结构化认知康复治疗在新加坡脑卒中后认知功能障碍患者中的应用效果分析
Analysis of the effectiveness of structured cognitive rehabilitation therapy in post-stroke cognitive impairment patients in Singapore
廖羽君 1党超 2坎迪耶·纳兰信德 1刘美璇3
作者信息
- 1. 南洋理工大学李光前医学院,新加坡失智症中心(新加坡 308232);新加坡国立大学杜克医学院
- 2. 南洋理工大学李光前医学院,新加坡失智症中心(新加坡 308232);中山大学附属第一医院神经科
- 3. 中山大学附属第一医院神经科
- 折叠
摘要
目的 目前关于脑卒中后认知功能障碍(post stroke cognitive impairment,PSCI)预后的研究较少,尤其是关于接受结构化认知康复治疗但预后无显著改善患者的脑血管病危险因素尚未有报道.本研究旨在探讨影响认知康复治疗应用效果的脑血管病危险因素,为临床实践提供依据.方法 对149例缺血性脑卒中患者[年龄(63.60±9.66)岁,男性64.4%]进行为期8周的非药物结构化认知康复治疗,并收集纵向的预后数据.采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)和痴呆生活质量量表(dementia-quality of life instrument,DemQOL)在基线、治疗结束时和治疗结束后6个月进行整体认知功能和生活质量评估.最后通过回归分析评估结构化认知康复治疗对卒中后认知功能障碍预后的影响.结果 卒中发作次数更多的患者在接受结构化认知康复治疗结束时MoCA评分提高不明显(OR=2.17,95%CI:0.98～4.81,P=0.056).与基线相比,脑白质高信号程度越严重的患者在接受结构化认知康复治疗结束时MoCA评分提高越不明显(OR=2.13,95%CI:1.04～4.38,P=0.039).存在深部微出血的患者在接受认知康复治疗后6个月MoCA评分改善不明显(OR=19.93,95%CI:1.04～384,P=0.047).结论 卒中发作次数、脑白质高信号程度和深部微出血等脑血管病危险因素影响认知康复治疗的预后.然而,这些发现仍需进一步研究验证,且可指导未来临床试验的设计.
Abstract
Objective Literature on cognitive prognoses in association with stroke-related and pre-stroke factors,are surprisingly meagre.Prognoses of patients with post stroke cognitive impairment(PSCI)to structured cognitive rehabilitation are not clearly understood.This study aimed to compare if the prognoses of stroke survicors after cognitive rehabilitation programme was associated with chronic cerebrovascular disease(CVD).Methods An eight-week non-pharmacological clinical programme was ran for patients with mild strokes to provide clinical support to stroke patients and collect longitudinal data on stroke prognoses.149 ischemic stroke survivors(age 63.6±9.66,64.4%males)underwent an eight-week structured group cognitive rehabilitation programme.Baseline,immediate post programme(Immediate-PP)and 6-month post programme(6-month-PP)global cognitive and quality of life outcomes were assessed by Montreal cognitive assessment(MoCA)and dementia-quality of life instrument(DemQOL).Regression analyses evaluated the influence of cognitive rehabilitation on outcomes.Results With every past stroke experienced by patients,they were less likely to demonstrate an improvement in MoCA score Immediate-PP(OR=2.17,95%CI:0.980-4.813,P=0.056).Patients with severe white matter hyperintensities were less likely to demonstrate an improvement in MoCA scores Immediate-PP compared to Baseline(OR=2.13,95%CI:1.04-4.38,P=0.039).Finally,patients with microhemorrhages in the deep region were less likely to demonstrate an improvement in MoCA at 6-month-PP(OR=19.93,95%CI:1.04-384,P=0.047).Conclusions Pre-stroke CVD is associated with poorer cognitive outcomes post cognitive rehabilitation.Our initial programme shows promising results-however further research into cognitive rehabilitation for stroke survivors with pre-stroke CVD is needed.The findings from our clinical rehabilitation programme will be useful guiding the design of a clinical trial.
关键词
脑血管病/脑卒中后认知功能障碍/缺血性脑卒中/结构化认知康复治疗/认知功能Key words
Cerebrovascular disease/Post stroke cognitive impairment/Ischemic stroke/Cognitive rehabilitation/Cognition引用本文复制引用
出版年
2024
NETL
NSTL
万方数据