经颅直流电刺激配合认知训练治疗卒中后认知障碍的疗效

Effect of transcranial direct current stimulation combined with cognitive training on post-stroke cognitive impairment

目的观察经颅直流电刺激(tDCS)配合认知训练治疗卒中后认知障碍(PSCI)的疗效。方法前瞻性研究选取2019-07—2021-07东莞市松山湖中心医院康复医学科及神经内科收治的卒中后认知障碍患者96例,按照随机方法分为A、B、C 3组,每组32例。A组采用tDCS刺激治疗,B组采用常规认知训练干预治疗,C组采用tDCS刺激治疗的同时配合认知训练干预治疗。tDCS治疗电流强度为1.0mA,20 min/次,2次/d,每周5天。认知训练为每次30 min,1次/d,每周5天。上述干预均为连续2周。在治疗前、治疗后进行简易精神状态量表(MMSE)、蒙特利尔认知评定量表(MoCA)、改良的Barthel指数量表(MBI)及功能独立性评定量表(FIM)的评估。结果本研究最终纳入统计分析的患者为94例(2例脱落),其中A组30例,B组32例,C组32例。tDCS对患者MMSE及MoCA评分的影响。组内比较:与治疗前相比,3组患者在治疗后MMSE及MoCA评分均有显著性提高(P<0.01)。组间比较:MMSE、MoCA治疗后在3组间整体差异有统计学意义;经两两比较之后,B组和C组,A组和C组之间的差异具有统计学意义(P<0.01),A组和B组之间差异无统计学意义(P>0.05)。t DCS对患者日常生活活动能力的影响,组内比较:3组患者在治疗后的MBI及FIM评分均较治疗前明显提高(P<0.01)。组间比较:3组患者MBI及FIM评分有显著性差异(P<0.01)。经两两比较之后,B组和C组,A组和C组之间差异具有统计学意义(P<0.01),A组和B组之间差异无统计学意义(P>0.05)。结论tDCS及认知训练均能改善PSCI患者的认知功能及日常生活活动能力。tDCS配合认知训练对PSCI患者的认知功能及日常生活活动能力改善作用更为明显。

Objective To observe the efficacy of transcranial direct current stimulation(tDCS)combined with cognitive training in the treatment of post-stroke cognitive impairment(PSCI).Methods A prospective study selected 96 patients with post-stroke cognitive impairment who were admitted to the Department of Rehabilitation Medicine and Department of Neurology of Dongguan Songshanhu Central Hospital from July 2019 to July2021.They were randomly divided into three groups:A,B,and C,32 cases in each group.Group A was treated with tDCS stimulation,group B was treated with conventional cognitive training intervention,and group C was treated with tDCS stimulation while cooperating with cognitive training intervention.The current intensity of tDCS treatment was 1.0 mA,20 min/time,2 times a day,5 days a week.Cognitive training is 30 minutes each time,once a day,5 days a week.The above interventions were for 2 consecutive weeks.Before and after treatment,evaluations were performed on the Mini Mental State Scale(MMSE),Montreal Cognitive Assessment Scale(MoCA),Modified Barthel Index(MBI)and Functional Independence Rating Scale(FIM).Results The number of patients finally included in the statistical analysis in this study was 94 cases(2 cases dropped out),including 30 cases in group A,32 cases in group B,and 32 cases in group C.The effect of tDCS on MMSE and MoCA scores of patients.Comparison within the group:Compared with before treatment,the MMSE and MoCA scores of the three groups of patients were significantly improved after treatment(P<0.01).Comparison between groups:After MMSE and MoCA treatment,there were statistical differences among the three groups as a whole;after pairwise comparison,the differences between groups B and C,and between groups A and C were statistically significant(P<0.01).There was no significant difference between group A and group B(P>0.05).The effect of tDCS on activities of daily living in patients.Comparison within groups:The MBI and FIM scores of the three groups of patients after treatment were significantly higher than those before treatment(P<0.01).Comparison between groups:There were significant differences in MBI and FIM scores among the three groups(P<0.01).After pairwise comparison,the differences between groups B and C,and between groups A and C were statistically significant(P<0.01),but there was no significant difference between groups A and B(P>0.05).Conclusion Both tDCS and cognitive training can improve the cognitive function and activities of daily living in patients with PSCI.tDCS combined with cognitive training has a more obvious effect on improving the cognitive function and activities of daily living in patients with PSCI.