经颅直流电刺激联合认知康复训练对脑卒中后认知障碍的疗效观察及分析

Effect and Analysis of Transcranial Direct Current Stimulation Combined with Cognitive Rehabilitation Training on Post-Stroke Cognitive Impairment

摘要: 目的：观察经颅直流电刺激(transcranial direct current stimulation, tDCS)联合认知康复训练对脑卒中后认知障碍(post-stroke cognitive impairment, PSCI)患者的认知功能和日常生活活动能力的临床疗效，并对其机制进行分析。方法：本研究选取符合纳入标准的36名PSCI患者，根据SPSS预先确定的随机方案，按照被选入的先后顺序分为真刺激组和假刺激组，2组患者均给予基础药物治疗(包括降压、降糖等药物)及常规康复训练(包括物理治疗、作业治疗及认知功能训练)，真刺激组在此基础上给予tDCS治疗，假刺激组给予tDCS假刺激。于治疗前和治疗3周后，利用简易智力状态检查(mini mental state examination, MMSE)和蒙特利尔认知评估(montreal cognitive assessment, MoCA)观察患者认知功能的变化，采用改良Barthel指数(modified barthel index, MBI)评价患者的日常生活活动能力。结果：治疗3周后，2组患者的认知功能均有所改善，MMSE、MoCA、MBI评分较组内治疗前显著升高，差异均有统计学意义(P < 0.05)，且真刺激组治疗3周后的MMSE、MoCA、MBI评分均显著优于假刺激组治疗3周后的MMSE、MoCA、MBI评分，差异有统计学意义(P < 0.05)。结论：tDCS联合认知康复训练可以有效改善PSCI患者的认知功能，提高日常生活活动能力，可以作为治疗PSCI的一种安全、有效的临床方法。

Abstract: Objective: To observe the clinical effect of transcranial direct current stimulation (tDCS) combined with cognitive rehabilitation training on cognitive function and activities of daily living in patients with post-stroke cognitive impairment (PSCI), and analyze its mechanism. Methods: 36 patients with PSCI who met the inclusion criteria were randomly divided into the real stimulation group and the sham stimulation group according to the SPSS protocol, the patients in both groups were treat-ed with basic drug therapy (including antihypertensive and hypoglycemic drugs) and routine reha-bilitation training (including physical therapy, occupational therapy and cognitive function train-ing), while the patients in the true stimulation group were treated with tDCS on the basis of the above treatment, sham stimulation group was given tDCS sham stimulation. Mini mental state ex-amination (MMSE) and Montreal cognitive assessment (MOCA) were used to observe the change of cognitive function before and 3 weeks after treatment, modified barthel index (MBI) was used to evaluate the activities of daily living of the patients. Results: After 3 weeks of treatment, the cogni-tive function was improved in both groups. The scores of MMSE, MOCA and MBI in both groups were significantly higher than those before treatment (P < 0.05), the scores of MMSE, MoCA and MBI in the real stimulation group were significantly higher than those in the sham stimulation group after 3 weeks of treatment (P < 0.05). Conclusion: tDCS combined with cognitive rehabilitation training can effectively improve the cognitive function and activities of daily living in patients with PSCI, and it can be used as a safe and effective method in the clinical treatment of PSCI.