切换至 "中华医学电子期刊资源库"

中华脑科疾病与康复杂志(电子版) ›› 2019, Vol. 09 ›› Issue (05) : 285 -288. doi: 10.3877/cma.j.issn.2095-123X.2019.05.007

所属专题: 文献

临床研究

重复经颅磁刺激联合多奈哌齐治疗脑卒中后认知障碍的临床观察
周学梅1, 杨占宇1, 吴艳1, 张祥1, 乔姗1, 郭艳萍1,()   
  1. 1. 215100 苏州,苏州瑞盛康复医院神经康复科
  • 收稿日期:2019-09-30 出版日期:2019-10-15
  • 通信作者: 郭艳萍
  • 基金资助:
    2018苏州市民生科技项目(SYSD2018055)

Clinical study of treatments to cognitive impairment by repetitive transcranial magnetic stimulation combined with donepezil on patients with stroke

Xuemei Zhou1, Zhanyu Yang1, Yan Wu1, Xiang Zhang1, Shan Qiao1, Yanping Guo1,()   

  1. 1. Department of Neurology Rehabilitation, Suzhou Ruisheng Rehabilitation Hospital, Suzhou 215100, China
  • Received:2019-09-30 Published:2019-10-15
  • Corresponding author: Yanping Guo
  • About author:
    Corresponding author: Guo Yanping, Email:
引用本文:

周学梅, 杨占宇, 吴艳, 张祥, 乔姗, 郭艳萍. 重复经颅磁刺激联合多奈哌齐治疗脑卒中后认知障碍的临床观察[J]. 中华脑科疾病与康复杂志(电子版), 2019, 09(05): 285-288.

Xuemei Zhou, Zhanyu Yang, Yan Wu, Xiang Zhang, Shan Qiao, Yanping Guo. Clinical study of treatments to cognitive impairment by repetitive transcranial magnetic stimulation combined with donepezil on patients with stroke[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2019, 09(05): 285-288.

目的

探讨重复经颅磁刺激(rTMS)联合多奈哌齐治疗脑卒中后认知障碍(PSCI)的临床疗效。

方法

选取苏州瑞盛康复医院神经康复科自2018年1月至2019年9月收治的76例PSCI患者,按照随机数字表法分为观察组与对照组,每组38例。2组患者均给予常规康复治疗,观察组增加口服多奈哌齐联合左侧前额叶背外侧10 Hz的rTMS治疗。在治疗前和治疗4周后分别采用蒙特利尔认知评估量表(MoCA)、简明精神状态检查表(MMSE)、改良Barthel指数(MBI)对患者的认知功能、日常生活能力进行评价。

结果

2组患者治疗4周后的MoCA评分、MMSE评分、MBI评分均高于治疗前,且观察组患者MoCA评分、MMSE评分、MBI评分高于对照组,差异均具有统计学意义(P<0.05)。

结论

rTMS联合多奈哌齐能在短期内改善PSCI患者的认知功能障碍及日常生活能力,临床疗效较好。

Objective

To investigate the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with donepezil in the treatment of post-stroke cognitive impairment (PSCI) patients.

Methods

Seventy-six PSCI patients, admitted to Department of Neurology Rehabilitation of Suzhou Ruisheng Rehabilitation Hospital from January 2018 to September 2019, were randomly divided into control group (n=38) and experimental group (n=38). Both groups were given routine rehabilitation treatment. In the experimental group, oral donepezil combined with 10 Hz rTMS was added. Before and 4 weeks after treatment, the cognitive function and the ability of daily living of the patients were evaluated by the Montreal cognitive assessment scale (MoCA), concise mental state check table (MMSE), modified Barthel index (MBI).

Results

The MoCA score, MMSE score and MBI score of the two groups after 4 weeks of treatment were higher than those before treatment, and the MoCA score, MMSE score and MBI score of the experimental group after 4 weeks of treatment were higher than those of the control group, the differences were statistically significant (P<0.05).

Conclusion

Donepezil combined with rTMS can improve the cognitive dysfunction and daily living ability of PSCI patients on a short period of time.

表1 2组一般资料对比
表2 2组患者治疗前后MoCA、MMSE、MBI评分比较(Mean±SD)
[1]
中国卒中学会,卒中后认知障碍管理专家委员会.卒中后认知障碍管理专家共识[J].中国卒中杂志, 2017, 12(6): 519-531.
[2]
Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment: epidemiology, mechanisms and management[J]. Ann Transl Med, 2014, 2(8): 80-95.
[3]
曲艳吉,卓琳,詹思延.中国脑卒中后认知障碍流行病学特征的系统评价[J].中华老年心脑血管病杂志, 2013, 15(12): 1294-1301.
[4]
Nys GM, van Zandvoort MJ, van der Worp HB, et al. Early cognitive impairment predicts long term depressive symptoms and quality of life after stork[J]. J Neurol Sci, 2006, 247(2): 149-129.
[5]
Lage C, Wiles K, Shergill SS, et al. A systematic review of the effects of low-frequency repetitive transcranial magnetic stimulation on cognition[J]. J Neural Transm (Vienna), 2016, 123(12): 1479-1490.
[6]
Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research[J]. Clin Neurophysiol, 2009, 120(12): 2008-2039.
[7]
Lefaucheur JP, Andre-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)[J]. Clin Neurophysiol, 2014, 125(11): 2150-2206.
[8]
Song W, Du B, Xu Q, et al. Low-frequency transcranial magnetic stimulation for visual spatial neglect: a pilot study[J]. J Rehabil Med, 2009, 41(3): 162-165.
[9]
中国医师协会神经调控专业委员会电休克与神经刺激学组.重复经颅磁刺激治疗专家共识[J].转化医学杂志, 2018, 7(1): 4-9.
[10]
Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review[J]. J Neural Transm, 2010, 117(1): 105-122.
[11]
Mohd Zulkifly MF, Ghazali SE, Che Din N, et al. The influence of demographic, clinical, psychological and functional determinants on post-stroke cognitive impairment at Day Care Stroke Center, Malaysia[J]. Malays J Med Sci, 2016, 23(2): 53-64.
[12]
Alexandrova ML, Danovska MP. Cognitive impairment one year after ischemic stroke:predictorsand dynamics of significant determinants[J]. Turk J Med Sci, 2016, 46(5): 1366-1373.
[13]
Sit JW, Chair SY, Choi KC, et al. Do empowered stroke patientsper form better at self-management and functional recovery after a stroke? A randomized controlled trial[J]. Clin Interv Aging, 2016, 11: 1441-1450.
[14]
方旭明,漆伟男,张安妮,等.经颅电刺激对血管性痴呆大鼠认知功能的改善作用及机制探讨[J].神经损伤与功能重建, 2016, 11(5): 381-384.
[15]
Lu H, Wu H, Cheng H, et al. Improvement of white matter and functional connectivity abnormalities by repetitive transcranial magnetic stimulation in crossed aphasia in dextral[J]. Int J Clin Exp Med, 2014, 7(10): 3659-3668.
[16]
Luo J, Zheng H, Zhang L, et al. High-frequency repetitive transcranial magnetic stimulation (RTMS) improves functional recovery by enhancing neurogenesis and activating BDNF/TRKB signaling in ischemic rats[J]. Int J Mol Sci, 2017, 18(2). pii: E455.
[17]
Hellmann J, Jüttner R, Roth C, et al. Repetitive magnetic stimulation of human-derived neuron-like cells activates cAMP-CREB pathway[J]. Eur Arch Psychiatry Clin Neurosci, 2012, 262(1): 87-91.
[18]
李亚梅,徐丽,杨艳,等.重复经颅磁刺激对脑梗死后轻度认知功能障碍的影响[J].中华物理医学与康复医学, 2015, 37(10): 739.
[19]
Demirtas-Tatlidede A, Alonso-Alonso M, Shetty RP, et al. Long-term effects of contralesional rtms in severe stroke: safety, cortical excitability, and relationship with transcallosal motor fibers[J]. NeuroRehabilitation, 2015, 36(1): 51-59.
[20]
Consalvev I. Baror R, Fried P, et al. Therapeutic noninvasive brain stimulation in alzheimer’s disease[J]. Curr Alzheimer Res, 2017, 14(4): 362-376.
[21]
Pennisi G, Ferri R, Cantone M, et al. A review of transcranial magnetic stimulation in vascular dementia[J]. Dement Geriatr Cogn Disord, 2011, 31(1): 71-80.
[22]
黄玮.血管性痴呆的发病机制研究进展[J].中国医药指南, 2012, 10(5): 62-64.
[23]
金世凯.多奈哌齐联合认知训练对脑卒中后认知功能障碍患者神经功能恢复的影响[J].中国实用神经疾病杂志, 2016, 19(10): 70-71.
[24]
尤汉生,毛秀琴,石俊,等.认知功能训练配合多奈哌齐治疗对脑卒中后认知障碍患者生活质量的影响[J].国际精神病学杂志, 2017, 44(2): 250-252, 256.
[25]
李雷,肖佩,陈巧,等.针灸联合多奈哌齐对老年脑卒中后认知障碍的影响[J].中国慢性病预防与控制, 2019, 27(8): 617-620.
[1] 王诗远, 张爱华. 慢性肾脏病相关认知障碍的发生机制研究进展[J]. 中华肾病研究电子杂志, 2023, 12(03): 163-167.
[2] 尚慧娟, 袁晓冬. 机械取栓术后应用依达拉奉右崁醇对急性缺血性脑卒中预后的改善[J]. 中华神经创伤外科电子杂志, 2023, 09(05): 295-301.
[3] 廖家权, 吴波, 唐昌敏. 体外冲击波联合肌电生物反馈对脑卒中后足下垂的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 286-292.
[4] 许方军, 曹晓光, 王修敏, 董学超, 刘云卫, 彭云飞, 周康. 虚拟情景互动技术联合肩胛骨运动控制强化训练对偏瘫患者上肢功能及日常生活活动能力的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 222-228.
[5] 侯牧韶, 刘子渤, 李红玲. 局部振动疗法治疗脑卒中后运动障碍的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 246-250.
[6] 常文轩, 王婷, 刘伟, 蓝天琦, 彭静, 汪诗瑶, 张晓鹏, 冯晨, 宫雪梅, 朱敏. 脑小血管病所致执行障碍的研究进展[J]. 中华消化病与影像杂志(电子版), 2023, 13(03): 179-182.
[7] 潘惠, 王明, 杨忠, 杜向东. 低频重复经颅磁刺激辅助治疗伴不同特征抑郁症的对照研究[J]. 中华临床医师杂志(电子版), 2023, 17(05): 562-568.
[8] 孙畅, 赵世刚, 白文婷. 脑卒中后认知障碍与内分泌激素变化的关系[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 471-476.
[9] 张许平, 刘佳成, 张舸, 杜艳姣, 李韶, 商丹丹, 王浩, 李艳, 段智慧. CYP2C19基因多态性联合血栓弹力图指导大动脉粥样硬化型非致残性缺血性脑血管事件患者抗血小板治疗的效果[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 477-481.
[10] 杨海华, 袁景林, 周晓梅, 牛军伟. RNF213基因突变所致烟雾病一家系病例临床分析并文献复习[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 495-498.
[11] 李昕, 李永凯, 江树青, 夏来百提姑·赛买提, 杨建中. 急性缺血性脑卒中静脉溶栓后出血转化相关危险因素分析[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 331-336.
[12] 邓颖, 黄山, 胡慧秀, 孙超. 老年缺血性脑卒中患者危险因素聚集情况分析[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 344-349.
[13] 祁研, 张岩, 陈雪, 刘颖, 史楠. 探讨高低频交互rTMS对老年脑卒中偏瘫患者肢体功能、吞咽功能及日常生活活动能力的影响[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 359-363.
[14] 王道合, 施媛媛. 8-iso-PGF2α及P选择素在评估脑小血管病患者认知功能中的价值[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 364-368.
[15] 许毛毛, 王宝军, 石雨, 陈超, 庞江霞. 人工寒潮和热浪对易卒中型肾血管性高血压大鼠脑卒中的影响[J]. 中华脑血管病杂志(电子版), 2023, 17(03): 237-243.
阅读次数
全文


摘要