高强度经颅交流电刺激对脑卒中后认知障碍患者认知功能及睡眠质量的影响

关键词：脑卒中后认知障碍  睡眠障碍  经颅交流电刺激  近红外光谱技术  中央执行网络

Keywords:post-stroke cognitive impairment  sleep disorders  transcranial alternating current stimulation  functional near-infrared spectroscopy  central executive network

摘要：

      摘要 目的：探讨高强度经颅交流电刺激（transcranial alternating current stimulation， tACS）对伴睡眠障碍的脑卒中后认知障碍（post-stroke cognitive impairment， PSCI）患者认知功能及睡眠质量的影响。 方法：纳入伴睡眠障碍的PSCI患者43例，随机分为真刺激组（22例）和伪刺激组（21例），分别进行高强度tACS真或伪刺激，刺激强度为15mA，每次40min，2次/d，共刺激10d。在治疗前、治疗后以及治疗后4周的随访期分别通过蒙特利尔认知评估量表（Montreal cognitive assessment， MoCA）和匹兹堡睡眠质量指数（Pittsburgh sleep quality index， PSQI）评价PSCI患者的认知功能及睡眠质量，并在治疗前、后，采集以上患者的静息态近红外脑功能成像数据。 结果：治疗后及随访期，真刺激组MoCA及PSQI的改善值均显著高于伪刺激组（P<0.01），且真刺激组MoCA及PSQI的改善率均显著高于伪刺激组（P<0.05）；在随访期真刺激组PSQI的缓解率显著优于伪刺激组（P<0.01）。此外，MoCA及PSQI的改变量呈显著相关性（P<0.05）。治疗后，真刺激组左侧中央执行网络关键脑区的功能连接显著提升（P<0.05）。 结论：高强度tACS可有效改善伴睡眠障碍的PSCI患者的认知功能及睡眠质量，其机制可能与中央执行网络的功能连接增强有关。

Abstract:

      Abstract Objective： To investigate the effects of high-intensity transcranial alternating current stimulation （tACS） on cognitive function and sleep quality in post-stroke cognitive impairment （PSCI） patients with sleep disorders. Method： A total of 43 PSCI patients with sleep disorders were enrolled and randomly assigned to either a tACS group （n=22） or a sham group （n=21）. The tACS group received real high-intensity tACS at 15 mA for 40 minutes per session， twice daily， for 10 days， while the sham group received sham stimulation. Cognitive function and sleep quality were assessed using the Montreal Cognitive Assessment （MoCA） and Pittsburgh Sleep Quality Index （PSQI） at three time points： before treatment， immediately after treatment， and at a 4-week follow-up. Resting-state functional near-infrared spectroscopy （fNIRS） data were also collected before and after treatment. Result： After treatment and at the 4-week follow-up， the improvement in MoCA and PSQI scores was significantly greater in the tACS group compared to the sham group （P<0.01）. The improvement rates of MoCA and PSQI scores were also significantly higher in the tACS group （P<0.05）. At follow-up， the remission rate of PSQI in the tACS group was significantly better than that in the sham group （P<0.01）. Additionally， a significant correlation was observed between the changes in MoCA and PSQI scores （P<0.05）. After treatment， the tACS group showed a significant increase in functional connectivity within key brain regions of the left central executive network （P<0.05）. Conclusion： High-intensity tACS can effectively improve cognitive function and sleep quality in PSCI patients with sleep disorders， and the mechanism may be associated with enhanced functional connectivity in the central executive network.