不同治疗时机的经颅直流电刺激治疗脑卒中后认知障碍的初步研究

关键词：经颅直流电刺激  卒中后认知障碍  康复

Keywords:transcranial direct current stimulation  post-stroke cognitive impairment  rehabilitation

摘要：

      摘要 目的：观察不同治疗时机的经颅直流电刺激（tDCS）对卒中后认知障碍（PSCI）患者认知功能和日常生活活动能力（ADL）的影响。 方法：选取中山大学附属第三医院康复医学科于2019年1月—2020年1月收治的卒中后认知障碍患者43例，用随机数字法分为试验组A（online治疗组）、试验组B（offline治疗组）以及对照组C（sham组）。试验组A患者在进行认知训练的同时进行2mA的阳极tDCS刺激；试验组B在认知训练结束4h以后进行相同tDCS刺激；对照组C在进行认知训练的同时进行tDCS假刺激。tDCS与认知康复训练均为30min/次，5次/周，连续2周。在治疗前、2周治疗后（治疗后）及治疗结束后1个月（随访时）三个时间点进行蒙特利尔认识评估量表（MoCA）、数字广度测试（DST）、连线测试A部分（TMT-A）及改良Barthel指数量表（MBI）的评估。 结果：本研究最终纳入统计分析的患者为41例（2例脱落）。治疗后、随访时3组患者的MoCA、DST、TMT-A及MBI评分均较治疗前明显提高（P＜0.05）。试验组A在治疗后、随访时MoCA评分的改善差值均显著性优于对照组C（P＜0.05）；试验组B在治疗后、随访时MoCA评分的改善差值均优于对照组C，但仅在随访时差异有显著性意义（P＜0.05）；试验组A与试验组B MoCA改善差值组间无显著性差异（P＞0.05）。试验组A治疗后、随访时数字广度正序、倒序均有显著性提高（P＜0.05），试验组B在随访时数字广度倒序有显著性提高（P＜0.05），对照组C治疗后数字广度的改善无显著性意义（P＞0.05）。 结论：tDCS联合认知康复训练能够更好地改善PSCI患者的工作记忆等认知功能以及ADL能力，其效果可以维持到治疗结束后1个月。tDCS治疗与认知康复训练同时进行可能比tDCS与认知康复训练分开进行更有优势。

Abstract:

      Abstract Objective：To observe the effects of different timing of transcranial direct current stimulation (tDCS) on cognitive function and activity of daily living(ADL) in patients with post-stroke cognitive impairment (PSCI). Method：Forty-three patients with PSCI were randomly divided into group A (online)， group B (offline) and control group C (sham). Patients in group A received 2mA anodal tDCS stimulation during cognitive training. Group B received the same tDCS stimulation 4 hours after the cognitive training. Group C received sham tDCS stimulation during cognitive training. TDCS and cognitive training were conducted for 30min， 5 times/week， for 2 continuous weeks. Montreal cognitive assessment scale (MoCA)， digit span test (DST)， trail marking test (TMT) part A and modified Barthel index scale (MBI) were evaluated before treatment(T0)， after treatment(T1)， and 1 month after treatment(T2). Result：In this study， 41 patients were included in the final statistical analysis. After treatment and during follow-up， the cognitive function and ADL ability of the 3 groups were improved when compared with the baseline (P<0.05). The differences of improvement in MoCA score in group A at T1 and T2 were better than that in control group C (P<0.05). The difference of improvement of MoCA score in group B was better than that in control group C only at T2 (P<0.05). There was no significant difference between group A and group B in MoCA improvement (P>0.05). The forward and backward DST in group A were significantly improved at T1 and T2 (P<0.05)， while the backward DST in group B was significantly improved only during follow-up (P<0.05)， the improvement of number breadth in group C was not significant (P>0.05). Conclusion：tDCS combined with cognitive rehabilitation training can better improve the cognitive functions such as working memory， attention， and ADL ability of PSCI patients， and the effect can be maintained until 1 month after the end of treatment. Compared with offline tDCS treatment， online tDCS treatment maybe improve the cognitive function of patients better.