经颅直流电刺激联合认知干预对脑梗死认知障碍患者记忆和执行功能的疗效研究

Effects of tDCS combined with cognitive intervention on memory and executive function in patients with cognitive impairment after cerebral infarction

目的:探讨经颅直流电刺激(transcranial direct current stimulation,tDCS)联合认知干预对脑梗死认知障碍患者记忆和执行功能的疗效及作用机制。方法:将60例脑梗死伴认知障碍患者随机分为对照组和观察组,各30例。2组患者均给予综合康复治疗,对照组给予sham-tDCS联合认知干预治疗,观察组给予tDCS联合认知干预治疗。分别于治疗前和治疗后采用Rivermead行为记忆测验第二版(RBMT-Ⅱ)、威斯康星卡片测验系统(WCST)、洛文斯顿作业疗法认知评定量表(LOTCA)和脑卒中专用生活质量量表(SS-QOL)进行比较,并采用RBMT-Ⅱ评分、WCST测验来评估观察组左、右病灶侧疗效评估。结果:治疗前2组患者各评定结果之间无显著性差异;治疗后2组RBMT-Ⅱ评分、WCST测验、LOTCA评分和SSQOL评分较治疗前均改善(P<0.05),观察组各评定结果改善均高于对照组(P<0.05);且治疗后观察组tDCS阳极刺激右病灶侧仅完成分类数(Cc)改善优于左病灶侧,其他指标比较无显著性差异(P>0.05)。结论:tDCS刺激病灶侧背外侧前额叶联合认知干预对脑梗死后认知障碍患者具有协同改善记忆和执行功能的作用,能进一步改善患者认知功能和生活质量。

Objective:To investigate the efficacy and mechanism of transcranial direct current stimulation(tDCS) combined cognitive intervention on memory and executive function in patients with cognitive impairment following cerebral infarction.Method:A total of 60 patients of cerebral infarction with cognitive impairment were randomly divided into the control group and the observation group,30 cases in each group. Besides given comprehensive rehabilitation,the control group was given sham-tDCS combined with cognitive intervention,and the observation group was given tDCS combined with cognitive intervention. Before and after treatment,Rivermead Behavioral Memory Test(RBMT-Ⅱ),Wisconsin Card Test System(WCST),Loewinston Occupational Therapy Cognitive Rating Scale(LOTCA) and Stroke Specific Quality of Life Scale(SS-QOL) were assessed,and RBMT-Ⅱ score and WCST test were used to evaluate the curative effect of the left and right lesion sides of the observation group.Result:Before treatment,there was no statistically significant difference between the two groups. After treatment,RBMT-Ⅱ score,WCST test,LOTCA score and SS-QOL score in two groups improved compared with those before treatment(P<0.05),and the improvement of evaluation results in the observation group was higher than that in the control group(P<0.05). After treatment,tDCS anode stimulation on the right side of the lesion only improved Categories Completed(Cc),which was better than that on the left side,and there was no difference in other indicators(P>0.05).Conclusion:tDCS stimulation of dorsolateral prefrontal cortex combined with cognitive intervention can synergistically improve memory and executive function in patients with cognitive impairment after cerebral infarction,and can further improve cognitive function and quality of life of patients.