重复经颅磁刺激结合认知训练治疗血管性认知障碍的临床疗效观察

Clinical curative effect observation of rTMS combined with cognitive training in the treatment of vascular cognitive impairment

目的探讨重复经颅磁刺激联合认知训练治疗血管性认知障碍的临床效果。方法选择2015年7月~2016年6月在我院康复医学科接受康复治疗的血管性认知障碍患者共91例,随机分为治疗组(46例)及对照组(45例)。治疗组采用复经颅磁刺激联合认知训练训练治疗,对照组为单纯认知训练,应用蒙特利尔认知评估量表(Mo CA)及洛文斯顿认知评价箱(LOTCA)评估患者认知功能。比较两组患者治疗前后Mo CA及LOTCA总分及各单项评分。结果治疗后,治疗组Mo CA总分及其单项(执行、抽象、记忆、定向)评分均高于对照组,差异有统计学意义(P<0.05);治疗组LOTCA总分及其单项(定向、知觉、思维能力)评分均高于对照组,差异有统计学意义(P<0.05)。治疗后两组Mo CA总分及LOTCA总分均高于治疗前,差异有统计学意义(P<0.01)。治疗后,LOTCA单项中,对照组知觉、思维、视运动评分均高于治疗前,差异有统计学意义(P<0.05);治疗组各项评分均高于治疗前,差异有统计学意义(P<0.01)。治疗后,Mo CA单项中,对照组除命名项外,其他项评分均高于治疗前,差异有统计学意义(P<0.01);治疗组各项评分均高于治疗前,差异有统计学意义(P<0.01)。结论重复经颅磁刺激联合认知训练可提高血管性认知障碍患者认知功能水平,改善患者生活质量。

Objective To observe the clinical effect of rTMS combined with cognitive training in the treatment of VCI. Methods A total of 91 patients with VCI who received rehabilitation treatment in our hospital from July 2015 to June 2016 were enrolled.The treatment group was treated with rTMS combined with cognitive training.The control group was given only cognitive training.Application of MoCA and LOTCA in patient＇s cognitive assessment.Results After treatment, the MoCA total scores and individual items （execution,abstract,memory and orientation） of the treatment group were higher than those in the control group,the differences were statistically significant （P〈0.05）,The total score of LOTCA and the indi- vidual items （orientation,perception,thinking） in the treatment group were higher than those in the control group,the differ- ences were statistically significant （P〈0.05）.After treatment scores of MoCA and LOTCA scales were both increased in the two groups compared with before treatment,the differences were statistically significant （P〈0.01）;Afler treatment,in the LOTCA individual,the scores of perception,thinking and visual and spatial perception in the control group were higher than before treatment,the differences were statistically significant （P〈0.01）;in the MoCA single item,the scores of other items expectnaming in the control group were higher than those before the treatment,and the differences were statistically significant （P〈0.01）;the individual itemes scores of the treatment group after treatment were higher than those before treat-ment,the differences were stastistically significant （P〈 0.01）.Conclusion rTMS combined with cognitive training can improve cognitive function and the quality of life of patients with VCI.