Effects of Environmental Enrichment on Cognitive Function in Patients with Vascular Dementia after Stroke

doi:10.3969/j.issn.1673-5765.2022.12.010

Abstract

Abstract: Objective To investigate the effects of environmental enrichment on cognitive function of patients with vascular dementia after stroke.
Methods This study prospectively enrolled the consecutive patients with vascular dementia after stroke who were admitted in 910th Hospital of PLA Joint Logistic Support Force from January 2020 to March 2022. All the included patients were randomly divided into conventional treatment group and enriched environment group. The conventional treatment group received conventional treatment including drug therapy and rehabilitation training, while the enriched environment group received enriched environment intervention including music therapy, jigsaw puzzle and exercise therapy on the basis of conventional treatment, 30 minutes each time, once a day, 5 days a week, for 8 weeks. Cognitive function, activities of daily living, depression state and quality of life were assessed by MMSE, modified Barthel index (MBI), Hamilton depression scale (HAMD) and stroke-specific quality of life (SS-QOL) before treatment, 4 weeks and 8 weeks after treatment. The above indexes were compared between the two groups before and after treatment.
Results A total of 60 patients were enrolled in the study, with 30 patients in each group. There were no statistical differences in baseline clinical information and the above four scores between the two groups before treatment. The MMSE, MBI and SS-QOL scores in two groups increased at 4 and 8 weeks after treatment compared with those before treatment, while HAMD score decreased, with all the above differences having statistical significance. For comparisons between the two groups at 4 and 8 weeks after treatment, MMSE (15.83±2.97 vs. 14.07±2.70, P=0.019; 16.73±2.07 vs.14.97±2.31, P=0.003), MBI (55.67±10.81 vs. 49.67±10.58, P=0.034; 63.33±8.24 vs. 57.50±9.80, P=0.015) and SS-QOL scores (88.70±9.00 vs. 79.13±9.34, P<0.001; 93.60±8.27 vs. 85.83±8.60, P=0.001) in enriched environment group were higher than those in conventional treatment group, and HAMD score (8.40±2.74 vs. 10.00±3.21, P=0.042; 7.40±2.79 vs. 9.13±2.21, P=0.010) was lower than that in conventional treatment group.
Conclusions Environmental enrichment can significantly improve the cognitive function, activities of daily living, depressive emotion and quality of life of patients with vascular dementia after stroke.

Key words: Environmental enrichment; Vascular dementia; Stroke; Cognitive function; Depression; Quality of life

摘要： 目的探讨丰富环境对卒中后血管性痴呆患者认知功能的治疗效果。
方法前瞻性连续入组中国人民解放军联勤保障部队第九一〇医院2020年1月-2022年3月收治的卒中后血管性痴呆患者，随机分为常规治疗组和丰富环境组。常规治疗组接受包括药物治疗和康复训练在内的常规治疗，丰富环境组在常规治疗的基础上进行包括音乐治疗、拼图游戏和运动治疗在内的综合干预，每次30 min，每日1次，每周5 d，连续8周。治疗前、治疗4周、治疗8周后采用MMSE、改良巴氏指数（modified Barthel index，MBI）、汉密尔顿抑郁量表（Hamilton depression scale，HAMD）及卒中专用生活质量量表（stroke-specific quality of life，SS-QOL）分别评估患者的认知功能、日常生活能力、抑郁状态和生活质量。比较两组治疗前后上述指标的差异。
结果研究共入组60例患者，常规治疗组和丰富环境组各30例。治疗前两组的一般临床资料、MMSE、MBI、HAMD、SS-QOL评分差异无统计学意义。治疗4周和8周后，两组的MMSE、MBI、SS-QOL评分均较治疗前增加，HAMD评分下降，差异均有统计学意义。组间比较显示，治疗4周、8周后丰富环境组的MMSE（15.83±2.97分 vs. 14.07±2.70分，P=0.019；16.73±2.07分 vs. 14.97±2.31分，P=0.003）、MBI（55.67±10.81分 vs. 49.67±10.58分，P=0.034；63.33±8.24分 vs. 57.50±9.80分，P=0.015）、SS-QOL评分（88.70±9.00分 vs. 79.13±9.34分，P＜0.001；93.60±8.27分 vs. 85.83±8.60分，P=0.001）均高于常规治疗组，HAMD评分（8.40±2.74分 vs. 10.00±3.21分，P=0.042；7.40±2.79分 vs. 9.13±2.21分，P=0.010）低于常规治疗组。
结论丰富环境可改善卒中后血管性痴呆患者的认知功能、日常生活能力、抑郁情绪及生活质量，值得在临床和社区中推广。

关键词: 丰富环境; 血管性痴呆; 卒中; 认知功能; 抑郁; 生活质量

ZHOU Tiantian, SU Wenjie, LIAN Songyong, LIN Youcong. Effects of Environmental Enrichment on Cognitive Function in Patients with Vascular Dementia after Stroke[J]. Chinese Journal of Stroke, 2022, 17(12): 1343-1349.

周甜甜, 苏文杰, 连松勇, 林友聪. 丰富环境对卒中后血管性痴呆患者认知功能的影响 [J]. 中国卒中杂志, 2022, 17(12): 1343-1349.

References

[1] UWAGBAI O，KALISH V B. Vascular dementia[M]. Treasure Island：StatPearls Publishing，2022.
[2] DU S Q，WANG X R，XIAO L Y，et al. Molecular mechanisms of vascular dementia：what can be learned from animal models of chronic cerebral hypoperfusion?[J]. Mol Neurobiol，2017，54（5）：3670-3682.
[3] SAMPEDRO-PIQUERO P，BEGEGA A. Environmental enrichment as a positive behavioral intervention across the lifespan[J]. Curr Neuropharmacol，2017，15（4）：459-470.
[4] ZHOU T T，LIN L，HAO C Z，et al. Environmental enrichment rescues cognitive impairment with suppression of TLR4-p38MAPK signaling pathway in vascular dementia rats[J/OL]. Neurosci Lett，2020，737：135318[2022-03-10]. https://doi.org/10.1016/j.neulet.2020.135318.
[5] 中华医学会神经病学分会，中华医学会神经病学分会神经康复学组，中华医学会神经病学分会脑血管病学组. 中国脑卒中早期康复治疗指南[J]. 中华神经科杂志，2017，50（6）：405-412.
[6] PENDLEBURY S T，ROTHWELL P M. Prevalence，incidence，and factors associated with pre-stroke and post-stroke dementia：a systematic review and meta-analysis[J]. Lancet Neurol，2009，8（11）：1006-1018.
[7] JAIN V，BAITHARU I，PRASAD D，et al. Enriched environment prevents hypobaric hypoxia induced memory impairment and neurodegeneration：role of BDNF/PI3K/GSK3β pathway coupled with CREB activation[J/OL]. PLoS One，2013，8（5）：e62235[2022-03-10]. https://doi.org/10.1371/journal.pone.0062235.
[8] BAYAT M，SHARIFI M D，HAGHANI M，et al. Enriched environment improves synaptic plasticity and cognitive deficiency in chronic cerebral hypoperfused rats[J/OL]. Brain Res Bull，2015，119（Pt A）：34-40[2022-03-10]. https://doi.org/10.1016/j.brainresbull.2015.10.001.
[9] KOELSCH S. Brain correlates of music-evoked emotions[J]. Nat Rev Neurosci，2014，15（3）：170-180.
[10] BLOOD A J，ZATORRE R J. Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion[J]. Proc Natl Acad Sci U S A，2001，98（20）：11818-11823.
[11] FERRERI L，MAS-HERRERO E，ZATORRE R J，et al. Dopamine modulates the reward experiences elicited by music[J]. Proc Natl Acad Sci U S A，2019，116（9）：3793-3798.
[12] SARKAMO T，TERVANIEMI M，LAITINEN S，et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke[J/OL]. Brain，2008，131（Pt 3）：866-876[2022-03-10]. https://doi.org/10.1093/brain/awn013.
[13] SIHVONEN A J，LEO V，RIPOLLES P，et al. Vocal music enhances memory and language recovery after stroke：pooled results from two RCTs[J]. Ann Clin Transl Neurol，2020，7（11）：2272-2287.
[14] CUMMING T B，TYEDIN K，CHURILOV L，et al. The effect of physical activity on cognitive function after stroke：a systematic review[J]. Int Psychogeriatr，2012，24（4）：557-567.
[15] MIJAJLOVIĆ M D，PAVLOVIĆ A，BRAININ M，et al. Post-stroke dementia-a comprehensive review[J/OL]. BMC Med，2017，15（1）：11[2022-03-10]. https://doi.org/10.1186/s12916-017-0779-7.
[16] ZHANG L L，FAN Y Z，KONG X Y，et al. Neuroprotective effect of different physical exercises on cognition and behavior function by dopamine and 5-HT level in rats of vascular dementia[J/OL]. Behav Brain Res，2020，388：112648[2022-03-10]. https://doi.org/10.1016/j.bbr.2020.112648.
[17] GAUDIER-DIAZ M M，ZHANG N，HAINES A H，et al. Social interaction modulates the neuroinflammatory response to global cerebral ischemia in male mice[J/OL]. Brain Res，2017，1673：86-94[2022-03-10]. https://doi.org/10.1016/j.brainres.2017.08.008.
[18] KIM E S，PARK N，PETERSON C. Perceived neighborhood social cohesion and stroke[J/OL]. Soc Sci Med，2013，97：49-55[2022-03-10]. https://doi.org/10.1016/j.socscimed.2013.08.001.
[19] 邹陈君. 非药物干预中丰富环境治疗老年期痴呆有效性的临床研究[D]. 宁波：宁波大学，2017.
[20] BRUNO R M，STEA F，SICARI R，et al. Vascular function is improved after an environmental enrichment program：the train the brain-mind the vessel study[J]. Hypertension，2018，71（6）：1218-1225.
[21] PALUMBO A，ALURU V，BATTAGLIA J，et al. Music upper limb therapy-integrated（MULT-I）provides a feasible enriched environment and reduces post stroke depression：a pilot randomized controlled trial[J]. Am J Phys Med Rehabil，2021，101（10）：937-946.
[22] AMATYA B，KHAN F，WINDLE I，et al. Evaluation of a technology-assisted enriched environmental activities programme for upper limb function：a randomized controlled trial[J/OL]. J Rehabil Med，2020，52（1）：jrm00003[2022-03-10]. https://doi.org/10.2340/16501977-2625.
[23] STEVENSON W，HASE Y，WILSON E，et al. Long-term effects of experimental carotid stenosis on hippocampal infarct pathology，neurons and glia and amelioration by environmental enrichment[J/OL]. Brain Res Bull，2020，163：72-83[2022-03-10]. https://doi.org/10.1016/j.brainresbull.2020.07.014.
[24] XU L L，QU C H，QU C J，et al. Improvement of autophagy dysfunction as a potential mechanism for environmental enrichment to protect blood-brain barrier in rats with vascular cognitive impairment[J/OL]. Neurosci Lett，2020，739：135437[2022-03-10]. https://doi.org/10.1016/j.neulet.2020.135437.
[25] ZHU H，ZHANG J J，SUN H M，et al. An enriched environment reverses the synaptic plasticity deficit induced by chronic cerebral hypoperfusion[J]. Neurosci Lett，2011，502（2）：71-75.
[26] PARK J M，SEONG H H，JIN H B，et al. The effect of long-term environmental enrichment in chronic cerebral hypoperfusion-induced memory impairment in rats[J]. Biol Res Nurs，2017，19（3）：278-286.
[27] STERN Y，ARENAZA-URQUIJO E M，BARTRES-FAZ D，et al. Whitepaper：defining and investigating cognitive reserve，brain reserve，and brain maintenance[J]. Alzheimers Dement，2020，16（9）：1305-1311.
[28] GELFO F，MANDOLESI L，SERRA L，et al. The neuroprotective effects of experience on cognitive functions：evidence from animal studies on the neurobiological bases of brain reserve[J/OL]. Neuroscience，2018，370：218-235[2022-03-10]. https://doi.org/10.1016/j.neuroscience.2017.07.065.