计算机认知训练对轻度认知障碍老年人认知功能的影响研究

目的 探讨应用自主编制的计算机认知训练程序进行训练对改善轻度认知障碍（mild cognitive impairment,MCI）老年人认知功能的效果。方法 2019年6月—8月,通过健康宣教活动选择59例MCI老年人作为研究对象并随机分组,其中,试验组30例老年人接受计算机认知训练（computer cognitive training,CCT）,训练内容包括注意力、执行功能、空间定向和工作记忆训练,对照组29例老年人不接受干预,正常生活。干预前和干预5周后,分别使用蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）和简易智能精神状态量表（Minimum Mental State Examination,MMSE）评估2组老年人的认知功能并进行统计分析,干预后对试验组30例老年人进行访谈。结果 干预前后试验组MoCA和MMSE得分增加幅度均显著大于对照组（P<0.05）;试验组大部分MoCA认知领域进步幅度均显著大于对照组（P<0.05）;访谈结果显示,部分老年人表示记忆能力有提升、反应增快,希望能继续接受该训练。结论 应用自主编制的计算机认知训练程序进行训练能够显著改善MCI老年人的认知功能。     

言语听觉反馈认知训练在脑外伤认知障碍患者中的应用研究

目的 探讨Forbrain言语听觉反馈认知训练在脑外伤认知障碍患者中的应用效果。方法 2021年10月—2022年5月选取唐山市某三级甲等医院神经外科住院保守治疗的80例脑外伤认知障碍患者,随机分为试验组与对照组,各40例,试验组在对照组干预措施的基础上增加Forbrain言语听觉反馈认知训练,对照组接受神经外科康复护理干预,均干预2周。于入组首日收集患者的一般资料与疾病资料,使用蒙特利尔认知评定量表（Montreal Cognitive Assessment,MoCA）和Barthel指数量表（Barthel Index,BI）完成患者认知功能和日常生活能力的评估,干预2周后使用相同量表再次进行评估。结果 试验组39例,对照组37例完成研究。干预前,两组一般资料及MoCA和BI评分均具有可比性（P>0.05）。干预后,(1)认知功能评估,试验组的MoCA总分与进步分数均高于对照组（P<0.001）;试验组在视空间功能、注意力、语言、抽象与记忆力维度的进步幅度大于对照组（P<0.001）;(2)日常生活能力评估,试验组的BI总分与进步分数均高于对照组（P<0.0...     

重复经颅磁刺激联合认知训练对缺血性脑卒中患者淡漠的效果研究

目的 探讨重复经颅磁刺激（repeat transcranial magnetic stimulation,rTMS）联合认知训练对缺血性脑卒中患者淡漠症状的影响。方法 采用便利抽样法,选取2021年1月—12月在海口市某三级甲等医院神经内科、康复科住院的96例缺血性脑卒中伴淡漠的患者为研究对象。采用2×2析因试验设计,计算机随机分组,将研究对象分为r组、s组、联合组、对照组,每组24例。在对照组干预措施的基础上,r组行rTMS治疗,s组行卡片式Stroop范式认知训练,联合组行rTMS联合卡片式Stroop范式认知训练,对照组给予缺血性脑卒中常规治疗、康复及护理干预措施,干预周期均为15 d,使用淡漠评定量表-知情者版（Apathy Evaluation Scale-Informant,AES-I）评估干预后患者淡漠水平改善情况。结果 87例完成干预,4组基线均衡,差异无统计学意义（P>0.05）。rTMS对降低AES-I总分及各维度得分有主效应（P<0.001）,卡片式Stroop范式认知训练对降低AES-I总分及兴趣、认知、行为维度得分有主效应（P<0.05）,...     

The effect of a multicomponent intervention to promote community activity on cognitive function in older adults with mild cognitive impairment: A randomized controlled trial

ObjectivesThis study aimed to examine the effectiveness of a multicomponent intervention combining physical, cognitive, and social activities developed to promote community activity in improving cognitive function in older adults with mild cognitive impairment (MCI).DesignSingle-blind randomized controlled trial.SettingA total of 83 Japanese older adults with MCI participated in the study from April to September 2017.InterventionsParticipants were randomly assigned to either the multicomponent intervention group (n = 41), attending 90-minute physical, cognitive, or social activity sessions using community resources twice weekly, or the health education control group (n = 42).OutcomesThe primary outcomes were cognitive functions, and the secondary outcomes were grip strength, walking speed, depressive symptoms, physical activities, number of outdoor activities, and conversation time.ResultsAnalysis using linear mixed models revealed significantly greater improvements in the intervention group in spatial working memory (p = 0.024) following intervention compared with the control group. Time spent in moderate-to-vigorous physical activity (p = 0.048) and step count (p = 0.059) decreased from the baseline post-intervention in the control group, whereas the baseline was maintained in the intervention group. No significant between-group differences were found post-intervention in the other primary and secondary outcomes.ConclusionsThis study showed that a 24-week multicomponent intervention program was effective in improving spatial working memory and maintaining physical activity in older adults with MCI. A follow-up investigation is required to determine whether continuation of physical, cognitive, and social activity can prevent dementia or reverse MCI in older adults.     

沉浸式虚拟现实认知训练对认知障碍患者干预效果的系统评价

目的 评价沉浸式虚拟现实(immersive virtual reality,IVR)认知训练对主观认知下降(subjective cognitive decline,SCD)、轻度认知障碍(mild cognitive impairment,MCI)、阿尔茨海默病(Alzheimer's disease,AD)患者认...     

轻度认知障碍患者记忆力下降体验的质性研究

目的 探讨轻度认知障碍患者记忆力下降的体验,为临床护理人员开展护理干预提供参考。 方法 采用目的抽样法,选取2021年5月—6月北京市某三级甲等医院神经内科门诊的9例轻度认知障碍患者作为研究对象进行半结构访谈,采用现象学研究中Colaizzi 7步分析法进行资料分析。 结果 轻度认知障碍患者记忆力下降的体验可归纳为3个主题：记忆力下降的疾病感知（轻视与否认的态度、反思与溯源的自省、互动关系的改变）;记忆力下降的情感体验（焦虑与恐惧情绪的产生、自我效能感的降低、自我开解态度的形成、对未来的期待）;记忆力下降的应对策略（生活方式的应对、体力与脑力活动的应对、未来规划的应对）。 结论 应加强对轻度认知障碍患者记忆力下降医疗知识的普及,关注其情感需求,给予心理疏导、家庭支持和社会支持,并进行个性化的认知干预,促进其认知改善,提高生活质量。     

Effects of early cognitive rehabilitation training on cognitive function and quality of life in critically ill patients with cognitive impairment: A randomised controlled trial

BackgroundPatients often develop cognitive dysfunction during admission to the ICU and after being transferred out of the ICU, which leads to physical disorders, sleep disorders, and psychological stress.Cognitive rehabilitation training can significantly improve patients' planning, decision-making ability, and executive function.ObjectiveThe aim of this study was to explore the role of early cognitive rehabilitation training in improving cognitive impairment in critically ill patients.MethodsThis study was a prospective, randomised, controlled clinical trial conducted from January 2017 to June 2021. Critically ill patients with cognitive impairment admitted to the Department of Intensive Care Medicine of The Third Hospital of Mianyang were randomly divided into the control (n = 68) and intervention groups (n = 68). Cognitive rehabilitation training (including digital operating system training, music therapy, aerobic training, and mental health intervention) was applied to the patients in the intervention group for 6 months, while the control group did not receive any cognitive intervention. Before 3 and 6 months after enrolment, the Montreal Cognitive Assessment and the 36-Item Short Form Health Survey Scale were used to evaluate cognitive function and quality of life, respectively, in both groups.ResultsA total of 136 critical patients were included in the final analysis. There were no significant differences in sex, age, years of education, complications, intensive care unit hospitalisation time, mechanical ventilation time, or the total score of the Montreal Cognitive Assessment scale when transferred out of the intensive care unit in 24 hours between the two groups. Six months later, the results of the follow-up showed that the cognitive function score in the intervention group was significantly higher than that in the control group (26.69 ± 2.49 vs. 23.03 ± 3.79). The analysis of quality of life showed that the scores in all areas in the intervention group improved. There were significant differences in physical functioning (69.02 ± 8.14 vs. 63.38 ± 11.94), role physical (62.02 ± 12.18 vs. 58.09 ± 8.83), general health (46.00 ± 15.21 vs. 40.38 ± 13.77), vitality (61.00 ± 11.01 vs. 54.38 ± 13.80), social functioning (70.00 ± 10.29 vs. 64.41 ± 13.61), role emotional (78.00 ± 8.00 vs. 72.15 ± 12.18), and mental health (71.00 ± 12.33 vs. 55.37 ± 10.76) between the two groups (P < 0.05).ConclusionEarly cognitive rehabilitation training can improve cognitive impairment in critically ill patients and their quality of life.     

Keys to staying sharp: A randomized clinical trial of piano training among older adults with and without mild cognitive impairment

BackgroundThe prevalence of dementia, the most expensive medical condition (Kirschstein, 2000 and Hurd et al., 2013 [1,2]), and its precursor, mild cognitive impairment (MCI) are increasing [3]. Finding effective intervention strategies to prevent or delay dementia is imperative to public health. Prior research provides compelling evidence that central auditory processing (CAP) deficits are a risk factor for dementia [4–6]. Grounded in the information degradation theory [7, 8], we hypothesize that improving brain function at early perceptual levels (i.e., CAP) may be optimal to attenuate cognitive and functional decline and potentially curb dementia prevalence. Piano training is one avenue to enhance cognition [9–13] by facilitating CAP at initial perceptual stages [14–18].ObjectivesThe Keys To Staying Sharp study is a two arm, randomized clinical trial examining the efficacy of piano training relative to music listening instruction to improve CAP, cognition, and everyday function among older adults. In addition, the moderating effects of MCI status on piano training efficacy will be examined and potential mediators of intervention effects will be explored.HypothesesWe hypothesize that piano training will improve CAP and cognitive performance, leading to functional improvements. We expect that enhanced CAP will mediate cognitive gains. We further hypothesize that cognitive gains will mediate functional improvements.MethodWe plan to enroll 360 adults aged 60 years and older who will be randomized to piano training or an active control condition of music listening instruction and complete pre- and immediate post- assessments of CAP, cognition, and everyday function.     

tDCS预刺激增强脑卒中认知功能障碍患者认知康复疗效的临床研究

目的:探讨经颅直流电刺激(tDCS)预刺激联合认知训练对脑卒中认知功能障碍(PSCI)患者认知功能的影响。方法:脑卒中后认知功能障碍患者76例随机分为观察组和对照组各38例,2组均采用常规药物和康复训练,观察组先给予tDCS预刺激,再进行认知训练,对照组先行认知训练,再进行tDCS刺激。治疗前和治疗4周后,采用蒙特利尔认知功能评测量表(MoCA)、改良Barthel指数(MBI)、事件相关电位P300对患者进行评定。结果:治疗4周后,2组较治疗前的MoCA及MBI评均明显提高(均P<0. 05),且观察组2项评分均高于对照组(均P<0. 05);2组较治疗前的P300潜伏期均明显缩短(均P<0. 05),波幅均明显增加(均P<0. 05),且观察组2项指标均更优于对照组(均P<0. 05)。结论:tDCS预刺激后给予认知训练方案对PSCI患者认知功能、ADL能力的改善作用优于先认知训练后tDCS刺激方案。     

Dimensions of physical frailty and cognitive function in older adults with amnestic mild cognitive impairment

ObjectiveThe objective of this study was to examine relationships between dimensions of physical frailty and severity of cognitive impairment in older adults with amnestic mild cognitive impairment (aMCI).Patients and methodsThe prevalence of physical frailty dimensions including slow gait speed, low physical activity, and low grip strength was examined among 201 sedentary older adults with aMCI. Associations between dimensions of physical frailty and severity of cognitive impairment, as measured with the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and individual dimensions of cognitive function were examined using multiple linear regression models.ResultsGreater than 50% of participants met physical frailty criteria on dimensions of slow gait speed, low physical activity and low grip strength. Slower gait speed was associated with elevated severity of cognitive impairment. Both gait speed and physical activity were associated with individual dimensions cognitive function.ConclusionsDimensions of physical frailty, particularly gait speed, were associated with severity of cognitive impairment, after adjusting for age, sex and age-related factors. Further studies are needed to investigate mechanisms and early intervention strategies that assist older adults with aMCI to maintain function and independence.     

Longstanding neuropathic pain after spinal cord injury is refractory to transcranial direct current stimulation: A randomized controlled trial

Neuropathic pain remains one of the most difficult consequences of spinal cord injury (SCI) to manage. It is a major cause of suffering and adds to the physical, emotional, and societal impact of the injury. Despite the use of the best available treatments, two thirds of people experiencing neuropathic pain after SCI do not achieve satisfactory pain relief. This study was undertaken in response to a recent clinical trial reporting short-term, clinically significant reductions in neuropathic SCI pain with primary motor cortex transcranial direct current stimulation (tDCS). In this investigation, we aimed to build on this previous clinical trial by extending the assessment period to determine the short-, medium-, and long-term efficacy of tDCS for the treatment of neuropathic pain after SCI. We found that, contrary to previous reports, after 5 tDCS treatment periods, mean pain intensity and unpleasantness rating were not significantly different from initial assessment. That is, in this trial tDCS did not provide any pain relief in subjects with neuropathic SCI pain (n = 10). A similar lack of effect was also seen after sham treatment. Because the injury duration in this study was significantly greater than that of previous investigations, it is possible that tDCS is an effective analgesic only in individuals with relatively recent injuries and pain. Future investigations comparing a range of injury durations are required if we are to determine whether this is indeed the case.     

Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial

OBJECTIVE: To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis. DESIGN: This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention. RESULTS: Regardless of group assignment, participants demonstrated significant gains on the primary outcome measures: the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL)--Amount of Use, and on secondary outcome measures including the Box and Block Test (BBT) and the MAL--How Well. Participants receiving rTMS failed to show differential improvement on either primary outcome measure. CONCLUSIONS: Although this study provided further evidence that even relatively brief sessions of CIT can have a substantial effect, it provided no support for adjuvant use of rTMS.     

Effect of long-term neck muscle training on pressure pain threshold: A randomized controlled trial

Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short-term results have been reported so far. The aim of the present study was to evaluate the long-term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain. Altogether 180 woman with chronic, non-specific neck pain were randomized into three groups: neck muscle endurance training, neck muscle strength training and control groups. The main outcome measures included pressure pain threshold measurement at six muscle sites and on the sternum. Neck pain was assessed by a visual analogue scale (VAS). At the 12-month follow-up statistically significantly higher pressure pain threshold values were obtained in both training groups at all muscle sites compared to the baseline, while no significant change occurred in the controls. Significantly higher changes in pressure pain threshold were detected at all six sites in the strength training group and at four out of six sites in the endurance training group compared to the control group. This is the first study to show an increase in pressure pain thresholds as a result of long-term muscle training. A decrease in neck pain was associated with reduced pressure pain sensitivity in neck muscles, showing that the pressure pain threshold may be a useful outcome measure of the effectiveness of neck muscle rehabilitation.     

经颅直流电刺激治疗轻中度焦虑和抑郁障碍共病患者的随机对照研究

目的：探讨经颅直流电刺激（tDCS）治疗轻中度焦虑和抑郁障碍共病的临床效果。方法：选取焦虑和抑郁障碍共病患者49例,随机分为观察组25例和对照组24例,分别进行经颅直流电刺激和假刺激治疗。比较2组患者治疗前后的汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评分,临床总体疗效及并发症发生情况。结果：与治疗前比较,观察组HAMA、HAMD评分在治疗1周后明显降低（P<0.05）,而且治疗后2、4周呈持续性降低（P<0.05）;对照组患者在治疗2周后才出现明显降低（P<0.05）,治疗后4周亦低于治疗后2周评分（P<0.05）。治疗后1、2、4周观察组的HAMA、HAMD评分均分别低于对照组（P<0.05）。2组患者临床疗效比较,观察组总有效率显著高于对照组（P<0.05）。2组并发症发生率差异无统计学意义。结论：tDCS治疗焦虑和抑郁障碍共病疗效显著,起效迅速,安全性好,值得临床推广应用。     

Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial

Rivera PA, Elliott TR, Berry JW, Grant JS. Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial.

Objective

To test the hypothesis that a problem-solving training program would lower depression, health complaints, and burden, and increase well-being reported by community-residing family caregivers of persons with traumatic brain injuries (TBIs).

Design

Randomized controlled trial.

Setting

General community.

Participants

Of the 180 people who expressed interest in the study, 113 did not meet eligibility criteria. A consenting sample of family caregivers were randomized into a problem-solving training group (4 men, 29 women; average age, 51.3y) or an education-only control group (34 women; average age, 50.8y). Care recipients included 26 men and 7 women in the intervention group (average age, 36.5y) and 24 men and 10 women in the control group (average age, 37.2y).

Intervention

Problem-solving training based on the D'Zurilla and Nezu social problem-solving model was provided to caregivers in the intervention group in 4 in-home sessions and 8 telephone follow-up calls over the course of their year-long participation. Control group participants received written educational materials and telephone calls at set intervals throughout their 12 months of participation.

Main Outcome Measures

Caregiver depression, health complaints, well-being, and social problem-solving abilities.

Results

Hierarchical linear models revealed caregivers receiving problem-solving training reported significant decreases in depression, health complaints, and in dysfunctional problem-solving styles over time. No effects were observed on caregiver well-being, burden, or constructive problem-solving styles.

Conclusions

Problem-solving training provided in the home appears to be effective in alleviating distress and in decreasing dysfunctional problem-solving styles among family caregivers of persons with TBI. Methodologic limitations and the implications for interventions and future research are discussed.     

Bi-cephalic transcranial direct current stimulation combined with functional electrical stimulation for upper-limb stroke rehabilitation: A double-blind randomized controlled trial

BackgroundStroke survivors often present poor upper-limb (UL) motor performance and reduced movement quality during reaching tasks. Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are widely used strategies for stroke rehabilitation. However, the effects of combining these two therapies to rehabilitate individuals with moderate and severe impairment after stroke are still unknown.ObjectiveOur primary aim was to evaluate the effects of concurrent bi-cephalic tDCS and FES on UL kinematic motor performance and movement quality of chronic post-stroke subjects with moderate and severe compromise. Our secondary aim was to verify the effects of combining these therapies on handgrip force and UL motor impairment.MethodsWe randomized 30 individuals with moderate and severe chronic hemiparesis after stroke into tDCS plus FES (n = 15) and sham tDCS plus FES (n = 15) groups. Participants were treated 5 times a week for 2 weeks. Kinematic motor performance (movement cycle time, velocity profile) and movement quality (smoothness, trunk contribution, joint angles) were assessed during an UL reach-to-target task.Handgrip force and motor impairment were also recorded before and after the intervention.ResultsParticipants allocated to the tDCS plus FES group improved movement cycle time (P = 0.039), mean reaching velocity (P = 0.022) and handgrip force (P = 0.034). Both groups improved the mean returning phase velocity (P = 0.018), trunk contribution (P = 0.022), movement smoothness (P = 0.001) and UL motor impairment (P = 0.002).ConclusionsConcurrent bi-cephalic tDCS and FES slightly improved reaching motor performance and handgrip force of chronic post-stroke individuals with moderate and severe UL impairment.Trial registrationClinicalTrials.gov (NCT02818608).     

阳极经颅直流电刺激治疗脑梗死后失语症疗效的Meta分析

目的 应用Meta分析评价阳极经颅直流电刺激治疗脑梗死后失语症的疗效。 方法 利用计算机检索中国生物医学文献数据库、中国知网及万方数据库、维普数据库、PubMed、MEDLINE、EMbase及Cochrane Library,同时手工检索相关杂志和资料中关于阳极经颅直流电刺激治疗脑梗死后失语症的临床随机对照试验,截止日期为2016年11月。由2位研究者按照纳入和排除标准筛选文献、整理资料、提取数据、质量评价,并交叉核对,随后采用RevMan5.3软件进行Meta分析。 结果 共纳入文献7篇,包括101例患者,Meta分析结果显示试验组患者经阳极经颅直流电刺激后,其失语症评分较对照组明显改善,SMD＝0.50,95％CI为(0.09,0.90),P=0.02<0.05,差异具有统计学意义。阳极经颅直流电刺激能显著提高卒中后失语症患者的图命名能力（P=0.03）。治疗过程中仅有11例患者出现轻微不良反应,但都在患者耐受范围内,不需特殊处理。 结论 阳极经颅直流电刺激对脑梗死后失语症患者的语言恢复具有显著疗效,并且还具有操作简单、安全性高等优点,是一种值得推广、应用的康复治疗技术。受纳入研究的文献数量及其他因素限制,本文结论还有待更多大样本、高质量临床随机对照试验加以验证,以期为临床应用阳极经颅直流电刺激提供参考资料。