研究背景：轻度认知障碍（Mild Cognitive Impairment，MCI）是预防和延缓老年痴呆发生的突破点。MCI患者常伴随各种消极情绪，其中抑郁最为常见，合并抑郁的MCI患者具有更高的痴呆转化率，因此有必要尽早采取干预性措施。MCI患者消极情绪的干预主要包括药物治疗和非药物干预，目前药物治疗由于效果不佳，副作用大而很少应用。非药物干预以心理干预为主，其中包括积极心理干预，这种干预方法以改善积极情绪为基础，能够改善抑郁和认知功能，具有简单易行等特点，适合护理人员应用。目前，积极心理干预对改善MCI合并抑郁人群的抑郁、认知功能的效果如何尚不清楚。因此本研究将探究其对MCI老年人的抑郁和认知功能的改善效果。

研究目的：本研究旨在明确护士主导的积极心理干预对合并有抑郁的MCI老人抑郁和认知能力的干预效果。

研究方法：采用非随机同期对照试验设计。采用便利抽样方法对符合纳入、排除标准要求者分为对照组和干预组，于2021年5月—2021年12月对两组老年人开展研究，对照组采取一对一的健康宣教，干预组采取与对照组相同的健康教育，并开展为期8周、每周1次、每次40~60分钟的积极心理干预，干预结束后对两组老年人进行为期3个月的随访，在干预前、干预结束后和干预结束随访3个月时，这3个时间点分别评估两组老年人的抑郁和认知功能。

研究结果：本研究共纳入70例研究对象，对照组和干预组分别为35例。（1）干预组35例老年人中，74.29%的老年人干预参与度达到90%以上，57.14%老年人家庭作业完成度达到60%以上。干预结束随访3个月期间，继续完成家庭作业的老年人仅占2.86%；（2）对两组老年人的抑郁量表得分进行独立样本t检验结果显示，积极心理干预8周后，干预组的抑郁量表平均得分为5.57分，对照组得分为7.83分，得分差异具有统计学意义（t=-3.46，P＜0.001）；干预结束随访3个月后，抑郁量表得分平均分数为3.97分，对照组老年人的得分为6.17分，两组得分有统计学意义（t=-4.48，P＜0.001）。重复测量方差分析结果显示对照组和干预组老年人抑郁量表得分存在时间和组间的交互效应（F_交互=8.11，P＜0.001），量表得分的组间差异有统计学意义（F_组间=9.11，P＜0.05），且均受时间因素影响，得分在不同时间差异有统计学意义（F_时间=23.58，P＜0.05）。干预组抑郁量表得分随着干预时间的延长而逐渐降低，对照组得分在干预后基本保持不变，在干预结束随访3个月期间有一定下降趋势。（3）对两组老年人认知量表得分进行独立样本t检验，经过8周的干预后，干预组认知量表平均得分为25.97分，对照组得分为23.17分，得分差异具有统计学意义（t=7.28，P＜0.05）；干预组在干预结束随访3个月时认知量表得分为26.66分，对照组得分为24.02分，得分差异具有统计学意义（t=8.01，P＜0.05）。重复测量方差分析结果显示，两组老人认知量表得分存在时间和组间的交互效应（F_交互=30.38，P＜0.001），量表得分组间差异有统计学意义（F_组间=42.80，P＜0.001），且均受时间因素影响，得分在不同时间差异有统计学意义（F_时间=33.67，P＜0.05）。干预组认知量表得分随干预时间变化显著升高，而对照组得分在干预后时点基本不变，在干预后随访的3个月期间轻微出现上升迹象。 

研究结论：由护士主导的积极心理干预能够改善MCI合并抑郁老年人的抑郁和认知功能。在干预结束随访3个月期间，积极心理干预对MCI合并抑郁老年人的抑郁和认知功能的积极影响趋势会有一定程度的下降，但仍能对老年人的抑郁和认知功能起到改善效果。

Background: Mild Cognitive Impairment (MCI) is a breakthrough point to prevent and delay the development of Alzheimer's Disease. Patients with MCI are often accompanied by various negative emotions, among which depression is one of the most common symptoms, and older adults with MCI and depression have a higher dementia conversion rate, so intervention measures as early as possible are necessary. Interventions for negative emotions in older adults with MCI mainly include pharmacological treatments and non-pharmacological interventions, pharmacological treatments are currently rarely applied due to poor effects and large side effects. Non-pharmacological interventions are mainly psychological interventions. Positive psychological intervention based on improving positive emotions can improve depression and cognitive function, which is easy to operate and suitable for nursing staff application. It is unclear how well positive psychological interventions can improve depression and cognitive function in older adults with MCI and depression. Therefore, this study will explore its improvement effect on the older adults with mild cognitive impairment and depression.

Objectives: Aiming to clarify the effect of nurse-led positive psychological intervention on depression status and cognitive function in older adults with MCI and depression. 

Methods: Non-randomized controlled trial design was adopted. Participants who met the inclusion and exclusion criteria were divided into the control group and the intervention group. From May 2021 to December 2021, two groups of older adults with MCI and depression were studied. The control group received one-to-one health education, and the intervention group received the same health education as the control group. The intervention group had a 40-60 minutes active psychological intervention for 8 weeks, and the two groups were followed up for 3 months after the intervention. The cognitive function and depression status of the two groups were assessed using the scales after the intervention and after 3 months of follow-up.

Results: A total of 70 older adults were collected in this study, including 35 for each of the intervention and control groups. (1) The study results showed that during the intervention period, a total of 35 older adults reached the standard of active psychological intervention, of which 74.29% of the older adults participated in more than 90%, and 57.14% of the older adults had homework completion of more than 60%. During the 3-month follow-up period after the intervention, only 2.86% of the older adults continued to complete the corresponding homework every day. (2) Independent sample T test was used to analyze the scores of PHQ-9 scale in the two groups. After 8 weeks of positive psychological intervention, the average PHQ-9 score of the intervention group was 5.57, and that of the control group was 7.83, the difference was statistically significant (t=-3.64, P<0.05); After the 3-month follow-up, the average PHQ-9 score of the intervention group was 3.97, while the PHQ-9 score of the control group was 6.17, and the difference was statistically significant (t=-4.48, P<0.05). Repeated measures ANOVA results showed that there were interaction effects of time and groups on the scores of the PHQ-9 scale(F=8.11, P<0.001), the difference between the two groups on the score was significant (F=9.11, P<0.05), and there was significant difference on the score at different times（F=23.58, P<0.05). The PHQ-9 score of the intervention group decreased gradually with the extension of the intervention time, while the score of the control group remained basically unchanged after the intervention and had a certain downward trend during the 3-month follow-up. (3) Independent sample T test was used to analyze the scores of MoCA scale in the two groups. After 8 weeks of intervention, the average MoCA score of the intervention group was 25.97, and that of the control group was 23.17, the difference was statistically significant (t=7.28，P<0.05)；The average MoCA score of the intervention group was 26.66, and that of the control group was 24.02, with statistically significant difference (t=8.01, P<0.05). The results of repeated measure ANOVA showed that the cognitive ability of the two groups was significantly affected by intergroup effect (F=42.80, P<0.001), interaction effect (F=30.38, P<0.001) and time effect (F=33.67, P<0.05). The MoCA score of the intervention group increased significantly with the change in intervention time, while the score of the control group remained unchanged at the post-intervention time point, and showed a slight increase after 3 months of follow-up.

Conclusion: A nurse-led positive psychological intervention was able to improve cognitive function and depression in MCI patients with depression. During the 3-month follow-up period after the end of the intervention, the positive influence trend of intervention was decreased, but it is still able to improve the depression and cognitive function in the older adults with MCI and depression.