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Article(id=1322607841249181796, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202504317, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1744732800000, receivedDateStr=2025-04-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263882218, onlineDateStr=2026-10-29, pubDate=1761321600000, pubDateStr=2025-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263882218, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263882218, creator=13701087609, updateTime=1793263882218, updator=13701087609, issue=Issue{id=1322607837742747790, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='1761321600000', pubDateStr='2025-10-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263881383, creator='13701087609', updateTime=1793264238791, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609336933794638, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609336933794639, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3830, endPage=3835, ext={EN=ArticleExt(id=1322607841647640679, articleId=1322607841249181796, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=A study of group cup stacking game in older adults with mild cognitive impairment, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the intervention effect of group cup stacking games on elderly individuals with advanced age and mild cognitive impairment (MCI).

Methods

Using a self-controlled before-and-after design and convenience sampling, 30 elderly individuals with advanced-age MCI from a nursing home in Guangzhou were selected as the research subjects. They received a 6-week intervention of group cup stacking games. The Mini Mental State Examination (MMSE), the Connections Test Executive Time, Digit Breadth, and General Self-Efficacy Scale were used to assess the overall cognitive functioning, executive functioning, attention, and self-efficacy of the participants, respectively. Differences between pre- and post-intervention were compared by paired t-test and Wilcoxon signed rank test.

Results

A total of 29 subjects were finally included in the study. Compared with pre-intervention, the overall cognitive function score of the subjects increased post-intervention (0.447, 95% CI: 0.062-0.826, P=0.023), and the score in the orientation cognitive domain also increased (0.380, 95% CI: -0.01-0.754, P=0.034). There were no statistically significant differences in the execution time of the Trail Making Test (0.123, 95% CI: -0.244-0.487, P=0.964), the Digit Span Test score (0.022, 95% CI: -0.343-0.385, P=0.707), and the self-efficacy score (0.297, 95% CI: -0.077-0.667, P=0.121).

Conclusion

The group cup stacking game intervention helps improve the overall cognitive function and orientation of elderly MCI patients with advanced age, and promotes their physical and mental health.

, authors=Min WEN, Jia-xian LIU, Yan-qun ZHANG, Min FU, Jia-jia LIU, authorsList=Min WEN, Jia-xian LIU, Yan-qun ZHANG, Min FU, Jia-jia LIU, authorCompany=null, correspAuthors=Jia-xian LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322607842956263536, articleId=1322607841249181796, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=团体叠杯游戏在高龄轻度认知障碍老年人中的应用研究, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

探究团体叠杯游戏在高龄轻度认知障碍老年人中的干预效果。

方法

按照自身前后对照设计，采用便利抽样法，选取广州市某养老机构的30名高龄轻度认知障碍老年人作为研究对象，对其进行为期6周的团体叠杯游戏干预。采用简易智力状态检查量表（Mini Mental State Examination, MMSE）、连线测验执行时间、数字广度和一般自我效能感量表分别评估研究对象的整体认知功能、执行功能、注意力和自我效能感情况。通过配对t检验和Wilcoxon符号秩检验比较干预前后的差异。

结果

最终共纳入研究对象29名。与干预前相比，研究对象干预后的整体认知功能评分增加（0.447，95% CI: 0.062~0.826，P=0.023）、定向力认知域上的评分增加（0.380，95% CI: -0.01~0.754，P=0.034）；在连线测验执行时间（0.123，95% CI: -0.244~0.487，P=0.964）、数字广度测验（0.022，95% CI: -0.34~0.385，P=0.707）和自我效能感（0.297，95% CI: -0.077~0.667，P=0.121）评分上的差异无统计学意义。

结论

团体叠杯游戏干预有助于改善高龄轻度认知障碍老年人的整体认知功能和定向力，促进其身心健康。

, authors=温敏, 柳家贤, 张雁群, 傅敏, 刘佳佳, authorsList=温敏, 柳家贤, 张雁群, 傅敏, 刘佳佳, authorCompany=null, correspAuthors=柳家贤, authorNote=

温敏（1998—），女，硕士在读，研究方向：老年护理

, correspAuthorsNote=
柳家贤，E-mail:
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温敏（1998—），女，硕士在读，研究方向：老年护理

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(In Chinese), articleTitle=The relationship among family caregiver support, Self-Efficacy, and Self-Supporting aging ability of Community-Dwelling older adults, refAbstract=null)], funds=[Fund(id=1322607852569608356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, awardId=20211238, language=CN, fundingSource=2021年度广东省中医药局科研项目(20211238), fundOrder=null, country=null), Fund(id=1322607853966311589, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, awardId=202388, language=CN, fundingSource=广州医科大学2023科研能力提升计划(202388), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322607843182755953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, xref=null, ext=[AuthorCompanyExt(id=1322607843191144562, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, companyId=1322607843182755953, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong 510000, China), AuthorCompanyExt(id=1322607843199533171, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, companyId=1322607843182755953, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=广州医科大学护理学院，广东　广州　510000)])], figs=[ArticleFig(id=1322607850988355742, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, language=EN, label=Table 1, caption=

Basic characteristics of elderly individuals with advanced-age MCI

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数(%)
总人数30（100.0%）
性别男2(6.7)
女28(93.3)
婚姻状况在婚2(6.7)
离异/丧偶/未婚28(93.3)
养老机构居住年限（年）<511(36.7)
≥519(63.3)
文化程度文盲2(6.7)
小学23(76.7)
初中及以上5(16.6)
参加社会活动不10(33.3)
偶尔14(46.7)
经常6(20.0)
合并基础疾病（种）无6(20.0)
≥224(80.0)
), ArticleFig(id=1322607851068047519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, language=CN, label=表1, caption=

高龄MCI老年人的基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数(%)
总人数30（100.0%）
性别男2(6.7)
女28(93.3)
婚姻状况在婚2(6.7)
离异/丧偶/未婚28(93.3)
养老机构居住年限（年）<511(36.7)
≥519(63.3)
文化程度文盲2(6.7)
小学23(76.7)
初中及以上5(16.6)
参加社会活动不10(33.3)
偶尔14(46.7)
经常6(20.0)
合并基础疾病（种）无6(20.0)
≥224(80.0)
), ArticleFig(id=1322607851399397536, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607841249181796, language=EN, label=Table 2, caption=

Comparison of MMSE scores across cognitive domains in older adults with MCI before and after intervention

, figureFileSmall=null, figureFileBig=null, tableContent=
项目人数总分（分,）定向力([分,M (P25,P75)])记忆力([分,M (P25,P75)])注意力和计算力([分,M (P25,P75)])回忆能力([分,M (P25,P75)] )语言能力([分,M (P25,P75)] )
干预前2923.90±2.7810.00(10.00,10.00)3.00(2.00,3.00)2.00(1.00,3.00)2.00(1.00,2.50)8.00(7.00,9.00)
干预后2924.97±2.4010.00(10.00,10.00)3.00(3.00,3.00)2.00(1.00,3.50)2.00(1.00,2.00)8.00(7.00,9.00)
差值1.00(-1.00,2.50)0.00(0.00,0.00)0.00(0.00,1.00)0.00(-1.00,1.00)0.00(-1.00,1.00)0.00(0.00,1.00)
Z值-2.370-2.121-0.881-0.8121.506-0.537
P值0.0230.0340.3780.4240.1430.591
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干预前后高龄MCI老年人MMSE各认知域得分比较

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项目人数总分（分,）定向力([分,M (P25,P75)])记忆力([分,M (P25,P75)])注意力和计算力([分,M (P25,P75)])回忆能力([分,M (P25,P75)] )语言能力([分,M (P25,P75)] )
干预前2923.90±2.7810.00(10.00,10.00)3.00(2.00,3.00)2.00(1.00,3.00)2.00(1.00,2.50)8.00(7.00,9.00)
干预后2924.97±2.4010.00(10.00,10.00)3.00(3.00,3.00)2.00(1.00,3.50)2.00(1.00,2.00)8.00(7.00,9.00)
差值1.00(-1.00,2.50)0.00(0.00,0.00)0.00(0.00,1.00)0.00(-1.00,1.00)0.00(-1.00,1.00)0.00(0.00,1.00)
Z值-2.370-2.121-0.881-0.8121.506-0.537
P值0.0230.0340.3780.4240.1430.591
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Comparison of connections test, attention, and self-efficacy scores of older adults with MCI before and after intervention

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项目人数连线时间([秒,M (P25,P75)])数字广度（分,）自我效能（分,）
干预前29172.00(122.00,238.00)9.86±2.5927.10±3.76
干预后29160.00(118.00,224.00)9.93±1.9128.00±2.95
差值-10.00(-50.00,53.50)0.00(-1.00,2.00)1.00(-1.00,3.50)
Z值0.046-0.376-1.601
P值0.9640.7070.121
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干预前后高龄MCI老年人连线测验、注意力和自我效能感得分的比较

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项目人数连线时间([秒,M (P25,P75)])数字广度（分,）自我效能（分,）
干预前29172.00(122.00,238.00)9.86±2.5927.10±3.76
干预后29160.00(118.00,224.00)9.93±1.9128.00±2.95
差值-10.00(-50.00,53.50)0.00(-1.00,2.00)1.00(-1.00,3.50)
Z值0.046-0.376-1.601
P值0.9640.7070.121
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团体叠杯游戏在高龄轻度认知障碍老年人中的应用研究
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温敏 , 柳家贤 , 张雁群 , 傅敏 , 刘佳佳
现代预防医学 | 临床与预防 2025,52(20): 3830-3835
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现代预防医学 |临床与预防 2025 , 52 (20) : 3830 -3835
团体叠杯游戏在高龄轻度认知障碍老年人中的应用研究
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温敏, 柳家贤 , 张雁群, 傅敏, 刘佳佳
作者信息
  • 广州医科大学护理学院，广东　广州　510000
通讯作者:
柳家贤，E-mail:
作者简介:

温敏（1998—），女，硕士在读，研究方向：老年护理

A study of group cup stacking game in older adults with mild cognitive impairment
Min WEN, Jia-xian LIU , Yan-qun ZHANG, Min FU, Jia-jia LIU
Affiliations
  • School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong 510000, China
出版时间: 2025-10-25 doi: 10.20043/j.cnki.MPM.202504317
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摘要
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目的

探究团体叠杯游戏在高龄轻度认知障碍老年人中的干预效果。

方法

按照自身前后对照设计，采用便利抽样法，选取广州市某养老机构的30名高龄轻度认知障碍老年人作为研究对象，对其进行为期6周的团体叠杯游戏干预。采用简易智力状态检查量表（Mini Mental State Examination, MMSE）、连线测验执行时间、数字广度和一般自我效能感量表分别评估研究对象的整体认知功能、执行功能、注意力和自我效能感情况。通过配对t检验和Wilcoxon符号秩检验比较干预前后的差异。

结果

最终共纳入研究对象29名。与干预前相比，研究对象干预后的整体认知功能评分增加（0.447，95% CI: 0.062~0.826，P=0.023）、定向力认知域上的评分增加（0.380，95% CI: -0.01~0.754，P=0.034）；在连线测验执行时间（0.123，95% CI: -0.244~0.487，P=0.964）、数字广度测验（0.022，95% CI: -0.34~0.385，P=0.707）和自我效能感（0.297，95% CI: -0.077~0.667，P=0.121）评分上的差异无统计学意义。

结论

团体叠杯游戏干预有助于改善高龄轻度认知障碍老年人的整体认知功能和定向力，促进其身心健康。

高龄  /  轻度认知障碍  /  团体  /  叠杯游戏  /  认知功能  /  执行功能  /  注意力  /  自我效能
Objective

To explore the intervention effect of group cup stacking games on elderly individuals with advanced age and mild cognitive impairment (MCI).

Methods

Using a self-controlled before-and-after design and convenience sampling, 30 elderly individuals with advanced-age MCI from a nursing home in Guangzhou were selected as the research subjects. They received a 6-week intervention of group cup stacking games. The Mini Mental State Examination (MMSE), the Connections Test Executive Time, Digit Breadth, and General Self-Efficacy Scale were used to assess the overall cognitive functioning, executive functioning, attention, and self-efficacy of the participants, respectively. Differences between pre- and post-intervention were compared by paired t-test and Wilcoxon signed rank test.

Results

A total of 29 subjects were finally included in the study. Compared with pre-intervention, the overall cognitive function score of the subjects increased post-intervention (0.447, 95% CI: 0.062-0.826, P=0.023), and the score in the orientation cognitive domain also increased (0.380, 95% CI: -0.01-0.754, P=0.034). There were no statistically significant differences in the execution time of the Trail Making Test (0.123, 95% CI: -0.244-0.487, P=0.964), the Digit Span Test score (0.022, 95% CI: -0.343-0.385, P=0.707), and the self-efficacy score (0.297, 95% CI: -0.077-0.667, P=0.121).

Conclusion

The group cup stacking game intervention helps improve the overall cognitive function and orientation of elderly MCI patients with advanced age, and promotes their physical and mental health.

Advanced age  /  Mild cognitive impairment  /  Groups  /  Cup stacking game  /  Cognitive function  /  Executive function  /  Attention  /  Self-efficacy
温敏, 柳家贤, 张雁群, 傅敏, 刘佳佳. 团体叠杯游戏在高龄轻度认知障碍老年人中的应用研究. 现代预防医学, 2025 , 52 (20) : 3830 -3835 . DOI: 10.20043/j.cnki.MPM.202504317
Min WEN, Jia-xian LIU, Yan-qun ZHANG, Min FU, Jia-jia LIU. A study of group cup stacking game in older adults with mild cognitive impairment[J]. Modern Preventive Medicine, 2025 , 52 (20) : 3830 -3835 . DOI: 10.20043/j.cnki.MPM.202504317
正文
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轻度认知障碍(mild cognitive impairment, MCI)是一种介于正常衰老和痴呆的病理状态，表现为认知功能进行性减退，但不影响日常生活能力，且未达到痴呆的诊断标准[1]。研究表明，MCI是痴呆临床前期的重要危险因素[2]，相较于认知未受损的健康老年人，MCI老年人发展为痴呆的风险要高出10倍之多[3]。这将严重损害老年人的身心健康，也将给其家庭、社会带来沉重的负担。因此，对MCI老年人进行早期干预刻不容缓。此外，与低龄老年人相比，养老机构高龄老年人的认知障碍形势更为严峻，其发生率高达41.3%，显著高于低龄老年人的8.4%[4]。因此，尽早对养老机构高龄MCI老年人进行科学有效的干预显得尤为重要。
养老机构内的高龄MCI老年人由于高龄所致的身体机能退化，以及生活环境改变所致的生活方式被动改变和社会参与减少等原因，常使其处于感觉缺失的状态[5]，而感觉刺激缺失是其进展为痴呆的重要危险因素[6]。感觉衰退理论认为老年人认知功能的下降与其感觉功能衰退存在很强的相互作用[7]。因此，向高龄MCI老年人提供可满足其日常感觉刺激的干预具有重要意义。此外，高龄MCI老年人由于对生命状态的负性状态等，常使其对传统体育锻炼和认知训练的参与度不高，仅为低龄老人的50%[8]，因此，设计可有效提高其参与积极性和持续性的活动具有现实需要。叠杯游戏是一种采用了蒙台梭利教具和融合了视觉、听觉和触觉等多感官刺激的游戏[9]。有研究发现[9]，团体叠杯游戏可提高幼儿思维的灵活性和身体协调性。但目前尚缺乏将其应用于高龄MCI老年人的有效证据。有研究表明[6]，多感官刺激可利用患者自身的感官优势，增加大脑树突分枝及树突棘密度，激发大脑结构的积极连接，促进其大脑结构重塑，延缓认知衰退。因此，本研究旨在通过在养老机构内开展团体叠杯游戏干预，探讨其对高龄MCI老年人认知功能的影响，为高龄MCI的非药物干预提供新方法。
1　对象与方法
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1.1　研究对象
2024年2月—4月，采取便利抽样法，选取广州市荔湾区颐和养老机构内的30名高龄MCI老年人为研究对象。纳入标准：①年龄≥80岁，改良巴氏指数评分（Modified Barthel Index, MBI）≥60分；②在养老机构居住3个月及以上；③意识清楚，可独立回答问题；④符合MCI的诊断标准（参照2018年中国痴呆与认知障碍诊疗指南中的MCI诊断标准），且经MMSE评估，根据受教育程度划界，文盲组（受教育年限=0年）<19分；小学组（受教育年限≤6年）<22分；初中、中专及以上组（受教育年限>6年存在一个或多个认知功能域损害，尚未达到痴呆的诊断）<26分；⑤知情同意。排除标准：①确诊痴呆及由其他明确病因（血管性痴呆、脑外伤、癫痫等）引起的认知障碍；②严重精神病，如双向情感障碍、躁狂症等；③视力、听力、肢体严重功能障碍或因其他原因而无法配合干预；④同时参与其他研究。剔除标准：①不能按要求完成6周游戏干预；②中途失联；③中途退出；④中途死亡。本研究已获广州医科大学医学伦理委员会审批，伦理审批号为：202404020。
1.2　研究方法
1.2.1　样本量和检验效能
根据既往相似研究中的数据[10]，利用G*power 3.1对样本量进行计算。设置Alpha error=0.05，Power=0.8，所需的样本量计算结果为25例，考虑20%的失访率，最终取样本量30例。此外，据调查，本研究中的养老机构共容纳了约350名高龄老年人，其中约120名为高龄MCI老年人，养老机构负责人统计既往活动参与率约25%，故本研究计划在此养老机构招募30名符合纳排标准的高龄MCI老年人进行初步探索。
1.2.2　干预方案
1.2.2.1　干预前准备
包括干预人员、物资和环境的准备。干预成员包括课题组的4名护理研究生，养老机构的4名社工，2名护士和1名医生。其中护理研究生和社工负责组织开展团体叠杯游戏干预，护士和医生负责保障老人参与游戏的人身安全。为所有研究对象免费提供叠杯游戏工具1套（彩色杯子12个、计时器1个），干预实施场所为养老机构内的活动室。将老人以3~6人/组进行分组。参考既往研究[11]的干预剂量，本研究的干预时间为6周，3次/周，45 min/次，具体时间为每次干预的上午的9:30~10:15，以避开老人的用餐和休息时间。
1.2.2.2　正式干预
干预方案的制订遵循安全有趣、循序渐进的原则。每次干预均包括热身、游戏训练和竞技比赛3个环节。时间具体分配为热身舒展10 min，叠杯游戏25 min，竞技比赛10 min。其中热身舒展活动主要以全身上下肢的关节及手部放松运动为主。每个关节活动频率以3个8拍为准，关节活动程度及范围可根据老人的个体情况进行。叠杯游戏按照操作难度递增的原则将游戏分为低级（6个杯）、中级（9个杯）、高级（12个杯），游戏进度和难易程度视老人的掌握程度决定，循序渐进地进行调整，以引发其学习兴趣和探索欲望，同时，增强其适应性和减少其畏难情绪。游戏的具体内容包括听指令（指定颜色、顺序）找杯子，老人需听到指令后快速做出相应动作，操作正确且用时少者获胜；根据游戏卡片（指定颜色、顺序和图案）摆放杯子，老人需根据卡片上规定的颜色、顺序和图案，以最快的速度排列杯子，且需保持一定时间（5秒）的结构稳定，若出现失误（如杯子倒塌），需重新进行，时间累计，用时最少者获胜。竞技比赛包括个人赛和小组赛，比赛内容根据游戏内容进行，比赛的奖励机制是根据每位老人的参与度和每次比赛结果兑换成积分券，老人可以根据自己的积分券购置生活日用品（纸巾、毛巾等），每2周兑换一次，以进一步增强老人的参与积极性和持续性。
1.3　结局变量定义
分别在干预前、干预6周后调查研究对象的整体认知功能、执行功能、注意力及自我效能感。
1.3.1　主要结局指标
整体认知功能：采用简易智力状态检查量表进行测量，该量表由Folstein等人编制，由李格等汉化修订，包括定向力、即刻记忆、注意力和计算力、回忆、语言能力5个认知域，共30个条目，总分30分，得分越高提示认知功能越好。中文版MMSE的重测信度为0.90。
1.3.2　次要结局指标
执行功能：采用连线测验进行测量，连线测验最初是由Partington人开发，分为A、B两个部分，分别用于执行功能维度中知觉运动和定势转移的检测，重测信度分别是0.790和0.890。
注意力：采用数字广度测验进行测量，数字广度测验取自韦氏智力测验第4版中文版的一部分，韦氏智力测验第4版由邹义壮修订，包括顺序和倒序背出所给数字两部分。重测信度>0.900。
自我效能感：采用一般自我效能感量表（General Self-Efficacy Scale, SES）进行测量，该量表由Klages等人编制，王才康等人汉化修订。该量表包括10个条目。条目分4级评分，从1（完全不正确）~4（完全正确）评分，总分10~40分。得分越高，自我效能感水平越强。该量表Cronbach α系数为0.967。
1.4　质量控制
干预前对干预人员和资料收集者进行专业规范化的培训和考核。干预过程中，密切观察老人实时状况，若老人出现情绪激动、跌倒等，干预人员立刻停止干预，协助老人休息，如有必要医护人员立刻进行相应处理，干预人员记录不良事件并分析发生原因。不良事件采用不良事件发生率（不良事件发生的例数与总例数的比值）进行评价，以百分率（%）的形式表示。全程记录老人的出勤情况和缺席原因。
1.5　统计处理
采用Excel(12.1.0.22215)录入数据。使用SPSS 27.0软件进行统计分析，符合正态分布的计量资料采用()表示，干预前后比较采用配对t检验；不符合正态分布的资料以M (P25,P75)表示，干预前后比较采用Wilcoxon符号秩检验；计数资料用例数、百分比表示，检验水准α＝0.05。
2　结果
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2.1　高龄MCI老年人的基本情况
共纳入30名高龄MCI老年人，但干预过程中有1名老人因自身疾病变化，于干预第4周退出干预，最终纳入29名。详见表1。
2.2　干预前后高龄MCI老年人整体认知功能比较
与干预前相比，干预后高龄MCI老年人的整体认知功能得分和定向力认知域得分增加，差异有统计学意义(P<0.05)；在记忆力、注意力和计算力、回忆能力和语言能力认知域得分上，差异无统计学意义(P>0.05)，见表2。
2.3　干预前后高龄MCI老年人执行功能、注意力和自我效能感比较
干预后高龄MCI老年人的执行功能、注意力和自我效能感得分与干预前相比，差异无统计学意义(P>0.05)，见表3。
3　讨论
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3.1　团体叠杯游戏有利于改善高龄MCI老年人的整体认知功能
本研究发现，高龄MCI老年人接受团体叠杯游戏干预后，其总体认知功能与定向力认知域得分增加，这与既往部分研究结论具有一致性[12]。探究其内在机制，可能是叠杯游戏中提供多样的视觉刺激，如色彩鲜艳的杯子、快速变换的堆叠造型，以及富有节奏感的听觉刺激，如杯子碰撞发出的清脆声响、统一有序的指令，能够有效激活大脑小胶质细胞，提升其活性，进而促进脑部血液循环，增强大脑的可塑性[13]。操作杯子时的触觉刺激，能够促使触觉神经与大脑中负责信息处理的关键区域建立更为紧密、高效的连接，从而增强手部的灵活度和身体协调性，最终对认知功能的改善起到积极的推动作用[14]。但干预前后MMSE各认知域的得分比较中，仅在定向力认知域上的差异有统计学意义。可能与记忆力、计算力等认知域的改变是一个复杂且长期的过程，长时间、规范化的任务训练，或者针对特定认知领域开展系统、专业的专项训练，才有可能实现这些认知域的改善有关[15]。而本研究由于时间、资源等限制，采用的是短期多感官认知刺激干预方案，在有限的时间内，尚不足以对其余认知域产生显著影响。这一结果表明，认知功能的改善是一个持续过程，尤其对于高龄MCI老年人这一特殊群体，需要更为长期、系统且有针对性的干预措施。
此外，有研究表明[16]，游戏化训练相较于单一训练，在改善认知功能方面更具优势。本研究使用较短时间的干预改善了高龄MCI老年人的总体认知功能，这可能存在两方面原因：一是叠杯游戏具有多感官刺激的协同作用，可以有效增强海马体功能，促使斑块周围的小胶质细胞大量聚集，对改善认知功能具有积极作用[17]；二是纳入的研究对象仍处于认知障碍早期阶段，其大脑仍具有一定的可塑性，能够对外部刺激做出较为积极的响应。这提示在未来的研究中，应进一步强化多感官刺激的协同作用，以实现干预成效的最大化提升[11]。
与个体干预模式相比，团体干预在诸多方面具有优势。从心理学角度来看，团体形式为个体提供了一个独特的社交环境。游戏过程中的互动，有利于激发个体的参与积极性与主动性。同时，竞赛环节的设置，极大增强了游戏的趣味性与挑战性，有利于激发老人的创造性思维，提升其思考能力。本研究的出勤记录显示，干预期间，仅有1名(3.33%)老人因自身病情加重脱落，其余老人均保持良好的出勤率，平均出勤率为90%，且未发生任何不良事件。高参与率和低失访率均表明团体叠杯游戏在养老机构高龄MCI老年人中具有可行性与安全性。
3.2　团体叠杯游戏对高龄MCI老年人的执行功能和注意力干预效果不明显
本研究结果表明，短期团体叠杯游戏无法显著改善高龄MCI老年人的执行功能和注意力，这可能与本研究的研究对象呈高龄和干预时间短有关。随着年龄的增长，老年人的前额叶皮质功能逐渐下降，可能导致其处理任务时难以抑制大脑细胞自动化的反应，从而影响其执行功能效率[18]。年龄和视觉负荷是影响视觉空间注意力的关键因素[19]。本研究干预前后其注意力评分和MMSE注意力认知域得分差异均无统计学意义，与刘倩等[11]的研究结果不一致，这可能与本研究中大部分老人文化程度以小学及以下为主，而刘倩等[11]的研究中大多数老年人为高中及以上学历，文化程度与注意力呈正相关关系[20]，从而可能对干预结果产生影响，提示未来研究应考虑文化程度对注意力的影响，制定针对性措施，以实现减缓认知功能下降的目的。此外，高龄MCI老年人由于衰老和多病共存等引起的身体生理变化，增加了其处理信息和对环境做出反应所需的时间，导致其注意力无法在短期干预中出现明显变化。因此，建议后续研究实施干预时充分考虑老年人的年龄和视觉负荷，适当地缩短单次训练时间和增加训练次数。
3.3　团体叠杯游戏对高龄MCI老年人的自我效能感干预效果不明显
本研究发现，6周的团体叠杯游戏干预无法明显提高高龄MCI老年人的自我效能感。这可能与高龄MCI老年人的个体状况有关。有研究表示[21]，影响老年人自我效能的因素包括性别、年龄、文化程度、婚姻状况、身体状况等。男性高于女性、有配偶的女性高于无配偶女性；年龄和自我效能感呈负相关；文化程度、健康状况与自我效能感呈正相关。本研究的研究对象具有小学及以下文化程度人数(83.3%)、女性人数(93.3%)、丧偶人数(90%)、患有两种及以上基础疾病人数(79.3%)占比大的特点，可能影响老人对自我效能提高的感知。这提示后续研究应关注老人个体情况对其自我效能感的影响，并给予针对性措施以有效提高其自我效能感。此外，本研究干预时间较短，也可能影响了老人对自我效能感的感知。建议后续研究适度延长干预时间，以验证干预对其自我效能感的影响。
综上，团体叠杯游戏可有效提高高龄MCI老年人的总体认知功能和定向力，可在养老机构高龄MCI老年人群中推广应用。由于受到各种资源的限制，未进行随机抽样和设立对照组，仅进行了小样本的初步探索，其结果可能不具有代表性；另外，本研究干预时间较短，未来应延长干预和随访时间，以进一步探究远期效果。
基金
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  • 2021年度广东省中医药局科研项目(20211238)
  • 广州医科大学2023科研能力提升计划(202388)
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2025年第52卷第20期
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doi: 10.20043/j.cnki.MPM.202504317
  • 接收时间：2025-04-16
  • 首发时间：2026-10-29
  • 出版时间：2025-10-25
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  • 收稿日期：2025-04-16
基金
2021年度广东省中医药局科研项目(20211238)
广州医科大学2023科研能力提升计划(202388)
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    广州医科大学护理学院，广东　广州　510000

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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