重复经颅磁刺激联合同步工作记忆训练改善脑卒中后认知障碍
文献类型：学位论文
| 作者 | 刘瑾 |
| 答辩日期 | 2024-06 |
| 文献子类 | 继续教育硕士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 李雪冰 |
| 关键词 | 脑卒中后认知功能障碍 工作记忆训练 重复经颅磁刺激治疗 同步治疗 |
| 学位名称 | 理学硕士 |
| 学位专业 | 健康心理学 |
| 其他题名 | Repetitive transcranial magnetic stimulation combined with synchronous working memory training improves cognitive impairment after stroke |
| 中文摘要 | In China, the overall prevalence of post-stroke cognitive impairment (PSCI) is 80.97%. PSCI can cause persistent cognitive decline, leading to high recurrence rate and mortality. However, PSCI in the acute stage is often ignored by medical teams, patients and family members. There is no gold standard for diagnosis and treatment. This study took PSCI as the research object, focusing on the impact of cognitive function impairment on patients' emotional problems and daily living ability after acute stroke, and further adopted a variety of intervention programs to treat PSCI, in order to achieve the goal of improving cognitive function and transferring to mood and daily living ability. Based on this, the study is divided into two parts: Study I comprised 325 patients with early stroke. The demographic information of the patients was collected, and their cognitive function (including global cognitive function, working memory capacity, and working memory ability), emotional problems (anxiety and depression), and activities of daily living (ADL) were assessed. The correlation between these factors was analyzed, as well as the relationship between cognitive function and emotional problems. Additionally, the association between stroke severity and ADL was examined. The results revealed a positive correlation between stroke severity and cognitive impairment/emotional problems, while a negative correlation was observed with ADL. Further analysis demonstrated that cognitive function played a significant mediating role in both the relationship between stroke severity and emotional problems, as well as between stroke severity and ADL. Moreover, particular emphasis was placed on improving cognitive function to identify the most effective physical intervention. The present study aimed to compare the effects of working memory training (WMT) and repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex on cognitive function, emotional state, and activities of daily living in patients with post-stroke cognitive impairment (PSCI). A total of 120 PSCI patients were randomly assigned into four groups: rTMS group, WMT+rTMS synchronous training group, WMT group, and blank control group. Pre- and post-test assessments were conducted to measure cognitive function, emotional state, and activities of daily living. Results indicated no significant differences in baseline cognitive function among the four groups. However, after treatment, the synchronous training group showed significantly higher scores than the other three groups on measures including Montreal Cognitive Assessment (MoCA), Rivermead Behavioural Memory Test (RBMT), N-back working memory task, and Stroop task. Regarding emotional state improvement after treatment, all three intervention groups demonstrated positive changes compared to baseline levels. Notably, the synchronous training group exhibited significantly greater improvements in Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores compared to both the WMT group and control group. Furthermore, all four groups showed improvements in activities of daily living after treatment; however,the synchronous training group achieved significantly higher scores on modified Barthel index (MBI) and Simple FuglMeyer Assessment (FMA) compared to the other three groups. In conclusion, patients with early post-stroke cognitive impairment (PSCI) experience impairments in cognitive function, emotional state, and activities of daily living. Furthermore, cognitive function acts as a mediator between stroke severity and emotion as well as activities of daily living. Simultaneous treatment involving repetitive transcranial magnetic stimulation (rTMS) and working memory training effectively enhances cognitive function, alleviates anxiety and depression symptoms, and improves activities of daily living in PSCI patients. Notably, the combined treatment yields superior outcomes compared to single interventions. This study provides a foundation for the promotion and utilization of this technology. |
| 英文摘要 | 我国脑卒中后认知功能障碍(post-stroke cognitive impairment, PSCI)总体患病率为 80.97%，PSCI 可引起持续性认知功能下降，导致较高的复发率、死亡率，但急性期PSCI 常被医疗团队、患者、家属忽视，诊断和治疗尚无金标准。本研究以 PSCI 为研究对象，重点考察急性脑卒中后，认知功能损害对患者的情绪问题、日常生活能力的影响，并进一步采取多种干预方案对 PSCI 进行治疗，以期达到改善认知功能，并迁移到情绪、日常生活能力的目标。 基于此，研究分为两部分：研究一纳入325名早期脑卒中患者，调查患者的一般资料，评定其认知功能（整体认知功能、工作记忆容量、工作记忆能力）、 情绪问题（焦虑、抑郁）、日常生活活动能力，分析各因素之间的相关性，并考察认知功能在脑卒中严重程度和情绪问题，以及脑卒中严重程度和日常生活活动能力之间的作用。结果显示，脑卒中严重程度与认知功能损害和情绪问题呈正相关，与日常生活活动能力呈负相关。进一步分析发现，认知功能在脑卒中严重程度和情绪问题，以及脑卒中严重程度和日常生活活动能力之间发挥显著的中介作用。进而，我们以认知功能改善为重点治疗目标，寻找最有效的物理干预手段。 研究二对比工作记忆训练(working memory training, WMT)、以左背外侧前额叶为靶点的重复经颅磁刺激治疗(repetitive transcranial magnetic stimulation, rTMS)、WMT+rTMS 的同步训练与空白对照组的治疗效果。采用随机分组前后 测设计，招募120名 PSCI 患者随机分为4组，进行20天训练。在前后测阶段分别考察了患者的认知功能、情绪状态和日常生活能力。结果显示，认知功能方面，治疗前，4 组患者成绩无差异；治疗后，同步组的成绩显著高于其他三组，具体评定指标包括蒙特利尔认知功能评定(Montreal Cognitive Assessment, MoCA)， Rivermead 行为记忆评定(Rivermead Behavioural Memory Test, RBMT)，N-back 工 作记忆任务以及 Stroop 任务；情绪状态方面，同步组、rTMS 组、WM 组在治疗后均有改善，同步组的汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)、汉密尔顿抑郁量表(Hamilton Depression Scale, HAMD)成绩改善情况显著大于 WM 组和对照组；日常生活能力方面，四组患者在治疗前后均有改善，同步组的改良 Barthel 指数评定量表成绩(modified Barthel index, MBI)、简化的Fugl-Meyer 运动量表(Simple Fugl-Meyer Assessment, FMA)成绩显著高于其他三组。 综上所述，PSCI 早期患者的认知功能、情绪状态、日常生活活动能力均受影响，认知功能在脑卒中严重程度与情绪、日常生活活动能力中起中介作用。同 进行 rTMS 治疗和 WM 训练可有效改善 PSCI 患者的认知功能，缓解焦虑抑郁情绪，改善日常生活活动能力，且同步治疗效果优于单一方式的治疗，本研究为该技术的推广使用提供依据 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/48304]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 刘瑾. 重复经颅磁刺激联合同步工作记忆训练改善脑卒中后认知障碍[D]. 中国科学院心理研究所. 中国科学院大学. 2024. |
入库方式： OAI收割
来源：心理研究所
浏览0
下载0
收藏0
其他版本
除非特别说明，本系统中所有内容都受版权保护，并保留所有权利。