药物与认知训练治疗血管性痴呆的临床研究

Clinical observation on comprehensive treatment of drugs and cognitive training for patients with vascular dementia after stroke

目的:利用蒙特利尔认知评估(MoCA)量表和日常生活能力(ADL)量表评估药物与认知功能训练对卒中后轻中度血管性痴呆(VD)患者认知和ADL能力改善的情况。方法:收集2011年11月至2016年3月甘肃省中医院门诊及住院符合诊断标准的72例轻中度VD患者随机分为对照组和治疗组,两组患者均给予神经营养、改善脑循环、运动疗法(PT)、作业疗法(OT)等治疗;对照组单纯采用盐酸多奈哌齐治疗,每日1次,每次5mg,晚上服用,共治疗60天。治疗组在对照组治疗基础上增加认知训练,认知训练每日2次,每次30分钟,治疗60天。分别于治疗前及治疗后30、60天后采用MoCA和ADL量表评价;分析两组治疗方法对认知功能和ADL能力改善的情况。结果:两组患者在治疗30天后MoCA及ADL评分均有提高,治疗组评分高于对照组(P<0.05);治疗60天后,治疗组MoCA和ADL评分明显高于对照组(P<0.05)。结论:盐酸多奈哌齐药物结合认知训练对于血管性痴呆患者的认知障碍的改善比单用纯盐酸多奈哌齐治疗更为明显。两组患者经过治疗后认知功能及ADL评分均有提高,且治疗时间越长疗效越明显。

Objective：To explore the effective treatment of early vascular dementia patients after stroke,patients were treated with drugs and cognitive training were evaluated by Montreal cognitive assessment and Activity of Daily Living Scale. Methods： 72 patients with vascular dementia were randomly divided into control and treatment group , in which patients were given neurotrophy, improving cerebral cir- culation, physical therapy and occupational therapy. Control group were given Donepezil Hydrochloride, 1 times/day, 5mg/times, every night, a total of 60 days of treatment, treatment group were added to cognitive training, 2 times / day, 30 minutes each time, a total of 60 days of treatment based on the control group＇ s treatment. MoCA and ADL scale were evaluated before treatment and after 30 and 60 days of treatment and the sit- uation of cognitive function and ADL ability were analysed in two groups. Results：The scores of MoCA and ADL were improved after 30 days of treatment in two groups, the scores of treatment group was higher than that of the control group （P〈0.05）.After 60 days of treatment, the MoCA and ADL scores in the treatment group were significantly higher than that of the control group （O〈0.05）. Conclusion：The comprehensive treatment of drugs and cognitive training for patients with vascular dementia after stroke was more effective than simple drug treatment in which both cognitive function and ADL ability were improved as time increases.