计算机辅助认知康复训练改善轻、中度认知障碍的临床研究

A clinical study on computer-assisted cognitive rehabilitation training to improve mild and moderate cognitive impairment

目的使用脑电近似熵(approximate entropy,ApEn)和Lempel-Ziv复杂度(Lempel-Ziv complexity,LZC)及认知量表评估轻、中度认知障碍患者进行计算机辅助认知康复训练的疗效。方法选择97例主诉记忆力下降并确诊为轻、中度认知障碍的患者,进行为期10 d的以“意念力游戏”为主题的计算机辅助认知康复训练。根据简明精神状态检查量表(mini mental state examination,MMSE)评分将所有患者分为轻度认知障碍组(25分≤MMSE≤28分)和中度认知障碍组(10分≤MMSE≤24分),并在训练前后对两组患者进行MMSE、蒙特利尔认知评估(MoCA)量表、阿尔茨海默病评价量表(ADAS-cog)评估,分析比较训练前后MMSE、MoCA、ADAS-cog评分。97例患者均在入组时及10 d后于静坐闭目状态下记录8 min时长的16导联的脑电信息,由燕山大学电气工程学院对脑电信号进行非线性测量以获取ApEn和LZC,计算认知训练前后16个导联ApEn和LZC的变化值,应用SPSS 25.0统计软件进行聚类分析及因子分析法将数据转变为图形,较为直观的观察该认知训练对于不同脑区的作用。结果认知训练10 d后,轻、中度认知障碍患者MMSE、MoCA、ADAS-cog评分均较前明显改善(P<0.05)。认知训练10 d后,轻、中度认知障碍患者各脑区脑电信号ApEn、LZC均较前显著增加(P<0.01);根据97例认知障碍患者训练前后16个导联的ApEn、LZC差值(即△ApEn训练后-训练前、△LZC训练后-训练前)所得聚类分析树状图和三维主成分因子分析图显示,10/20国际系统16导联中的Fp1、Fp2、F7、F8导联(双侧额极、前颞区)在第1、2、3个公因子上均有较高的载荷(即更接近于1),且此4个导联之间距离较短,表明此4个导联ApEn、LZC变化趋势更具有一致性且较为突出。结论“意念力游戏”认知康复训练可以提高中老年轻、中度认知障碍患者的脑功能状态,改善其总体认知功能。脑电信号ApEn、LZC作为脑功能评价的客观指标,观察到Fp1、Fp2、F7、F8导联(即双侧额极、前颞区)可能是对该康复训练较为敏感的区域。

Objective To assess the efficacy of computer-assisted cognitive rehabilitation in patients with mild and moderate cognitive impairment.Methods A total of 97 patients who complained of memory decline and were diagnosed with mild or moderate cognitive impairment were selected for 10 days of computer-aided cognitive rehabilitation training with the theme of“mind play”.According to the mini mental state examination(MMSE)score,all patients were divided into mild cognitive impairment group(25≤MMSE≤28)and moderate cognitive impairment group(10≤MMSE≤24).MMSE,Montreal Cognitive Assessment(MoCA)scale,and Alzheimer s disease evaluation scale(ADAS-cog)were conducted before and after training.All 97 patients recorded the EEG information of 16 leads for 8 minutes at the baseline,and 10 days after training,sitting with their eyes closed.The EEG signals were non-linear measured by the School of Electrical Engineering of Yanshan University to obtain ApEn and LZC.The change values of 16 leads ApEn and LZC before and after cognitive training were calculated.The SPSS 25.0 statistical software was used to perform cluster analysis and factor analysis to convert the data into graphs,and the effect of cognitive training on different brain regions was observed more intuitively.Results After 10 days of cognitive training,the scores of MMSE,MoCA and ADAS-cog in patients with mild and moderate cognitive impairment were significantly improved(P<0.05).After 10 days of cognitive training,the EEG signals ApEn and LZC in all brain regions of patients with mild and moderate cognitive impairment increased significantly(P<0.01).According to the cluster analysis dendrogram and three-dimensional principal component factor analysis plot obtained by the ApEn,LZC difference of 16 leads before and after training(i.e.,△ApEn after training-pre-training,△LZC training-pre-training),the Fp1,Fp2,F7,and F8 leads(bilateral frontal pole,anterior temporal region)in the 16-lead of the 10/20 international system had higher loads(i.e.,closer to 1)on the 1st,2nd and 3rd common factors,and the distance between these 4 leads was short.The results showed that the change trend of ApEn and LZC in these four leads was more consistent and prominent.Conclusions“Mind play”cognitive rehabilitation training could improve the brain function status of middle-aged,and elderly with mild and moderate cognitive impairment,and improve their overall cognitive function.The EEG signals ApEn and LZC could be used as objective indicators for brain function evaluation.The Fp1,Fp2,F7,and F8 leads(i.e.,bilateral frontal poles and anterior temporal regions)may be sensitive areas of rehabilitation.