.DOI:10.3969/j.issn.1009-6493.2016.02.006.DONG X X,HU H,SHI Y R.Research progress on cognitive intervention for patients with mild cognitive impairment[J].Chinese Nursing Research,2016,30(2):144-146.DOI:10.3969/j.issn.1009-6493.2016.02.006.
[28]张立,唐强.头穴丛刺改善脑卒中后认知功能障碍[J].针灸临床研究,2007,23(6):27-28.DOI:10.3969/j.issn.1005-0779.2007.06.022.ZHANG L,TANG Q.Clinical observation on the promotion of cognitive impairment after apoplexy by cluster acupuncture on the head points[J].Journal of Clinical Acupuncture and Moxibustion,2007,23(6):27-28.DOI:10.3969/j.issn.1005-0779.2007.06.022.
[29]李国辉,赖莹莹.针刺结合认知康复训练治疗轻度认知功能障碍临床观察[J].山东中医药大学学报,2009,33(2):124-125.DOI:1007-659X(2009)02-0124-02.LI G H,LAI Y Y.Treatment of mild cognitive impairment with acupuncture and cognitive training[J].Journal of Shandong University of Traditional Chinese Medicine,2009,33(2):124-125.DOI:1007-659X(2009)02-0124-02.
[30]施利军.“治未病”思想在防治老年性痴呆中的指导作用[D].沈阳:辽宁中医药大学,2012.
[31]黄帝内经素问[M].北京:人民卫生出版社,1956:78.
[32]林珮琴.类证治裁[M].太原:山西科学技术出版社,2010:356.
[33]黄金,胡进,朱熊兆,等.社区2型糖尿病患者认知功能现状及其影响因素研究[J].中国全科医学,2016,19(2):135-141.DOI:10.3969/j.issn.1007-9572.2016.02.003.HUANG J,HU J,ZHU X Z,et al.Status and influencing factors for the cognitive function of patients with type 2 diabetes mellitus[J].Chinese General Practice,2016,19(2):135-141.DOI:10.3969/j.issn.1007-9572.2016.02.003.
[34]周媛媛,周香莲,王杰,等.轻度认知功能障碍向痴呆进展的危险因素及保护因素研究[J].中国全科医学,2018,21(33):4149-4156.DOI:10.3969/j.issn.1007-9572.2018.00.204.ZHOU Y Y,ZHOU X L,WANG J,et al.Risk Factors and protective factors for the progression of mild cognitive impairment towards dementia[J].Chinese General Practice,2018,21(33):4149-4156.DOI:10.3969/j.issn.1007-9572.2018.00.204.