计算机模拟训练对血管性认知功能障碍的干预效果研究

doi:10.3969/j.issn.1673-5765.2017.10.008

摘要/Abstract

摘要：

目的探索计算机模拟训练对血管性认知功能障碍（vascular cognitive impairment，VCI）的干预效果，为VCI患者提供有效的治疗方法。方法选取2015年10月-2016年11月火箭军总医院神经内科门诊和住院诊断VCI患者80例，所有研究对象均由神经内科接受认知评估培训的医生，使用统一规范的指导语进行基线评估，包括蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）及计算机多维认知评估，包括视觉注意、推理、空间想象、计算、言语记忆、语言阅读、词语再认、图片即刻回忆、执行等方面；将完成基线评估的所有研究对象按3∶5的比例完全随机化分为对照组（30例）及训练干预组（50例）。对照组仅接受常规内科药物治疗，干预组在药物治疗基础上，参加由经过培训的神经内科专科医生使用统一的指导语进行的计算机模拟训练，每次训练1 h。训练30次后（时间周期为30～60 d），两组患者再次接受多维认知评估。观察计算机模拟训练对视觉注意、推理、空间想象、计算、言语记忆、语言阅读、词语再认、图片即刻回忆、执行能力的干预效果。结果对两组患者基线资料分析发现，在性别、年龄、教育水平方面两组患者差异无显著性。两组患者基线MoCA及计算机多维认知评估的各个分项目评分均相近，差异无显著性。干预组训练后， MoCA量表除定向力在训练前后无明显差异外，其余项目均有所好转（P＜0.05）；计算机多维认知评估的9个分项目均有所好转（P＜0.05）。而对照组患者推理能力（P =0.006）、言语记忆能力（P =0.001）较前下降，其余认知项目无明显变化。与对照组相比，计算机模拟训练可改善VCI患者的视觉注意、推理、空间想象、计算、言语记忆、语言阅读、词语再认、图片即刻回忆及执行能力（P＜0.05）。结论基于计算机的认知功能训练能够不同程度的改善血管性认知障碍的视觉注意、推理、空间想象、计算、言语记忆、语言阅读、词语再认、图片即刻回忆及执行能力，为VCI提供了一种新的干预手段。

文章导读： 基于计算机的认知功能训练能够不同程度的改善认知功能，而且无创、个体化、费用低、易于广泛开展，可作为血管性认知功能障碍的一项预防及干预手段。

关键词: 血管性认知功能障碍; 计算机模拟训练; 多维认知评估

Abstract:

Objective To explore the effect of computer simulated training on cognition in patients with vascular cognitive impairment (VCI), so as to provide effective treatment for patients with VCI. Methods A total of 80 patients diagnosed with VCI in Department of Neurology of the hospital during October 2015 to November 2016 were enrolled in this study. The patients were randomized into control (n =30) and intervention (n =50) group at a ratio of 3 : 5. All patients were evaluated by the Montreal Cognitive Assessment (MoCA) and computer cognitive evaluation visual attention, reasoning, spatial imagination, calculation, speech memory, reading, word recognition, immediaterecall of pictures and execution ability under the guide of experienced neurologists. The control group only received conventional drug therapy. On the basis of conventional drug therapy, theintervention group received computer simulated training for a period of 30 to 60 days by trained neurologists, 1 h per time. Both groups received multidimensional recognition evaluation after 30 times of exercise. The intervention effect including visual attention, reasoning, spatial imagination, calculation, speech memory, reading, word recognition, immediate-recall of pictures and execution ability were observed. Results Analysis the basic data found that gender, age, education level of the two groups of patients were of no significant difference. The control and intervention groups did not differ on baseline cognition abilities. In MoCA scale, despite of the direction ability had no obvious change, the other cognitive sub-items were improved after computer simulated training in treatment group (P <0.05) and 9 sub-items all got improved (P <0.05). In addition to the reasoning (P =0.06) and speech memory abilities (P =0.01) decreased of the control group, the other cognitive sub-items had no obvious change. Compared with control group, computer simulated training led improvement in visual attention, reasoning, spatial imagination, calculation, speech memory, reading, word recognition, and immediate-recall of pictures and execution ability (P <0.05). Conclusion Computer-based cognitive function training can improve vascular cognitive impairment in different degrees, including visual attention, reasoning, spatial imagination, calculation, speech memory, reading, word recognition, immediate-recall of pictures and execution ability, which provides a new mean of intervention for VCI.

Key words: Vascular cognitive impairment; Computer simulation training; Multidimensional cognitive evaluation

宇佳利，尹世敏，卢燕，徐芳，王秋佳，王磊. 计算机模拟训练对血管性认知功能障碍的干预效果研究[J]. 中国卒中杂志, 2017, 12(10): 921-928.

YU Jia-Li, YIN Shi-Min, LU Yan, XU Fang, WANG Qiu-Jia, WANG Lei. The Intervention Effect Study on Computer Simulated Training in Vascular Cognitive Impairment[J]. Chinese Journal of Stroke, 2017, 12(10): 921-928.

参考文献

[1] 血管性认知功能损害专家共识组. 血管性认知功能

损害的专家共识[J]. 中华内科杂志，2007，46（12）：

1052-1055.

[2] DICHQANS M，LEYS D. Vascular cognitive

impairment[J]. Circ Res，2017，120（3）：573-591.

[3] SAQQU R，SCHUMACHER T，GERICH F，et

al. Astroglial NF-kB contributes to white matter

damage and cognitive impairment in a mouse model

of vascular dementia[J]. Acta Neuropathol Commun，

2016，4（1）：76.

[4] BOWLER J V，GORELICK P B. Advances in

vascular cognitive impairment 2006[J]. Stroke，2007，

38（2）：241-244.

[5] CAO W W，WANG Y，DONG Q，et al. Deep

microbleeds and periventricular white matter

disintegrity are independent predictors of attention/

executive dysfunction in non-dementia patients with

small vessel disease[J]. Int Psychogeriatr，2017，29

（5）：793-803.

[6] INGLES J L，BOULTON D C，FISK J D，et

al. Preclinical vascular cognitive impairment

and Alzheimer disease：neuropsychological test

performance 5 years before diagnosis[J]. Stroke，

2007，38（4）：1148-1153.

[7] 贾建平. 重视血管性认知障碍的早期诊断及干预[J].

中华神经科杂志，2005，38（1）：4-6.

[8] 叶海程，杨珊莉，陈立典，等. 计算机辅助认知训练

对脑卒中患者认知功能及功能独立性的影像[J]. 实

用医学杂志，2014，30（17）：2742-2744.

[9] WECHSLER D. Manual for the Wechsler

Intelligence Scale for children revised[J]. New York：Psychological Corp，1974，19（Suppl 1）：221-234.

[10] BREWER J B，ZHAO Z，DESMOND J E，et

al. Making memories：brain activity that predicts

how well visual experience will be remembered[J].

Science，1998，281（5380）：1185-1187.

[11] 袁莉，李秋俐，尹世敏，等. 急性缺血性卒中患者

多维认知功能评估研究[J]. 中国卒中杂志，2014，9

（6）：466-471.

[12] BARBA R，MARTÍNEZ-ESPINOSA S，

RODRÍGUEZ-GARCÍA E，et al. Poststroke

dementia：clinical features and risk factors[J]. Stroke，

2000，31（7）：1494-1501.

[13] ZHOU A，JIA J. The value of the clock drawing

test and the mini-mental state examination for

identifying vascular cognitive impairment no

dementia[J]. Int J Geriatr Psychiatry，2008，23（4）：

422-426.

[14] CHA Y J，KIM H. Effect of computer-based

cognitive rehabilitation（CBCR）for people with

stroke：a systematic review and meta-analysis[J].

NeuroRehabilitation，2013，32（2）：359-368.

[15] VAN DE VEN R M，MURRE J M，VELTMAN

D J，et al. Computer-based cognitive training for

executive functions after stroke：a systematic

review[J]. Front Hum Neurosci，2016，10：150. doi:

10.3389/fnhum.2016.00150. eCollection 2016.

[16] BORELLA E，CARRETTI B，ZANONI G，et al.

Working memory training in old age：an examination

of transfer and maintenance effects[J]. Arch Clin

Neuropsychol，2013，28（4）：331-347.

[17] 陈衍，符虔，刘香倩. 生理性认知老化干预训练研究

综述[J]. 开封教育学院学报，2015，35（1）：179-180.[18] MCAVINUE L P，GOLEMME M，CASTORINA

M，et al. An evaluation of a working memory

training scheme in older adults[J]. Front Aging

Neurosci，2013，5：20. doi: 10.3389/fnagi.2013.

00020. eCollection 2013. http://xueshu.baidu.

com/s?wd=paperuri%3A%289c63da01d810

070f9764851de5832830%29&filter=sc_long_

sign&tn=SE_xueshusource_2kduw22v&sc_

vurl=http%3A%2F%2Feuropepmc.org%2

Farticles%2FPMC3662021&ie=utf-8&sc_

us=17904044025227953937.

[19] CORBETT A，OWEN A，HAMPSHIRE A，et al.

The effect of an online cognitive training package

in healthy older adults：an online randomized

controlled trial[J]. J Am Med Dir Assoc，2015，16

（11）：990-997.

[20] WILLIS S L，TENNSTEDT S L，MARSISKE

M，et al. Long-term effects of cognitive training

on everyday functional outcomes in older adults[J].

JAMA，2006，296（23）：2805-2814.

[21] 姜财，杨珊莉，黄佳，等. 计算机辅助认知训练对脑

卒中患者认知功能恢复的影响及其机制的fMRI研

究[J]. 中国康复医学杂志，2015，30（9）：911-914.

[22] 周惠嫦，张盘德，陈丽珊，等. 计算机辅助认知训练

对血管性认知障碍的疗效观察[J]. 中国康复医学杂

志，2012，27（6）：551-553.

[23] GUNNING-DIXON F M，BRICKMAN A M，

CHENG J C，et al. Aging of cerebral white matter：a

review of MRI findings[J]. Int J Geriatr Psychiatry，

2009，24（2）：109-117.

[24] 李婷，李春波. 认知老化的神经机制及假说[J]. 上海

交通大学学报（医学版），2013，33（7）：1030-1034.