Huai Yaping, Yang Weiwei, Lv Yichen, Wang Kui, Zhou Hongyu, Lu Yiqing, Zhang Xiaoyun, Wang Yaze, Wang Jibing, Wang Xin
Department of Rehabilitation Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China.
Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital, Yangzhou, China.
Front Neurol. 2025 Jan 7;15:1503737. doi: 10.3389/fneur.2024.1503737. eCollection 2024.
This study aims to observe the effect of enrichment rehabilitation (ER) on cognitive function in post-stroke patients and to clarify its underlying mechanism.
Forty patients with post-stroke cognitive impairment (PSCI) meeting the inclusion criteria were randomly assigned to two groups: conventional medical rehabilitation (CM group) and ER intervention (ER group). All patients underwent assessments of overall cognitive function, attention function, and executive function within 24 h before the start of training and within 24 h after the 8 weeks of training. We investigated the altered resting-state functional connectivity (RSFC) with the right dorsolateral prefrontal cortex (DLPFC) in patients with PSCI following ER training through functional magnetic resonance imaging (fMRI). Additionally, twenty people undergoing routine physical examinations in the outpatient department of our hospital were selected as the healthy control (HC) group.
Before training, both groups of PSCI patients exhibited significant impairment in overall cognitive function, attention function, and executive function compared to the HC group. However, there was no significant difference between the two PSCI patient groups. Following 8 weeks of treatment, both PSCI patient groups demonstrated substantial improvement in overall cognitive function, attention function, and executive function. Moreover, the ER group exhibited greater improvement after training compared to the CM group. Despite the improvements, the cognitive behavioral performance assessment scores of both PSCI patient groups remained lower than those of the HC group. RSFC analysis in the ER group revealed strengthened positive functional connectivity between the right DLPFC and the left superior frontal gyrus (SFG) and left anterior cingulate gyrus (ACG), along with decreased functional connectivity between the right DLPFC and the right superior temporal gyrus (STG) and right precentral gyrus post-ER intervention.
ER intervention is more effective than conventional medical rehabilitation in improving the cognitive function of PSCI patients, potentially by augmenting the FC between the right DLPFC and dominant cognitive brain regions, such as the left SFG and left ACG while attenuating the FC between the right DLPFC and non-dominant hemisphere areas including the STG and precentral gyrus within the right hemisphere.
本研究旨在观察强化康复（ER）对脑卒中后患者认知功能的影响，并阐明其潜在机制。
将40例符合纳入标准的脑卒中后认知障碍（PSCI）患者随机分为两组：传统医学康复组（CM组）和ER干预组（ER组）。所有患者在训练开始前24小时内及训练8周后24小时内接受整体认知功能、注意力功能和执行功能评估。通过功能磁共振成像（fMRI），我们研究了ER训练后PSCI患者右侧背外侧前额叶皮质（DLPFC）静息态功能连接（RSFC）的变化。此外，选取20例在我院门诊进行常规体检的人员作为健康对照组（HC组）。
训练前，与HC组相比，两组PSCI患者在整体认知功能、注意力功能和执行功能方面均表现出显著损害。然而，两组PSCI患者之间无显著差异。经过8周治疗后，两组PSCI患者在整体认知功能、注意力功能和执行功能方面均有显著改善。此外，与CM组相比，ER组训练后改善更大。尽管有所改善，但两组PSCI患者的认知行为表现评估得分仍低于HC组。ER组的RSFC分析显示，ER干预后，右侧DLPFC与左侧额上回（SFG）和左侧前扣带回（ACG）之间的正性功能连接增强，同时右侧DLPFC与右侧颞上回（STG）和右侧中央前回之间的功能连接减少。
ER干预在改善PSCI患者认知功能方面比传统医学康复更有效，可能是通过增强右侧DLPFC与优势认知脑区（如左侧SFG和左侧ACG）之间的功能连接，同时减弱右侧DLPFC与非优势半球区域（包括右侧半球的STG和中央前回）之间的功能连接来实现的。
