Exploring the therapeutic potential of Qi Teng Mai Ning recipe in ischemic stroke and vascular cognitive impairment

Background:This study aims to explore the therapeutic effects of the Qi Teng Mai Ning recipe on ischemic stroke and vascular cognitive impairment through its potential to modulate cellular autophagy,with a focus on identifying its active ingredients and their target proteins.Methods:The study began with the identification of active ingredients in the Qi Teng Mai Ning recipe.It proceeded to screen the gene expression omnibus database for ischemic stroke and vascular cognitive impairment-associated differentially expressed mRNAs and to identify cellular autophagy-related proteins via the Human Autophagy Database.These proteins were annotated with Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functions and subjected to molecular docking with the recipe’s core active ingredients.In vitro cell experiments were conducted on hypoxic HT22 cells,involving CCK8 assay,lentiviral transfection to silence autophagy related 9B(ATG9B),immunofluorescence staining,and qPCR validation to investigate the effects of the recipe on autophagy.Results:The analysis identified 104 active ingredients targeting 408 proteins and forming a complex ingredient-target network.Intersecting 55 ischemic stroke-related and 909 vascular cognitive impairment-related differentially expressed mRNAs revealed 14 co-expressed mRNAs.Molecular docking showed quercetin,kaempferol,myrcene,and conferone as key ingredients targeting autophagy-related proteins.Cellular experiments indicated that the recipe significantly enhanced cell viability under hypoxic conditions,reduced apoptosis,and modulated the expression of autophagy-related factors,thereby decreasing apoptosis rates in HT22 cells.Conclusion:The Qi Teng Mai Ning recipe offers protective effects against ischemic stroke and vascular cognitive impairment by modulating autophagy-related proteins.Its efficacy highlights the potential of traditional Chinese medicine in treating these conditions,though further research is needed to fully understand its mechanisms and clinical applications.

Evolving Profile and Determinants of Post-Stroke Cognitive Impairment in the 3rd Month among Kinshasa’s Survivors (Democratic Republic of the Congo)

Background: Neurocognitive impairments are common among stroke survivors. Despite their negative impact on daily life, their evolving, and determinants are not fully known in our context. To determine evolving characteristics of post-stroke cognitive impairment in the 3rd month as well as determinants among Kinshasa’s adult survivors is the aim of this study. Methods: We sought to determine neurocognitive deficits in the 3rd month in a prospective single-group cohort study in 3 hospital centers in Kinshasa. Eighty-six adult stroke survivors with a neurological and neuroimaging computerized diagnosis of stroke were assessed using MOCA (Montreal Cognitive Assessment) in the first and the third months post-stroke. Results: Neurocognitive disorders ranged from 79.1% in the first month to 54.7% in the third month after stroke (with 4.7% with severe decline). Gender female [AOR = 86.3 (CI95%: 2.8 - 2643.7);p 0.01], Chronic hypertension ([AOR = 26.8 (CI95%: 2.55 - 282.55);p 0.01]), the pathological lipid profile [AOR = 8.7 (CI95%: 1.10 - 68.82);p = 0.04] and worse MOCA score at the first month ([AOR = 41.2 (CI95%: 8.13 - 2134.81);p = 0.021]) were identified as worse predictors of cognitive impairments at the third month post-stroke. Conclusion: Post-stroke cognitive impairment is common and decreases in the 3rd month post-stroke. Chronic hypertension, gender, lipid profile, and the first month MOCA score are predictors of worse cognitive performance in Kinshasa survivors. These findings suggested the role of early management in improving cognition and the control of stroke risk factors.

β2-Microglobulin exacerbates neuroinflammation,brain damage,and cognitive impairment after stroke in rats

β2-Microglobulin(β2M),a component of the major histocompatibility complex class I molecule,is associated with aging-related cognitive impairment and Alzheimer’s disease.Although upregulation ofβ2M is considered to be highly related to ischemic stroke,the specific role and underlying mechanistic action ofβ2M are poorly understood.In this study,we established a rat model of focal cerebral ischemia by occlusion of the middle cerebral artery.We found thatβ2M levels in the cerebral spinal fluid,serum,and brain tissue were significantly increased in the acute period but gradually decreased during the recovery period.RNA interference was used to inhibitβ2M expression in the acute period of cerebral stroke.Tissue staining with 2,3,5-triphenyltetrazolium chloride and evaluation of cognitive function using the Morris water maze test demonstrated that decreasedβ2M expression in the ischemic penumbra reduced infarct volume and alleviated cognitive deficits,respectively.Notably,glial cell,caspase-1(p20),and Nod-like receptor pyrin domain containing 3(NLRP3)inflammasome activation as well as production of the inflammatory cytokines interleukin-1β,interleukin-6,and tumor necrosis factor-αwere also effectively inhibited byβ2M silencing.These findings suggest thatβ2M participates in brain injury and cognitive impairment in a rat model of ischemic stroke through activation of neuroinflammation associated with the NLRP3 inflammasome.

Efficacy of enhanced extracorporeal counterpulsation combined with atorvastatin in the treatment of cognitive impairment after stroke

BACKGROUND Cerebral apoplexy patients are prone to cognitive impairment,and it is very important to choose appropriate treatment methods to improve their cognitive impairment after stroke.AIM To evaluate the effects of enhanced external counterpulsation(EECP)in con-junction with atorvastatin on cognitive function,neurotransmitter levels,and the repair of brain tissue damage in patients with cognitive impairment due to stroke.METHODS In this retrospective study,data from 60 patients with poststroke cognitive impairment due to stroke who were treated in our hospital from February 2021 to July 2022 were analyzed and divided into a treatment group(n=30)and a control group(n=30)according to the different nursing methods applied.Patients in the treatment group received EECP in addition to atorvastatin,while those in the control group received atorvastatin alone.Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and activities of daily living(ADL)scale scores were compared between the two groups.Additionally,the two groups were compared in terms of serum acetylcholine(ACh),acetylcholin-esterase(AChE),nitric oxide(NO),endothelin-1(ET-1),β2-microglobulin(β2-MG),glial fibrillary acidic protein(GFAP),and visinin-like protein 1(VILIP-1)in the serum.Blood flow measurements from the anterior cerebral artery(ACA),middle cerebral artery(MCA)and posterior cerebral artery(PCA)were compared between the two groups before and after treatment,and the pulsatility index(PI)and resistance index(RI)of each artery were determined.RESULTS MMSE,MoCA,and ADL scores all improved in both groups following treatment,with the study group showing more improvement than the control group(P<0.05).After treatment,there were statistically significant increases in both ACh and NO levels,whereas decreases occurred in AChE,ET-1,β2-MG,VILIP-1,and GFAP,levels and the PI and RI of the left-ACA,right-ACA,left-MCA,right-MCA,left-PCA,and right-PCA.The study group showed greater gains in all metrics than the control group(P<0.05).CONCLUSION EECP combined with atorvastatin is effective in the treatment of cognitive impairment after stroke and can effectively improve the cognitive function,neurotransmitter levels,and brain tissue damage status of patients.

The Effect of Ginkgo Biloba Leaf Dropping Pill Combined with Butylphthalide Capsule on Cognitive Dysfunction in Patients after Acute Ischemic Stroke and Its Impact on Serum Cytokines

Objective: To investigate the therapeutic effect of Ginkgo biloba extract dropping pills combined with butylphthalide capsules on cognitive dysfunction in patients after acute ischemic stroke (AIS) and its impact on serum cytokines CRP, IL-6, and Hcy. Methods: This study selected 76 patients with cognitive dysfunction after ischemic stroke who were hospitalized at Zhuji People’s Hospital from January 2023 to January 2024. The patients were divided into two groups. The control group was treated with butylphthalide capsules, while the combination group received Ginkgo biloba extract dropping pills in addition to the treatment given to the control group. The neurological function, cognitive function, activities of daily living, and levels of serum cytokines CRP, IL-6, and Hcy were compared between the two groups after 1 month and 3 months of treatment. Results: The NIHSS scores, MMSE scores, ADL scores, and levels of CRP, IL-6, and Hcy in both groups showed statistically significant differences compared to before treatment (P Conclusion: The combination of Ginkgo biloba extract dropping pills and butylphthalide capsules has a better therapeutic effect on cognitive dysfunction in patients after ischemic stroke. It can improve the neurological function and cognitive function of patients, enhance their ability to perform daily activities, and reduce inflammatory responses.

C-C chemokine receptor type 2-overexpressing exosomes alleviated experimental post-stroke cognitive impairment by enhancing microglia/macrophage M2 polarization

BACKGROUND Human-derived mesenchymal stromal cells have been shown to improve cognitive function following experimental stroke.The activity of exosomes has been verified to be comparable to the therapeutic effects of mesenchymal stromal cells.However,the effects of exosomes derived from human umbilical cord mesenchymal stem cells(HUC-MSCs)(ExoCtrl)on post-stroke cognitive impairment(PSCI)have rarely been reported.Moreover,whether exosomes derived from C-C chemokine receptor type 2(CCR2)-overexpressing HUC-MSCs(ExoCCR2)can enhance the therapeutic effects on PSCI and the possible underlying mechanisms have not been studied.AIM To investigate the effects of ExoCtrl on PSCI and whether ExoCCR2 can enhance therapeutic effects on PSCI.METHODS Transmission electron microscopy,qNano®particles analyzer,and Western blotting were employed to determine the morphology and CCR2 expression of ExoCtrl or ExoCCR2.ELISA was used to study the binding capacity of exosomes to CC chemokine ligand 2(CCL2)in vivo.After the intravenous injection of ExoCtrl or ExoCCR2 into experimental rats,the effect of ExoCtrl and ExoCCR2 on PSCI was assessed by Morris water maze.Remyelination and oligodendrogenesis were analyzed by Western blotting and immunofluorescence microscopy.QRT-PCR and immunofluorescence microscopy were conducted to compare the microglia/macrophage polarization.The infiltration and activation of hematogenous macrophages were analyzed by Western blotting and transwell migration analysis.RESULTS CCR2-overexpressing HUC-MSCs loaded the CCR2 receptor into their exosomes.The morphology and diameter distribution between ExoCtrl and ExoCCR2 showed no significant difference.ExoCCR2 bound significantly to CCL2 but ExoCtrl showed little CCL2 binding.Although both ExoCCR2 and ExoCtrl showed beneficial effects on PSCI,oligodendrogenesis,remyelination,and microglia/macrophage polarization,ExoCCR2 exhibited a significantly superior beneficial effect.We also found that ExoCCR2 could suppress the CCL2-induced macrophage migration and activation in vivo and in vitro,compared with ExoCtrl treated group.CONCLUSION CCR2 over-expression enhanced the therapeutic effects of exosomes on the experimental PSCI by promoting M2 microglia/macrophage polarization,enhancing oligodendrogenesis and remyelination.These therapeutic effects are likely through suppressing the CCL2-induced hematogenous macrophage migration and activation.Key words:Cognitive impairment;Stroke;Exosomes;C-C chemokine receptor type 2;Microglia/macrophage polarization;Remyelination.

Impaired Cognition and Stroke Rehabilitation Outcomes: Are They Related?

Background: Stroke survivors who exhibit impaired cognition at admission to inpatient rehabilitation may experience participation challenges and poorer functional outcomes than those without impaired cognition. Differences in functional outcomes between stroke survivors with and without impaired cognition may be attributed to age, level of cognitive impairment, and severity of stroke. Materials and Methods: A retrospective secondary data analysis was conducted using health-related administrative data acquired from a Southwestern Ontario hospital’s stroke rehabilitation database. The aim was to explore potential linkages between post-stroke impaired cognition and functional gains, rehabilitation stays, and living settings after discharge from rehabilitation. Results: An aggregate sample of 393 males and 314 females subclassified as experiencing mild, moderate, and severe stroke was analyzed. At inpatient rehabilitation admission, 21.5% (n = 152) of these patients had no impaired cognition, 33.7% (n = 238) had mild impaired cognition, 22.2% (n = 157) had moderate impaired cognition, and 22.6% (n = 160) had severe impaired cognition. Cognitively impaired stroke patients were significantly (p 0.001) older, had (mostly) moderate to severe stroke with significantly (p = 0.012) more moderate cognitive impairment, had significantly (p 0.001) longer rehabilitation stays, and a high propensity for being discharged to longer-term care facilities compared to non-cognitively impaired patients. Conclusion: Presence of significant dissimilarity in rehabilitation stays and post-discharge destinations among stroke survivors with and without cognitive impairment is attributed to the age of the patient, level of cognitive impairment, and rigorous rehabilitation interventions.

Incidence and Risk Factors of Cognitive Impairment 3 Months after First-ever Stroke: A Cross-sectional Study of 5 Geographic Areas of China

This study examined the incidence, neuropsychological characteristics and risk factors of cognitive impairment 3 months after stroke in China. Five regions that differed in geography and economy in China were selected. Patients from the hospitals located in the five regions were prescreened at admission, and the demographic data, vascular risk factors and clinical characteristics of stroke were obtained. A battery of cognitive-specific domain tests was performed in the patients who failed to pass cognitive screening 3 months post stroke. Patients were diagnosed as having post-stroke cognitive impairment (PSCI) or no cognitive impairment (NCI) based on the results of the neuropsy-chological tests. Univariate analysis was performed for suspect risk factors, and significant variables were entered in multivariable logistic regression analysis. Our results showed that a total of 633 patients were recruited 3 months after stroke; complete cognitive tests were performed in 577 of the stroke pa-tients. The incidence of PSCI in these Chinese patients was 30.7%. There were 129 (22.4%) patients with visuospatial impairment, 67 (11.6%) with executive impairment, 60 (10.4%) with memory impairment and 18 (3.1%) with attention impairment. The risk factors associated with PSCI were older age (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.20–2.58), low education level (OR 2.45, 95% CI 1.65–3.64), depressive symptom (OR 1.69, 95% CI 1.09–2.61), obesity (OR 2.57, 95% CI 1.41–4.71), stroke severity 3 months post stroke (OR 1.62, 95%CI 1.10–2.37) and cortex lesion (OR 1.55, 95% CI 1.04–2.31). It was concluded that PSCI occurs commonly 3 months after first-ever stroke in Chinese patients. Visuospatial ability may be the most frequently impaired cognitive domain for the patients with stroke. The critical risk factors of PSCI are older age, low education level, depressive symptom, obesity, stroke severity 3 months post stroke and cortex lesion.

Relationship between β-amyloid protein 1-42, thyroid hormone levels and the risk of cognitive impairment after ischemic stroke

BACKGROUND Post-stroke cognitive impairment(PSCI)is not only a common consequence of stroke but also an important factor for adverse prognosis of patients.Biochemical indicators such as blood lipids and blood pressure are affected by many factors,and the ability of evaluating the progress of patients with PSCI is insufficient.Therefore,it is necessary to find sensitive markers for predicting the progress of patients and avoiding PSCI.Recent studies have shown thatβ-amyloid protein 1-42(Aβ1-42)and thyroid hormone levels are closely related to PSCI,which may be the influencing factors of PSCI,but there are few related studies.AIM To investigate the relationship between serum levels of Aβand thyroid hormones in acute stage and PSCI and its predicted value.METHODS A total of 195 patients with acute cerebral infarction confirmed from June 2016 to January 2018 were enrolled in this study.Baseline data and serological indicators were recorded to assess cognitive function of patients.All patients were followed up for 1 year.Their cognitive functions were evaluated within 1 wk,3 mo,6 mo and 1 yr after stroke.At the end of follow-up,the patients were divided into PSCI and non-PSCI according to Montreal cognitive assessment score,and the relationship between biochemical indexes and the progression of PSCI was explored.RESULTS Compared with patients with non-PSCI,the levels of Aβ1-42,triiodothyronine(T3)and free thyroxin were lower in the patients with PSCI.Repeated measures analysis of variance showed that the overall content of Aβ1-42 and T3 in PSCI was also lower than that of the non-PSCI patients.Further analysis revealed that Aβ1-42(r=0.348),T3(r=0.273)and free thyroxin(r=0.214)were positively correlated with disease progression(P<0.05),suggesting that these indicators have the potential to predict disease progression and outcome.Cox regression analysis showed that Aβ1-42 and T3 were important factors of PSCI.Then stratified analysis showed that the lower the Aβ1-42 and T3,the higher risk of PSCI in patients who were aged over 70,female and illiterate.CONCLUSION Aβ1-42 and T3 have the ability to predict the progression of PSCI,which is expected to be applied clinically to reduce the incidence of PSCI and improve the quality of life of patients.

Related factors of cognitive impairment after stroke

BACKGROUND: Cognitive impairment after stroke associates with various factors, such as age, educational years, etc. Besides concerning about the recovery of limb function after stroke, we should also focus on the rehabilitation of cognition. Moreover, we’d better pay attention to the control of all the risk factors of stroke, and improve the quality of life in stroke patients. OBJECTIVE: To analyze the factors that affect cognitive impairment after stroke. DESIGN: A related factors analysis. SETTINGS: Department of Neurology of Dalian Port Hospital and Dalian Second People’s Hospital. PARTICIPANTS: Totally 148 stroke inpatients were selected from Department of Neurology, Dalian Port Hospital and Dalian Second People’s Hospital from April 2004 to December 2005, including 100 males and 48 females, aging 45-75 years with an average age of (67±8) years; Their educational years ranged 2-10 years with an average of (6.1±3.7) years; The disease course ranged 15-30 days; All were right-handed. Inclusive criteria: All were accorded with the diagnostic standard set by the Fourth National Academic Meeting for Cerebrovascular Disease; Confirmed by CT or MRI; Informed consents were obtained from all the subjects. METHODS: After the disease conditions were stable, the patients were assessed with Wechsler memory scale (WMS) and Wisconsin card sorting test (WCST). WMS included forward and backward recitation of numbers and short-term memory (verbal memory, visual recognition). The number of times for correct and wrong classifications in WCST and the time to complete the trail making tests A and B were recorded. The focal volume, area and layer were recorded at 24 hours after admission. The general data of the patients were recorded, including name, sex, age, educational years, history of hypertension, history of diabetes mellitus. Electroencepalograph (EEG) was examined to record the wave shape, blood lipids were detected, and the cognition related indexes were analyzed with the Pearson correlation analysis. The correlation between cognitive indexes after stroke and the influencing factors were analyzed with multiple linear regression analysis. MAIN OUTCOME MEASURES: ① Correlation between cognitive indexes and imaging indexes; ② Influencing factors for cognitive indexes after stroke. RESULTS: All the 148 stroke patients were involved in the analysis of results. ① Correlation between cognitive indexes and CT indexes: There were obvious negative correlations between numerical symbol and focal layer (r =-0.234, P < 0.05), as well as between verbal memory and the focal area and volume (r =-0.363, -0.279, P < 0.05); Trail making test A had obvious positive correlation with focal area and volume (r =0.256, 0.256, P < 0.05). Results of multiple linear regression analysis: Correct classification was correlated with triglyceride (partial wave and θ wave (partial regression coefficient=0.231-0.908, P < 0.05); Verbal memory was correlated with EEG α wave, focal volume, sex, educational years and diabetes mellitus (partial regression coefficient=0.219-1.017, P < 0.05-0.01). Visual recognition had correlation with educational years and hypertension (partial regression coefficient=0.326, -1.163, P < 0.01). Trail making tests A and B were correlated with focal volume (partial regression coefficient=4.680, -18.561, P < 0.05). CONCLUSION: The factors that affect the cognitive function after stroke include sex, age, educational years, hypertension, diabetes mellitus, triglyceride, EEG wave shape, and the focal area, volume and layer.

Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Cerebral small vessel disease（CSVD） is a common etiology of vascular cognitive impairment with no dementia（V-CIND）. Studies have revealed that cerebral microbleeds（CMBs）, a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients（29.3%） had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits（odds ratio = 4.4; 95% confidence interval： 1.602-12.081, P = 0.004） and 5 or more CMBs overall（odds ratio = 17.6, 95% confidence interval： 3.23-95.84, P = 0.001） had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs.

Clinical study of different modes of repetitive transcranial magnetic stimulation in the treatment of post‑stroke executive dysfunction

Objective:To investigate the clinical efficacy of intermittent theta burst stimulation(iTBS)and high frequency repetitive transcranial magnetic stimulation(rTMS)on post‑stroke executive impairment(PSEI).Methods:Ninety patients with PSEI who were hospitalized in the rehabilitation department of Xuzhou Central Hospital and Xuzhou Rehabilitation Hospital from April 2021 to June 2022 were selected and divided into iTBS group,high‑frequency group and control group.All three groups of patients received routine rehabilitation training,given rTMS treatment with iTBS,10 Hz and shame stimulation for 4 weeks.Before and after treatment,all the patients were evaluated with the Montreal cognitive assessment(MoCA),the frontal assessment battery(FAB),troop color‑word test(SCWT),shape trails test(STT),digit span test(DST)and event related potential P300.Results:After treatment,MoCA,FAB,SCWT,STT,DST scores,P300 latency and amplitude were significantly better in the three groups than before treatment(P<0.05).MoCA,FAB,SCWT,STT‑B,DST scores,P300 latency and amplitude in the iTBS group and high‑frequency group were better than in the control group,with significant differences(P<0.05).The difference between iTBS group and high‑frequency group was not statistically significant(P>0.05).Conclusion:iTBS can improve PSEI,and the efficacy is comparable to 10Hz rTMS.iTBS takes less time with better efficiency,and it is worth popularizing and applying in clinic.

The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine

The Xingnao Jieyu capsule has been shown to effectively relieve neurologic impairments and les- sen depression. It remains poorly understood whether this capsule can be used to treat post-stroke depression. Thus, in the present study, we established a rat model of post-stroke depression using left middle cerebral artery occlusions in combination of chronic unpredictable stress and solitary housing during development. Experimental rats received intragastric perfusion with 0.82, 0.41, and 0.20 g/kg Xingnao Jieyu capsules separately dissolved in 2 mL distilled water. Fluoxetine served as a positive control. The treatment was conducted over 28 days. Sugar water consumption test, open-field test, real-time fluorescent quantitative PCR and immunohistochemical staining results demonstrated that intragastric perfusion with various doses of Xingnao Jieyu capsules increased sugar water consumption, voluntary behaviors and synaptotagmin mRNA and protein expression in rats with post-stroke depression. These therapeutic effects were similar to those of fluoxetine. These results indicate that Xingnao Jieyu capsules upregulate synaptotagmin expression in hip pocampi of rats with post-stroke depression, and exert antidepressant effects.

醒脑开窍针刺法联合中药治疗脑梗死后轻度认知障碍的疗效观察

目的 观察醒脑开窍针刺法联合补肾益髓汤治疗脑梗死后轻度认知障碍的临床疗效。方法 将80例脑梗死后轻度认知障碍的患者随机分为研究组(40例)和对照组(40例)。两组均予基础治疗,研究组在基础治疗外另予醒脑开窍针刺法联合补肾益髓汤治疗。比较两组临床疗效,观察两组治疗前后简易精神状态检查表(mini-mental state examination,MMSE)、蒙特利尔认知评估(Montreal cognitive assessment,MoCA)和Rivermead行为记忆测验(Rivermead behavioural memory test,RBMT)的评分变化,观察两组治疗前后连线测验-B(trail making test-B,TMT-B)结果、血清淀粉样蛋白A(serum amyloid A,SAA)和β-淀粉样蛋白(amyloid β-protein,Aβ)水平以及脑微循环指标(颈总动脉的平均血流量、最大血流速度、最小血流速度、临界压力、脉搏速度、特性阻抗、外周阻力和动态阻力)的变化。结果 研究组总有效率高于对照组(P<0.05)。治疗后,两组MMSE、MoCA和RBMT评分均高于同组治疗前(P<0.05),且研究组上述评分均高于对照组(P<0.05)。治疗后,两组TMT-B结果以及SAA和Aβ水平均优于同组治疗前(P<0.05),且研究组上述指标优于对照组(P<0.05)。治疗后,两组脑微循环指标均较治疗前改善(P<0.05),且研究组优于对照组(P<0.05)。结论 在基础治疗以上,采用醒脑开窍针刺法联合补肾益髓汤治疗脑梗死后轻度认知障碍可提高临床疗效,能进一步改善患者认知功能,并调节SAA和Aβ水平。

卒中后认知障碍评估工具筛查准确性的Meta分析

背景卒中后认知障碍(PSCI)给患者及其家庭带来沉重的负担,早期识别及干预有助于延缓PSCI的发生及进展,因此,使用准确的神经心理评估工具对PSCI进行筛查,对于患者的管理和治疗至关重要。目的采用Meta分析的方法评价PSCI筛查工具的筛查准确性,为准确筛查PSCI提供依据。方法检索数据库中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Embase、Web of Science、Cochrane Library中有关PSCI筛查工具的诊断性试验研究,检索日期为建库至2022年12月。2位研究者各自筛选文献、提取数据、评估偏倚风险。采用Stata 17.0软件分析数据。结果共纳入57篇文献,包含12113例患者,报告了7种PSCI筛查工具:美国国立神经疾病和卒中研究院-加拿大卒中网5-min测验(NINDS-CSN 5-min测验)、蒙特利尔认知评估量表(MoCA)、简易精神状况检查量表(MMSE)、老年认知功能减退知情者问卷(IQCODE)、阿登布鲁克认知能力检查-修订版(ACE-R)、认知功能电话问卷修订版(TICS-m)、5分钟蒙特利尔评估(MoCA-5 min)。Meta分析结果显示:MoCA筛查PSCI的合并灵敏度及特异度分别为0.84(95%CI=0.80~0.87)和0.74(95%CI=0.67~0.80),合并AUC为0.87(95%CI=0.84~0.90);MMSE筛查PSCI的合并灵敏度及特异度为0.73(95%CI=0.67~0.79)和0.76(95%CI=0.69~0.82),合并AUC为0.81(95%CI=0.77~0.84);IQCODE筛查PSCI的合并灵敏度及特异度为0.73(95%CI=0.48~0.89)和0.95(95%CI=0.75~0.99),合并AUC为0.91(95%CI=0.88~0.93);NINDS-CSN 5-min测验筛查PSCI的合并灵敏度及特异度为0.83(95%CI=0.78~0.87)、0.69(95%CI=0.60~0.76),合并AUC为0.85(95%CI=0.81~0.88);ACE-R筛查PSCI的合并灵敏度及特异度为0.90(95%CI=0.80~0.95)、0.61(95%CI=0.19~0.91),合并AUC为0.90(95%CI=0.87~0.92);TICS-m筛查PSCI的合并灵敏度及特异度为0.84(95%CI=0.75~0.91)、0.67(95%CI=0.61~0.74),合并AUC为0.66(95%CI=0.60~0.71)。结论IQCODE和ACE-R的合并AUC较高,且IQCODE具有较高的合并特异度,ACE-R具有较高的合并灵敏度,故IQCODE和ACE-R是较为准确的PSCI筛查工具。因IQCODE和ACE-R纳入文献数量有限,以上结论仍需多中心、大样本研究予以验证。

中医传统功法在卒中后认知障碍患者中应用效果的Meta分析

目的系统评价中医传统功法对卒中后认知障碍患者的干预效果。方法利用计算机检索The Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中文科技期刊数据库中有关中医传统功法干预卒中后认知障碍患者的随机对照试验,检索时限为建库至2023年12月31日,采用RevMan 5.4软件进行Meta分析。结果共纳入15项随机对照试验研究,包括918例研究对象。Meta分析结果显示,中医传统功法在提高卒中后认知障碍患者的认知功能[SMD=0.86,95%CI(0.68,1.04),P<0.001]、缩短P300检测的潜伏时间[MD=-11.52,95%CI(-16.06,-6.98),P<0.001]、增加P300检测的波幅高度[MD=1.06,95%CI(0.44,1.67),P<0.001]等方面均优于对照组。结论中医传统功法可有效提高卒中后认知障碍患者的认知功能。

脑卒中患者认知功能障碍与注意功能受损的关系

目的探讨脑卒中患者认知功能障碍与注意功能受损的关系。方法选取2021年7月至2022年3月聊城市人民医院康复科收治的30例符合入组标准的脑卒中患者作为研究对象,按照MMSE评分分为认知障碍组(15例)与非认知障碍组(15例),另选取同期的15名在该院进行健康体检的健康者作为对照组。比较三组的数字广度测试(顺背、倒背)、符号数字模式测验(SDMT)和连线测验(A和B)5项注意功能检查。结果非认知障碍组的数字广度顺背、倒背分数、符号数字模式测验以及连线测验-A的时间、连线测验-B的时间结果优于认知障碍组,差异有统计学意义(P<0.05)。对照组的数字广度顺背、倒背分数、符号数字模式测验以及连线测验-A的时间、连线测验-B的时间结果亦优于认知障碍组,差异均有统计学意义(P<0.05);非认知障碍组与对照组在数字广度顺背、连线测试-A及符号数字模式测验得分之间比较,差异无统计学意义(P>0.05),但对照组的数字广度倒背分数、连线测验-B的时间结果优于非认知障碍组,差异有统计学意义(P<0.05)。结论脑卒中患者在认知功能筛查无异常的情况下已经开始出现注意功能受损。

益智开窍针法联合八段锦在脑卒中后认知障碍患者中的应用效果

目的分析益智开窍针法联合八段锦运动对脑卒中后认知障碍患者神经功能、认知功能的影响。方法选取2023年1月至9月南昌市洪都中医院收治的80例脑卒中后认知障碍患者为研究对象,按照随机数字表法分对照组和研究组,各40例。对照组进行八段锦运动,研究组在对照组基础上进行益智开窍针法治疗,观察两组患者的神经功能、日常生活能力、认知功能、神经递质水平、血液流变学指标、临床疗效。结果研究组治疗后的美国国立卫生研究院卒中量表(NIHSS)、红细胞沉降率(ESR)、红细胞压积(HCT)、全血黏度(WBV)水平低于对照组,Berg平衡量表(BBS)评分、日常生活能力(ADL)、简明精神状态检查表(MMSE)、蒙特利尔认知评估量表(MoCA)评分、多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)水平高于对照组,差异有统计学意义(P<0.05)。结论采用益智开窍针法、八段锦运动联合治疗,可使患者的神经功能得到改善,提高患者认知功能,使患者日常生活能力提高,促使患者的恢复,使用效果较好。

血清LRG1水平与急性缺血性脑卒中患者认知障碍和卒中复发的关系

目的探讨血清富亮氨酸α-2糖蛋白-1(LRG1)水平在判断急性缺血性脑卒中(AIS)患者认知障碍中的价值及其与卒中复发的关系。方法选取2020年1月—2021年10月南阳市中心医院AIS患者125例,收集所有患者的临床资料和同型半胱氨酸(Hcy)、血脂检测结果,并检测血清LRG1水平。依据蒙特利尔认知评估量表(MoCA)将患者分为认知障碍组(MoCA评分<26分)和无认知障碍组(MoCA评分≥26分)。依据6个月后的卒中复发情况分为复发组和未复发组。采用Pearson相关分析或Spearman相关分析评估LRG1与其他指标的相关性。采用多因素Logistic回归分析评估AIS患者发生认知障碍的危险因素。采用受试者工作特征(ROC)曲线评价各项指标判断AIS患者发生认知障碍和卒中复发的效能。结果认知障碍组总胆固醇(TC)水平和高血脂所占比例均显著高于无认知障碍组(P<0.05),LRG1和高密度脂蛋白胆固醇(HDL-C)水平均显著低于无认知障碍组(P<0.001),其他临床资料2个组之间差异均无统计学意义(P>0.05)。Pearson相关分析和Spearman相关分析结果显示,发生认知障碍的AIS患者血清LRG1与HDL-C呈正相关(r=0.497,P<0.05),与高血脂、TC呈负相关(r值分别为-0.492、-0.486,P<0.05)。多因素Logistic回归分析结果显示,LRG1和HDL-C水平降低是AIS患者发生认知障碍的危险因素[比值比(OR)值分别为0.845、0.876,95%可信区间(CI)分别为0.748~0.954、0.793~0.968,P<0.05]。ROC曲线分析结果显示,血清LRG1、HDL-C单项检测和联合检测判断AIS患者发生认知障碍的曲线下面积(AUC)分别为0.840、0.670、0.851。复发组血清LRG1和HDL-C水平均低于未复发组(P<0.05),TC水平和高血脂所占比例均高于未复发组(P<0.05);ROC曲线分析结果显示,血清LRG1、HDL-C、TC单项检测和联合检测判断AIS患者卒中复发的AUC分别为0.781、0.696、0.806、0.899。结论血清LRG1水平与AIS患者认知障碍和卒中复发有关,或可作为此类患者认知障碍和卒中复发的预测指标。

神经可塑性机制在卒中后认知功能恢复中的作用

卒中后认知障碍(PSCI)因其高发病率、高致残致死率而在国际卒中研究领域备受瞩目,但因其发病机制未完全阐明而限制了有效治疗手段。临床观察性研究表明,卒中后12个月内患者的认知功能呈不同程度的恢复,这一恢复与神经可塑性机制密切相关。深入了解神经可塑性机制对于制定最佳的卒中后神经系统修复策略并对受损脑功能进行补偿具有重要意义。本文首先介绍了卒中后自发神经可塑性机制,包括神经细胞的可塑性、突触神经环路的可塑性和脑网络的可塑性,及其与认知功能之间的关系,揭示了神经可塑性与脑功能恢复的动态和复杂性。随后探讨了增强神经可塑性的方法,包括药物治疗、康复训练、非侵袭性脑刺激和其他方法,提倡早期干预效果好。尽管一些新兴方法尚缺乏明确的临床依据,但初步研究中的疗效令人鼓舞,有望开启卒中后治疗的新篇章。