高频重复经颅磁刺激对脑卒中后认知功能障碍的影响

Effects of high frequency repetitive transcranial magnetic stimulation on post-stroke cognitive impairment

目的:观察高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对脑卒中后认知障碍(poststroke cognitive impairment,PSCI)患者认知功能及日常生活活动能力(activities of daily living,ADL)的影响。方法:将25例PSCI患者随机分为刺激组(12例)和安慰刺激组(13例)。两组患者均予常规药物治疗及康复训练,刺激组在此基础上予左前额叶背外侧区10Hz rTMS治疗,安慰刺激组予假刺激,共治疗4周。治疗前、治疗2、4周后采用蒙特利尔认知评估量表、维多利亚版Stroop测试、Rivermead行为记忆测验评估患者认知功能,予改良Barthel指数量表评估患者ADL。结果:刺激组患者执行、记忆及整体认知功能在治疗2周及4周后均显著改善(P<0.05),安慰刺激组患者上述功能在治疗4周后显著改善(P<0.05),刺激组患者执行功能及总体认知功能提高的幅度显著高于安慰刺激组患者(P<0.05)。两组患者ADL在治疗2周及4周后均显著提高(P<0.05),刺激组患者提高的幅度显著高于安慰刺激组患者(P<0.05)。结论:高频rTMS治疗可有效改善PSCI患者认知功能及ADL。

Objective： To explore effects of high frequency repetitive transcranial magnetic stim-ulation （rTMS） on cognitive function and activities of daily living （ADL） of patients with post-stroke cognitive impairment （PSCI）. Method： Twenty-five patients with PSCI were randomly divided into rTMS group （n=12） and sham rTMS group （n=13）. Both groups received conventional medicine treatment and rehabilitation training. For rTMS group, 10Hz rTMS was given at the left side of the dorsolateral prefrontal cortex for 4 weeks and for the sham rTMS group, a sham treatment was given. Before treatments, after 2 weeks and 4 weeks of treatments, patients were assessed with Montreal cognitive assessment scale, the Vito-ria version of the Stroop test and Rivermead behavioral memory test for cognitive function and modified Barthel index rating scale for ADL. Result： The executive function, memory and the general cognitive function were significantly improved after 2 and 4 weeks of treatments（P〈0.05） in the rTMS group and were significantly improved after 4 weeks of treatments in the sham rTMS group （P〈0.05）. The improvement of executive function and the general cognitive function of the rTMS group was significantly higher than that of the sham rTMS group （P〈0.05）. The abilities of daily living of both groups were significantly increased after 2 and 4 weeks of treatments （P〈0.05）. The improvement of rTMS group was significantly higher than that of the sham rTMS group （P〈0.05）. Conclusion： High frequency rTMS is effective in promoting the cognitive function and the ADL of patients with PSCI.