计算机辅助认知训练对脑损伤患者认知功能和抑郁的影响

Effect of computer-assisted cognitive training on the cognitive function and depression in patients with brain injury

目的观察计算机辅助的认知训练对脑损伤患者认知功能和抑郁的影响。方法采用单盲方法,选择脑损伤后18 d至1年,有认知功能障碍和抑郁症状的患者46例,随机分为计算机辅助训练组(26例)和传统康复训练组(20例)。所有患者均接受传统康复训练(Bobath、Brunnstrom等神经发育促进技术,2次/d,30～40 min/次)和药物治疗。同时给予辅助训练组患者计算机辅助认知训练,30 min/次,2次/d。训练时间均为5周。认知功能判断采用神经行为认知功能检查量表(NC2SE)和画钟试验,并结合临床判定;抑郁状态评定采用汉密尔顿抑郁量表(HAMD,>8分为抑郁)。结果训练前,辅助训练组与传统康复训练组NCSE量表的定向能力、专注能力、语言能力、记忆能力、计算能力、推理能力、结构组织能力评分,画钟试验评分及HAMD评分,差异均无统计学意义,P>0.05。①训练后,两组NCSE量表各项评分及画钟试验评分均较训练前提高(P<0.05或P<0.01);与传统康复训练组比较,辅助训练组除结构组织能力外,NCSE其他各项评分及画钟试验评分均提高,差异有统计学意义(P<0.05或P<0.01)。②训练后,辅助训练组HAMD评分较训练前显著降低(P<0.01),传统康复训练组无明显改变;辅助训练组HAMD评分较传统康复训练组下降(P<0.05)。结论计算机辅助的认知训练能够改善脑损伤患者认知功能障碍,并使抑郁症状得到改善。

Objective To observe the effect of computer-assisted cognitive training on the cognitive function and depression in patients with brain injury. Methods Forty-six patients with cognitive impairment and depressive symptoms from 18 days to 1 year after brain injury were selected using single-blind method. The patients were divided into a computer-assisted training group （n = 26） and a traditional rehabilitation training group （ n = 20）. All patients received traditional rehabilitation training such as Bobath and Brunnstrom neurodevelopmental techniques, for 30 to 40 minutes twice a day, and drug therapy. At the same time, the computer-assisted training group received computer-assisted cognitive training for 30 mi- nutes, twice a day. The training period was 5 weeks for both groups. The neurohehavioral cognitive status examination （NCSE） scale, clock drawing test and clinical judgment were used to identify the cognitive function; the Hamilton depression （HAMD, 〉 8 ） scale was used to assess the depressive state. Results Before the training, there were no significant differences in the abilities of orientation, focus, language, memory, calculation, reasoning ability, and structure organizational skill scores of the NCSE scale, clock drawing test scores and HAMD scores between the computer-assisted training group and the traditional rehabilitation training group （P 〉 0.05）. ①After the training, all the scores of the NCSE scale and the scores of the clock drawing test were higher than those before training in both groups （P 〈 0.05 or P 〈 0.01 ） ; compared with the traditional rehabilitation training group, apart from the structure organizational skills, all other NCSE scale scores and the clock drawing test scores increased in the computer-assisted training group （P 〈 0.05 or P 〈0.01 ）. ②After the training, the HAMD score in the computer-assisted training group was significantly lower than that before training （ P 〈 0. 01 ）, and there was no significant change in the traditional rehabilitation training group. The HAMD score in the computer-assisted training group was lower than that in the traditional rehabilitation training group （P 〈 0.05）. Conclusion The computer-assisted cognitive training may improve cognitive impairment and depressive symptoms in patients with brain injury.