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针对记忆主诉老人的认知训练及情绪的 影响——行为与脑的可塑性
其他题名Cognitive training in Elderly with Subjective Memory Complaints and the Effect of Emotion: Plasticity of Behavior and Brain
尹述飞
学位类型博士
导师李娟
2015-05
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业心理学
关键词记忆主诉 认知训练 可塑性 情绪 fMRI
摘要中国人口老龄化的步伐日益加快,伴随老化所发生的老年期神经退行性疾病,特别是老年性痴呆(Alzheimer's disease,AD)已经成为影响我国人口健康和生活质量、阻碍经济社会持续发展的公共健康问题。AD 的发展是个长期的过程,如果在发生痴呆后再开始治疗,虽仍可能延缓大脑衰退的进程,但已有的损害不能再逆转。记忆主诉是老年人的认知健康状况远离常态的初始阶段。记忆主诉老人是老年痴呆的高风险人群,他们会主观上报告记忆力下降,但客观测验成绩上并没有明显变化。如果能在老年痴呆的最初始阶段——记忆主诉阶段,就开展有针对性干预是预防和延缓痴呆发生的有效切入点。
老年人大脑的可塑性问题已经成为国际认知老化领域的一大热点。尽管老年人的认知功能随老化表现出下降趋势,但老化的大脑依然具有一定的可塑性。目前已有研究提示,认知训练能提高健康老年人的认知能力和脑功能,但针对记忆主诉老人的可塑性研究才处于起步阶段,迫切需要设计严谨、测查指标丰富的设计来探讨认知训练对延缓记忆主诉老人脑老化的影响。另外,如何使得训练收益更大化是训练领域的一个重要研究问题。已有研究提示情绪等个体性因素可能会影响被试从认知训练中的获益,但目前还没有研究直接考察这个问题。
本研究围绕记忆主诉老人的认知与脑的可塑性这一主题展开,采用严格的随机控制设计(randomized controlled trial, RCT),探讨认知训练对记忆主诉老人认知功能和脑功能的作用;并直接考察情绪改善能否促进训练收益。研究一通过对记忆主诉老人实施认知训练来考察记忆主诉老人认知功能的可塑性。结果发现,认知训练后,相对于控制组而言,认知训练组被试的记忆主诉明显减少;在情节记忆、工作记忆和整体认知功能测验上的成绩均显著提高;而更为重要的是日常记忆功能也有明显改善。研究二考察了认知训练对记忆主诉老人的静息态脑功能的影响。结果发现,干预后控制组被试在枕叶和颞叶等后部脑区的自发活动及其与其他脑区的功能连接增强,而认知训练组老人的自发活动和功能连接则保持不变或表现出下降趋势;相关分析发现控制组老人自发活动及功能连接的增强与行为成绩的下降相关。对纵向扫描数据的分析发现,老年人在颞枕结合部等后部脑区的自发活动随老化而增强。这些结果提示,控制组老人枕叶和颞叶自发活动及功能连接的增强可能是脑功能下降的表现;认知训练组并没有表现出这种脑改变,而且行为成绩还提高了,说明认知训练提高了神经活动的有效性,能够抵御伴随老化发生的脑功能下降。研究三通过团体辅导来考察情绪对认知训练收益的影响。结果发现,通过团体辅导,团辅认知组被试的焦虑和抑郁情绪相对改善,而主观幸福感等积极情绪相对得到保持;而且在认知训练中的获益更大。
在本研究中,我们发现记忆主诉老人依然具有认知和脑功能的可塑性,可以通过认知训练的方式来延缓脑老化的过程;而且积极情绪能够促进认知训练的效果。本研究对于改善老年人的脑功能,以及进一步预防和延缓老年痴呆具有重要意义。
其他摘要The elderly population is increasing rapidly in China, along with high incidence of neurodegenerative diseases, especially Alzheimer’s disease (AD), a significant public health issue that hinders economic and social development. The progression of AD might begin decades before onset of clinical symptoms, if we wait until the late stages with functional impairment, it may be too late to treat the underlying disease process. Individuals with subjective memory complaints (SMC) report declining memory without measurable cognitive deficits and this group of individuals straddles the boundary between normal aging and mild cognitive impairment. It would be more appropriate to prevent or postpone the disease process by intervening in this earlier stage of SMC. The plasticity of aging brain has become the hot issues in worldwide. It is well-established that aging is associated with deterioration in cognitive ability and brain. Despite the inevitable age-related decline, the aging brain reserves plasticity. Cognitive training may improve the cognitive and brain functions in cognitively normal elderly. The elderly with SMC demonstrate some neurodegenerative brain changes and have high risk of developing dementia, while relatively little is known about the effectiveness of cognitive training for SMC. Moreover, it is important to exaggerate the training effects. Existing data suggests that individual differences in emotion might affect the benefit from training, however, there is few research directly investigate this question.
The dissertation focused on functional brain plasticity in the elderly with SMC. In studyⅠ, a four-week cognitive training that combined memory strategy training with executive function training, was conducted to evaluate the effects of cognitive training on cognitive and daily functions. After training, the cognitive training group showed decreased subjective memory complaints and improvements in episodic memory, working memory, global function and daily memory functions. In studyⅡ, we employed the amplitude of low frequency fluctuations (ALFF), fractional ALFF (fALFF) and functional connectivity (FC) analyses to examine the effects of cognitive training on resting-state brain activity. Results showed that after training, spontaneous activity indexed by the ALFF in the occipital lobe and fALFF in the middle temporal gyrus significantly increased in the control group, while no change was found in the intervention group. In addition, training-related changes in spontaneous activity in the control group was negatively correlated with behavioral changes. The mean value of FC in the occipital lobe and the middle temporal gyrus in the intervention group decreased, while that in the control group showed a trend of increase; FC changes was negatively correlated with behavioral changes in the control group. Resting-state
spontaneous activity at the posterior regions and the relevant FC increased in normal aging, therefore, the cognitive training countered this age advancing-related brain function changes to keep them maintain or even reverse the changes. In study Ⅲ, we investigated the effects of positive emotion that induced by group counseling on cognitive training benefit. The results revealed that the group counseling could improve the emotion in the elderly, and positive emotion could boost the benefit from the cognitive training.
In conclusion, cognitive training could be used to postpone brain decline in the
elderly with SMC and positive emotion could improve the effect of training. These
findings provide new insights in understanding of brain plasticity in the elderly with SMC.
学科领域发展与教育心理学
语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/19748
专题认知与发展心理学研究室
作者单位中国科学院心理研究所
推荐引用方式
GB/T 7714
尹述飞. 针对记忆主诉老人的认知训练及情绪的 影响——行为与脑的可塑性[D]. 北京. 中国科学院研究生院,2015.
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