10Hz重复经颅磁刺激对脑卒中患者不同负荷言语和空间工作记忆的影响

关键词：重复经颅磁刺激  工作记忆  脑卒中

Keywords:repetitive transcranial magnetic stimulation  working memory  stroke

摘要：

      摘要 目的：探讨10Hz重复经颅磁刺激（rTMS）对脑卒中工作记忆损害患者不同负荷言语和空间工作记忆表现的影响。 方法：纳入29例左侧大脑卒中后工作记忆障碍患者随机分为rTMS组（14例）和对照组（15例），对照组进行假刺激，rTMS组给予10Hz rTMS。分别在干预前和4周后进行数字和空间N-back任务测试、数字广度顺序（DSF）和逆序（DSB）的工作记忆评估，并进行蒙特利尔认知评估量表（MoCA）和功能性独立量表（FIM）的评估。 结果：两组DSF、数字1、2-back和空间1、2-back任务正确率、MoCA及子测试中注意、记忆、执行功能、FIM总分，以及rTMS组DSB的干预前后差异有显著性意义（P＜0.05）；干预后DSB，数字1、2-back、空间2-back、FIM、MoCA总分以及子测试中记忆、执行功能的组间差异具有显著性意义（P＜0.05）。线性混合效应模型分析中，相较于对照组，rTMS组数字N-back任务改善更易受负荷影响（P＜0.05）。控制年龄等混杂因素以及不同内容工作记忆任务的影响，数字1、2-back任务正确率的改善与FIM的改善呈正相关（P＜0.05），数字2-back任务和MoCA总分、执行功能的改善呈正相关（P＜0.05）。 结论：rTMS可显著增强脑卒中患者言语和空间工作记忆操作能力，并在认知需求更高的言语工作记忆任务操作（2-back）中改善更为明显。另外，rTMS带来较高负荷言语工作记忆的改善与脑卒中患者认知及自理和生存能力的改善相关。

Abstract:

      Abstract Objective： To explore the effects of 10Hz repetitive transcranial magnetic stimulation (rTMS) on verbal and spatial working memory with different loads in patients with stroke. Method： Twenty-nine patients with working memory impairments after the left hemisphere stroke were randomly assigned into the rTMS group （n=14） and control group （n=15）. The patients in the rTMS group were treated with 10Hz rTMS while the patients in the control group received sham stimulation. Before and after the intervention， digital /spatial N-back tasks and digit span forward (DSF) and digit span backward (DSB) tests were used to assess work memory. Montreal Cognitive Assessment (MoCA) and the Functional Independence Measure (FIM) was used to assess cognitive function. Result： There were statistically significant differences before and after the intervention in the scores of DSF， the accuracy rates of 1-back and 2-back tasks of digit and space， the scores of MoCA， attention， memory， executive function， and FIM for the rTMS and control groups, and the scores of DSB in the rTMS group（P<0.05）. Post-intervention differences in DSB, digit 1 and 2-back, spatial 2-back, FIM, MoCA total score, and subtests of memory and executive function were significant between the groups(P＜0.05). The linear mixed-effect analysis showed that improvements in the accuracy rates of digital N-back tasks in the rTMS group were more affected by load compared to the control group（P<0.05）. Controlling for the confounding factors such as age and effects of different content working memory tasks, improvements in the accuracy rates of digital 1-back and 2-back tasks were positively correlated with the improvements in the score on FIM (P<0.05), and the improvements of the digital 2-back task was positively correlated with the improvement of MoCA scores and executive function(P<0.05). Conclusions： rTMS can significantly improve verbal and spatial working memory manipulation in stroke patients， with more significant improvement in high cognitive demand working memory（2-back）. In addition， the improvement in higher-load verbal working memory brought by rTMS is associated with the improvement in cognition，self-care，and survival ability of patients with stroke.