经颅直流电刺激和认知训练对脑梗死后认知功能障碍患者认知功能恢复的作用

Effects of Transcranial Direct-current Stimulation and Cognitive Training on Cognitive Function Recovery in Patients with Cognitive Impairment after Cerebral Infarction

目的:观察经颅直流电刺激(tDCS)与认知训练相结合对脑梗死后认知功能障碍患者认知功能恢复的作用。方法:选取120例脑梗死后认知功能障碍患者,采用随机分组法分为对照组60例,研究组60例。患者均进行常规治疗,在此基础上对照组进行虚拟现实认知功能训练,研究组接受tDCS联合虚拟现实认知训练,对两组治疗前后的认知功能情况(采用LOTCA认知功能评定量表评估)、P300潜伏期及波幅情况、脑血液循环情况及神经功能情况进行比较,并记录治疗期间不良反应发生率。结果:对照组和研究组患者在治疗前的LOTCA评分(总分及各维度得分)、P300潜伏期及波幅、平均血流量、平均速度、血管阻力情况、NIHSS评分,中枢神经特异蛋白、神经元特异性烯醇化酶组间差异无统计学意义(P>0.05)。治疗后,两组患者的LOTCA评分、P300波幅、脑血流平均血流量、脑血流平均速度均较治疗前升高,且研究组高于对照组(P<0.05),P300潜伏期、血管阻力、NIHSS评分及中枢神经特异蛋白、神经元特异性烯醇化酶水平低于治疗前,且研究组更低(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论:tDCS联合虚拟现实认知训练能够改善脑梗死后患者的认知功能和神经功能评分,且具有较高的安全性。

Objective:To analyze the effects of transcranial direct current stimulation combined with virtual reality cognitive exercises on cerebral blood flow and neurological functions in patients with cognitive impairments following a stroke.Method:A total of 120 patients with poststroke cognitive dysfunction were selected and divided into control group(n=60) and study group(n=60).After all patients were treated with conventional therapy,the control group received virtual reality cognitive training,and the study group received virtual reality cognitive training with tDCS.The cognitive function between both groups(assessed by LOTCA cognitive rating scale),P300 latency and amplitude(monitored by MK-15 ampere evoked potential system),cerebral blood flow circulation(monitored by color Doppler ultrasound),neurological function(assessed by NIHSS score),and the incidence of adverse reactions during treatment were recorded.Results:LOTCA score(total score and each dimension score),P300 latency and amplitude,mean blood flow,mean velocity,vascular resistance,NIHSS score,CNS-specific protein,neuronspecific enolase in both two groups before treatment were no differences(P>0.05).The LOTCA score,amplitude,mean blood flow and mean velocity were increased compared with those before treatment,and the study group was higher than the control group(P<0.05).P300latency,vascular resistance,NIHSS,CNS specific enolase were decreased compared to pre-treatment,which were even lower in the study group(P<0.05).The occurrence of adverse reactions did not vary significantly between the two groups(P>0.05).Conclusion:tDCS combined with virtual reality cognitive training may be an effective method to improve cognitive function and neurological function in patients after stroke,and does not increase the incidence of adverse reactions in patients,with a high safety profile.