背景:卒中后认知障碍(PSCI)是卒中后康复干预的重点和难点,发生率高达61%,这可能与脑血管功能的恶化有关。计算机辅助认知训练(CACT)可以通过针对激活的大脑区域的科学训练来改善认知功能,成为近年来流行的训练方法。经颅直流电刺激(tDCS),一种非侵入性脑刺激技术,可以调节脑血管神经功能,对脑卒中后认知功能障碍的康复有一定的作用。这项研究检查了CACT和tDCS对卒中后认知和脑血管功能的有效性,并探讨了CACT结合tDCS是否更有效。
方法:将72例PSCI患者随机分为常规认知训练(CCT)组(n=18),tDCS组(n=18),CACT组(n=18),CACT联合tDCS组(n=18)。每组患者接受相应的20分钟治疗,每周15次,连续3周。采用蒙特利尔认知评估量表(MoCA)和日常生活活动量表(IADL)评估患者的认知功能和日常生活活动能力。经颅多普勒超声(TCD)用于评估脑血管功能,包括脑血流速度(CBFV),脉搏指数(PI),和屏气指数(BHI)。在治疗前后测量这些结果。
结果:与基线相比,各组治疗后MoCA和IADL评分均显著升高(P<0.01)。CCT之间的疗效没有显着差异,CACT和tDCS组。CACT联合tDCS组MoCA评分较其他三组改善更明显(P<0.05),特别是在视觉空间和执行方面。仅CACT联合tDCS组治疗后BHI显著改善(p≤0.05),其他组无改善。此外,各组治疗前后CBFV或PI无显著差异。
结论:CACT和tDCS均可作为CCT治疗的替代方案,以改善卒中后的认知功能和日常生活能力。CACT联合tDCS可以更有效地改善PSCI患者的认知功能和日常生活活动能力,尤其是视觉空间和执行能力,这可能与BHI反映的脑血管舒缩功能改善有关。
背景:该研究已在中国临床试验注册中心(ChiCTR2100054063)注册。注册日期:2021年8月12日。
BACKGROUND: Post-stroke cognitive impairment (PSCI) is the focus and difficulty of poststroke rehabilitation intervention with an incidence of up to 61%, which may be related to the deterioration of cerebrovascular function. Computer-aided cognitive training (CACT) can improve cognitive function through scientific training targeting activated brain regions, becoming a popular training method in recent years. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, can regulate the cerebral vascular nerve function, and has an effect on the rehabilitation of cognitive dysfunction after stroke. This study examined the effectiveness of both CACT and tDCS on cognitive and cerebrovascular function after stroke, and explored whether CACT combined with tDCS was more effective.
METHODS: A total of 72 patients with PSCI were randomly divided into the conventional cognitive training (CCT) group (n = 18), tDCS group (n = 18), CACT group (n = 18), and CACT combined with tDCS group (n = 18). Patients in each group received corresponding 20-minute treatment 15 times a week for 3 consecutive weeks. Montreal Cognitive Assessment (MoCA) and the Instrumental Activities of Daily Living Scale (IADL) were used to assess patients\' cognitive function and the activities of daily living ability. Transcranial Doppler ultrasound (TCD) was used to assess cerebrovascular function, including cerebral blood flow velocity (CBFV), pulse index (PI), and breath holding index (BHI). These outcome measures were measured before and after treatment.
RESULTS: Compared with those at baseline, both the MoCA and IADL scores significantly increased after treatment (P < 0.01) in each group. There was no significantly difference in efficacy among CCT, CACT and tDCS groups. The CACT combined with tDCS group showed greater improvement in MoCA scores compared with the other three groups (P < 0.05), especially in the terms of visuospatial and executive. BHI significantly improved only in CACT combined with tDCS group after treatment (p ≤ 0.05) but not in the other groups. Besides, no significant difference in CBFV or PI was found before and after the treatments in all groups.
CONCLUSIONS: Both CACT and tDCS could be used as an alternative to CCT therapy to improve cognitive function and activities of daily living ability after stroke. CACT combined with tDCS may be more effective improving cognitive function and activities of daily living ability in PSCI patients, especially visuospatial and executive abilities, which may be related to improved cerebral vasomotor function reflected by the BHI.
BACKGROUND: The study was registered in the Chinese Registry of Clinical Trials (ChiCTR2100054063). Registration date: 12/08/2021.