计算机化认知训练干预糖尿病轻度认知障碍的研究进展

Advances in computerised cognitive training for mild cognitive impairment in patients with diabetes mellitus

摘要:

糖尿病（DM）是轻度认知障碍（MCI）和阿尔茨海默病（AD）的独立危险因素。中国≥60岁人群中MCI患病率为14.5%，每年10%～15%的MCI患者进展为AD。糖尿病合并MCI（DM-MCI）患者认知衰退更迅速，目前尚无特效治疗药物。计算机化认知训练（CCT）因安全、经济、可居家实施，成为延缓MCI向痴呆转化的潜在非药物干预策略。现有证据表明，自适应、多认知域、持续至少12周的CCT方案可在短期内显著改善MCI患者整体认知功能和情景记忆，其机制涉及海马默认网络功能连接增强、右侧角回灰质体积增加以及脑网络结构和功能耦合重塑。针对DM-MCI的探索性研究提示，CCT可能通过提升执行功能间接优化糖尿病自我管理行为，但对糖化血红蛋白等客观代谢指标的改善有限。然而，当前证据存在明显不足。该综述系统地梳理了CCT干预DM-MCI的临床证据、神经机制及实施挑战，为认知训练纳入糖尿病标准照护体系提供循证依据。

Abstract:

Diabetes mellitus （DM） is an independent risk factor for mild cognitive impairment （MCI） and Alzheimer disease （AD）. In China， the prevalence of MCI among individuals aged ≥60 years is 14.5%， with 10%-15% of MCI patients progressing to AD annually. Patients with DM complicated by MCI （DM-MCI） experience more rapid cognitive decline， and no specific pharmacological therapy is currently available. Computerised cognitive training （CCT） has emerged as a promising non-pharmacological intervention strategy to delay the progression from MCI to dementia due to its safety， affordability， and feasibility for home-based delivery. Current evidence indicates that adaptive， multidomain CCT programs lasting at least 12 weeks can significantly improve global cognitive function and episodic memory in MCI patients in the short term. The underlying neural mechanisms involve enhanced functional connectivity between the hippocampus and the default mode network， increased gray matter volume in the right angular gyrus， and remodeling of structural and functional coupling across brain networks. Exploratory studies on DM-MCI suggest that CCT may indirectly improve diabetes self-management behaviors by enhancing executive function， but its effects on objective metabolic markers， such as glycated hemoglobin， are limited. However， obvious shortcomings exist in current evidence. This review systematically synthesizes the clinical evidence， neural mechanisms， and implementation challenges of CCT in DM-MCI， providing evidence-based support for integrating cognitive training into the standard care system for diabetes.