Fishman Keera N, Ashbaugh Andrea R, Swartz Richard H
Department of Psychology, Faculty of Social Sciences, University of Ottawa, ON, Canada (K.N.F., A.R.A.).
Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S.).
Stroke. 2021 Jan;52(2):458-470. doi: 10.1161/STROKEAHA.120.032131. Epub 2021 Jan 20.
Cognitive impairment after stroke, especially executive and attention dysfunction, is common, negatively affects daily functioning, and has limited treatment options. A single-blind, parallel-design, randomized controlled trial was used to examine the impact of goal setting on poststroke cognitive performance.
Stroke survivors (n=72; mean age, 68.38 [SD=11.84] years; 69.4% men) in the chronic phase (≥3 months) after stroke from an academic stroke prevention clinic were randomly assigned to receive goal-setting instructions (n=36) or standard instructions (n=36) after completing baseline cognitive measures of executive function (primary outcome), attention/working memory, verbal learning, and verbal recall.
A one-way mixed multivariate analysis of covariance (MANCOVA) found a group by instructional manipulation interaction effect for executive function (Wilks λ=0.66; [3,66]=11.30; ≤0.001; η=0.34), after adjusting for age and years of education. After similar adjustment, attention/working memory (Wilks λ=0.86; [5,63]=2.10; =0.043; η=0.16) and verbal learning ([1,60]=5.81; =0.019; η=0.09) also showed improvement after instruction but not verbal recall (Wilks λ=0.95; [1,56]=2.82; =0.099; η=0.05). There were no adverse events.
Goal setting improved executive function, attention/working memory, and learning in a heterogeneous sample in the chronic phase after stroke. This suggests that >3 months after stroke, vascular cognitive impairment is not a fixed deficit; there is a motivational contributor. Brief treatments targeting goal-oriented behavior and motivation may serve as a novel approach or adjunct treatment to improve cognitive outcomes after stroke. Future research should investigate the use of goal setting on functional outcomes (eg, instrumental activities of daily living and vocational function) in this population, highlighting new potential avenues for treatment for vascular cognitive impairment. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03511300.
中风后的认知障碍，尤其是执行功能和注意力障碍很常见，会对日常功能产生负面影响，且治疗选择有限。一项单盲、平行设计的随机对照试验用于研究目标设定对中风后认知表现的影响。
来自一家学术性中风预防诊所的中风幸存者（n = 72；平均年龄68.38 [标准差 = 11.84]岁；69.4%为男性）在中风慢性期（≥3个月）完成执行功能（主要结局）、注意力/工作记忆、言语学习和言语回忆的基线认知测量后，被随机分配接受目标设定指导（n = 36）或标准指导（n = 36）。
在调整年龄和受教育年限后，单因素混合协方差分析（MANCOVA）发现，在执行功能方面存在指导操作的组间交互效应（威尔克斯λ = 0.66；[3,66] = 11.30；P≤0.001；η = 0.34）。经过类似调整后，注意力/工作记忆（威尔克斯λ = 0.86；[5,63] = 2.10；P = 0.043；η = 0.16）和言语学习（[1,60] = 5.81；P = 0.019；η = 0.09）在指导后也有改善，但言语回忆没有（威尔克斯λ = 0.95；[1,56] = 2.82；P = 0.099；η = 0.05）。没有不良事件发生。
目标设定改善了中风慢性期异质性样本中的执行功能、注意力/工作记忆和学习能力。这表明中风后超过3个月，血管性认知障碍并非固定缺陷；存在动机因素。针对目标导向行为和动机的简短治疗可能是改善中风后认知结局的一种新方法或辅助治疗方法。未来的研究应调查在该人群中目标设定对功能结局（如日常生活工具性活动和职业功能）的作用，为血管性认知障碍突出新的潜在治疗途径。注册信息：网址：https://www.clinicaltrials.gov。唯一标识符：NCT03511300。
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