经颅直流电刺激治疗卒中后认知障碍的相关研究进展OACSTPCD
Research Progress of Transcranial Direct Current Stimulation Therapy for Cognitive Impairment after Stroke
卒中后认知障碍(PSCI)是指脑卒中后出现认知功能下降,严重影响患者的生活质量及生存时间.与其他神经系统疾病引起的认知障碍相比,可预防性和可治疗性是PSCI的重要特点,因此早期干预尤为重要.经颅直流电刺激(tDCS)属于非侵入性脑刺激技术,具备安全性高、疼痛感低等优点,是PSCI的一种有效神经康复治疗手段.PSCI的tDCS治疗方案通常为1~2 mA的刺激强度作用于背外侧前额叶皮层20~30 min.刺激部位通常选择背外侧前额叶,也有学者证实其他刺激区域的有效性,如双侧M1区、右顶叶皮层等.tDCS通过影响神经递质(如星形胶质细胞中的钙离子和γ-氨基丁酸)、神经元的状态、脑血流量以及大脑功能区域的连接发挥疗效,改善认知功能.tDCS不仅可产生即刻的促进效应、刺激后约1 h有效的后效应,而且具有长时程增强(LTP)和长时程抑制(LTD)效应.因此,在临床应用tDCS时应把握好治疗时机.目前认知功能的各种传统治疗手段(如药物治疗、认知训练、虚拟现实技术、针灸等)虽各有所长,但仍存在着药物不良反应、治疗时间长、恢复慢等问题.为弥补单独应用tDCS的局限与不足、达到更佳的治疗效果,可选择在tDCS刺激的同时或1 h内联合应用其他认知康复手段.本文旨在综述tDCS及其他认知康复方法在PSCI方面的相关研究进展,藉此为PSCI全面康复提供治疗经验和参考依据.
Post-stroke cognitive impairment(PSCI)refers to the symptoms of cognitive decline after stroke,which seriously impairs patients'quality of life and survival time.Compared with cognitive impairment caused by other neurological diseases,pre-ventability and treatability are important characteristics of PSCI,making early intervention particularly important.Transcranial direct current stimulation(tDCS)is a non-invasive brain stimulation technique with the advantages of high safety and low pain,and it is an effective neurological rehabilitation treatment for PSCI.The tDCS treatment regimen for PSCI usually consists of a stimulation intensity of 1 to 2 mA applied to the dorsolateral prefrontal cortex for 20 to 30 minutes.The stimulation site is usually the dorsolateral prefrontal lobe,but researchers have also confirmed the effectiveness of other stimulation sites,such as the bilateral M1 area and right parietal cortex.tDCS improves cognitive function by affecting neurotransmitters(such as calcium ions and γ-aminobu-tyric acid in astrocytes),the state of neurons,cerebral blood flow,and the connectivity of functional areas of the brain.tDCS not only produces an immediate boosting effect and an after-effect that is effective about 1 hour after stimulation,but also has long-term enhancement(LTP)and long-term depression(LTD)effects.Therefore,the timing of treatment should be grasped when tDCS is applied clinically.At present,various traditional treatments for cognitive function(such as drug therapy,cognitive training,virtual reality technology,acupuncture,etc.)have their own strengths,but there are still problems such as adverse drug reactions,long treat-ment time and slow recovery.In order to overcome the limitations and shortcomings of tDCS alone and to achieve a better therapeu-tic effect,the combined application of other cognitive rehabilitation measures at the same time or within 1 hour of tDCS stimulation is an alternative approach.This article aims to review the research progress of tDCS and other cognitive rehabilitation methods in PSCI,so as to provide therapeutic experience and reference for the comprehensive rehabilitation of PSCI.
刘员辰;张立新
中国医科大学附属盛京医院,辽宁 沈阳 110000
卒中后认知障碍脑卒中经颅直流电刺激联合治疗时机
post-stroke cognitive impairmentstroketranscranial direct current stimulationcombination therapytiming
《康复学报》 2024 (003)
304-310 / 7
国家重点研发计划项目(2020YFC2005700,2020YFC2007600)
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