认知训练联合重复经颅磁刺激对帕金森病轻度认知功能障碍的效果分析

Effect analysis of cognitive training combined with repeated transcranial magnetic stimulation on mild cognitive impairment in Parkinson's disease

目的 探讨认知训练联合重复经颅磁刺激(rTMS)对帕金森病轻度认知功能障碍(PD-MCI的效果。方法 57例PD-MCI患者,随机分为观察组(28例)和对照组(29例)。两组患者均接受帕金森病(PD)常规康复治疗,在此基础上,观察组接受rTMS+认知训练,对照组仅接受认知训练。比较两组患者治疗前后简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、洛文斯顿作业疗法认知成套测试(LOTCA)、统一帕金森病评定量表(UPDRS)-Ⅰ、d2注意力测试评分及改良Hoehn-Yahr分级。结果 治疗后,两组MMSE评分均高于本组治疗前,且观察组MMSE评分(27.57±1.26)分高于对照组的(24.07±1.00)分(P<0.05)。治疗后,两组MoCA评分均高于本组治疗前,且观察组MoCA评分(26.32±1.16)分高于对照组的(20.10±2.06)分(P<0.05)。治疗后,两组定向能力、视知觉、空间知觉、动作运用、视运动组织、思维操作评分均高于本组治疗前,且观察组高于对照组(P<0.05)。治疗后,两组d2注意力测试评分高于本组治疗前,且观察组d2注意力测试评分(91.29±2.27)分高于对照组的(82.83±1.26)分(P<0.05)。治疗后,两组UPDRS-Ⅰ评分均低于本组治疗前,且观察组UPDRS-Ⅰ评分(4.64±0.83)分低于对照组的(6.72±0.80)分(P<0.05)。治疗前后,两组改良Hoehn-Yahr分级组内及组间比较均无统计学差异(P>0.05)。结论 认知训练联合rTMS、单纯认知训练均能明显改善PD-MCI患者的认知功能,但两者联合效果较单一治疗效果更佳。

Objective To explore the effect of cognitive training combined with repeated transcranial magnetic stimulation(rTMS)on mild cognitive impairment in Parkinson's disease(PD-MCI).Methods 57 patients with PD-MCI were randomly divided into an observation group(28 cases)and a control group(29 cases).Both groups of patients received conventional rehabilitation treatment in parkinson's disease(PD),on this basis,the observation group received rTMS+cognitive training,and the control group only received cognitive training.Patients in both groups were compared in terms of Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment Scale(MoCA),Loewenstein Occupational Therapy Cognitive Assessment(LOTCA),Unified Parkinson's Disease Rating Scale(UPDRS-I),d2 attention test scores and the modified Hoehn-Yahr staging before and after treatment.Results After treatment,MMSE score in both groups were higher than that before treatment,and the observation group had higher MMSE score of(27.57±1.26)points than(24.07±1.00)points in the control group(P<0.05).After treatment,MoCA score in both groups was higher than that before treatment,and the observation group had higher MoCA score of(26.32±1.16)points than(20.10±2.06)points in the control group(P<0.05).After treatment,the scores of orientation,visual perception,spatial perception,motor use,visual motor organization and thinking operation in both groups were higher than those before treatment,and the observation group was higher than the control group(P<0.05).After treatment,the d2 attention test score in both groups was higher than that before treatment,and the observation group had higher d2 attention test score of(91.29±2.27)points than(82.83±1.26)points in the control group(P<0.05).After treatment,the UPDRS-Ⅰ score in both groups was lower than that before treatment, and the observation group had lower UPDRS-Ⅰ score of (4.64±0.83) points than (6.72±0.80) points in the control group (P<0.05). Before and after treatment, there was no significant difference in the modified Hoehn-Yahr staging between and within the two groups (P>0.05). Conclusion Cognitive training combined with rTMS can significantly improve the cognitive function in patients with PD-MCI, but the combined effect of the two is better than that of a single treatment.