认知干预对老年脑卒中失语症患者言语功能和生活质量的影响

The effect of cognitive intervention on language function and quality of life in elderly patients with post- stroke aphasia

目的观察言语训练基础上的认知干预对老年脑卒中失语症患者语言功能和生活质量的影响。方法随机数字法将55例老年脑卒中失语症患者分为实验组（28例）和对照组（27例）；对照组接受常规药物治疗并进行言语训练，实验组则在对照组治疗的基础上进行针对性认知干预。所有患者接受8周的康复治疗。于治疗前后使用简易精神状态检查（MMsE）量表、江苏常州产ZM2．1型语言障碍诊治仪和简化SF36生存质量量表（中文版）对所有患者分别进行认知功能、语言功能和生活质量评估。结果治疗后2组患者的MMSE评分、全部言语项目评分和生活质量所有维度评分较组内治疗前均提高（P〈0．05）；治疗后实验组的MMSE的定向力、记忆能力、注意力和计算力、言语能力各子项目评分、总分比较，差异均有统计学意义（均P〈0．05）；实验组的简单指令、复杂指令、是否判断、命名、简单理解、复杂理解、听读字、计算、记忆、匹配、简单常识、复杂常识、定向力、比较等14个言语项目的评分依次为（76．6±14．1）分、（66．1±12．8）分、（72．5±12．1）分、（55．0±19．5）分、（67．5±21．4）分、（44．8±17．0）分、（65．4±16．7）分、（39．3±25．8）分、（36．4±18．7）分、（75．9±18．6）分、（68．3±18．2）分、（58．7±17．4）分、（70，7±19．6）分、（59．9±14．6）分，与对照组治疗后的（67．4±19．3）分、（58．2±14．9）分、（63．0±14．1）分、（43．3±22．2）分、（55．6±20．6）分、（35．0±18．9）分、（53．7±19．3）分、（25．9±19．2）分、（26．3±17．8）分、（65．3±17．1）分、（58．0±19．5）分、（50．0±13．3）分、（60．5±17．2）分、（50．2±17．5）分相比，差异均有统计学意义（均P〈0．05）；实验组的情感职能、一般健康状况、精神健康、社会功能、精力等5个非躯体功能维度的生活质量评分分别为（66．7±18．2）分、（67．2±12．6）分、（71．0±5．6）分、（64．7±9．0）分、（55．4±14．8）分，与对照组治疗后的（53．1±21．2）分、（60．7±9．8）分、（63．1±4．2）分、（59．3±10．2）分、（46．9±15．6）分比较，差异均有统计学意义（均P〈0．05）。结论在言语训练的同时，积极进行认知干预有利于老年脑卒中失语症患者的言语功能改善和生活质量的提高。

[Abstract] Objective To investigate the effect of cognitive intervention on language function and quality of life （QOL） in elderly patients with post stroke aphasia. Methods Fifty-five elderly patients with post-stroke aphasia were randomly divided into the control group （n--27） and the experimental group （n： 28）. The control group received comprehensive treatment including speech language therapy （SLT）, while the experimental group was subjected to additional cognitive intervention. All patients were enrolled in an eight-week rehabilitation program. The mini-mental state examination （MMSE） was used to assess cognitive function, a device for diagnosis and treatment of language disorders, ZM 2.1, was used to evaluate language function, and the 36-item short-formhealth survey （SF-36） （Chinese version） was used to assess quality of life （QOI.）, before and after treatment. Results After treatment, MMSE scores, language function scores in all categories and QOI. scores in all dimensions improved in both groups （P〈0.05 for both）. Furthermore, after treatment, there were significant differences between the two groups in MMSE scores of orientation, recall, attention and calculation, and in scores of overall language ability and the individual categories （ P〈0.05 for all）. Scores of the experimental group w the control group for the individual categories of language function were as follows： simple instructions （76.6 ± 14. 1 vs. 67.4 ± 19.3）, complex instructions （66.1±12.8 vs. 58.2±14.9）, yes or no （72.5±12.1 vs 63.0±14.1）, naming （55.0 19.5 vs. 43.3±22.2）, simple comprehension （67.5±21.4 vs. 55.6±20.6）, complex comprehension （44.8±17.0 vs. 35.0±18.9）, listening and reading words （65.4±16.7 vs53.7±19.3）, calculation （39.3±25.8 vs 25. 9±19. 2）, memory （36.4±18.7vs. 26.3±17.8）, matching （75.9±18.6 vs. 65.3 ± 17.1 ）, simple general knowledge （68.3 ± 18.2 vs. 58.0 ± 19.5 ）, complex general knowledge （58.7±17.4 vs 50.0±13.3）, orientation （70.7± 19.6 vs. 60.5±17.2） and comparison （59.9± 14.6 vs. 50.2±17.5） （P〈0.05 for all）. There were significant differences between the two groups in emotional function （66.7±18.2 vs. 53.1±21.2）, general health （67.2±12.6 vs. 60.7±9.8）, mental health （71.0±5.6 vs. 63.1±4.2）, social functioning （64.7±9.0 vs. 59.3±10.2） and vitality （55.4±14.8 vs. 46.9±15.6） （ P〈0.05 for all）. Conclusions Cognitive intervention combined with SLT can contribute to the recovery of language function and the improvement of QOL in elderly patients with post-stroke aphasia.