视觉反馈平衡训练对脑卒中患者认知功能相关静息态脑网络的影响

Effect of visual feedback balance training on the resting brain network related to the cognitive function of stroke patients

目的探讨视觉反馈平衡训练对脑卒中患者认知功能相关静息态脑网络的影响。方法回顾性分析2018-02—2021-01于秦皇岛市第一医院就诊的认知功能有障碍的脑卒中患者(138例),其中A(视觉反馈平衡训练)、B(常规训练)组各69例,另选69例同期体检健康人员为C组。3组进行对比分析,包括一般资料、训练前后MoCA评分以及训练前后左右侧海马功能连接的变化。结果A、B组患者的一般资料均无显著差异(P>0.05)。训练后MoCA评分比较,A组患者的回忆力评分、视空间和执行能力评分以及总分[分别为(4.06±0.84)分、(3.31±1.33)分、(22.92±4.42)分]均显著高于B组[分别为(3.68±0.77)分、(2.89±1.10)分、(19.56±3.89)分](P<0.05)。与C组对比,A组患者训练后左侧海马与左侧颞叶(t=9.371,P<0.001)、左侧尾状核(t=4.992,P=0.001)以及左侧丘脑(t=4.450,P=0.002)的连接增加,与右侧前扣带回(t=—4.106,P<0.001)、右侧额上回(t=—3.221,P=0.003)以及右侧额中回(t=—7.079,P=0.001)的连接减少;右侧海马与右侧杏仁核(t=10.530,P=0.001)、右侧小脑后叶(t=8.543,P<0.001)、右侧顶叶(t=4.764,P=0.001)、右侧颞上回(t=5.215,P<0.001)以及右侧颞中回(t=5.185,P=0.002)的连接增加,与左侧额上回(t=—4.698,P<0.001)以及左侧额下回(t=—4.807,P=0.004)的连接减少。Logistic回归分析发现,丘脑(OR=12.013,P=0.024)、基底节(OR=6.015,P=0.045)、顶叶(OR=12.378,P=0.016)、枕叶(OR=8.304,P=0.031)、额叶(OR=19.569,P=0.005)、颞叶(OR=11.246,P=0.011)均与MoCA评分具有相关性。结论脑卒中患者的认知功能障碍主要表现在回忆力、语言能力、视空间和执行能力方面。视觉反馈平衡训练对脑卒中患者认知功能恢复效果尚可。认知功能障碍患者左右侧海马与脑区功能连接存在异常改变,且额叶与脑卒中患者发生认知功能障碍密切相关。

Objective To explore the effect of visual feedback balance training on the resting brain network related to the cognitive function of stroke patients.Methods A retrospective analysis was performed on stroke patients with cognitive impairment(138 cases)who were treated in First Hospital of Qinhuangdao from February 2018 to January 2021,and there were 69 cases in group A(visual feedback balance training)and group B(routine training)respectively.In addition,69 cases healthy people who underueut physical examination during the same period were selected as group C.The three groups were compared and analyzed,including general data,MoCA scores before and after training,and changes in the functional connectivity of the left and right hippocampus before and after training.Results Group A,B had no significant difference in the the general data of patients(P>0.05).Comparing the MoCA scores after training,the recall scores,visuospatial and executive ability scores and total scores of the patients in group A((4.06±0.84)points,(3.31±1.33)points and(22.92±4.42)points,respectively)were significantly higher than those of group B((3.68±0.77)points,(2.89±1.10)points and(19.56±3.89)points,respectively)(P<0.05).Compared with group C,the connection between the left hippocampus and the left temporal lobe(t=9.371,P<0.001),the left caudate nucleus(t=4.992,P=0.001)and the left thalamus(t=4.450,P=0.002)increased after training in group A,and the connection with the right anterior cingulate gyrus(t=-4.106,P<0.001),right upper frontal gyrus(t=-3.221,P=0.003)and right middle frontal gyrus(t=-7.079,P=0.001)decreased.The connection between the right hippocampus and the right amygdala(t=10.530,P=0.001),the right posterior cerebellum(t=8.543,P<0.001),the right parietal lobe(t=4.764,P=0.001),the right superior temporal gyrus(t=5.215,P<0.001)and the right middle temporal gyrus(t=5.185,P=0.002)increased,the connection with the left upper frontal gyrus(t=-4.698,P<0.001)and the left lower frontal gyrus(t=-4.807,P=0.004)decreased.Logistic regression analysis found that the thalamus(OR=12.013,P=0.024),basal ganglia(OR=6.015,P=0.045),parietal lobe(OR=12.378,P=0.016),occipital lobe(OR=8.304,P=0.031),frontal lobe(OR=19.569,P=0.005)and temporal lobe(OR=11.246,P=0.011)were all related to MoCA score.Conclusion The cognitive dysfunction of stroke patients is mainly manifested in memory,language ability,visual space and executive ability.There are abnormal changes in the functional connection between the left and right hippocampus and brain regions in patients with cognitive dysfunction,and the frontal lobe is closely related to the cognitive dysfunction in stroke patients.