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Objective:To analyze the influencing factors of post stroke cognitive impairment (PSCI) and their correlation with cognitive scores in patients with acute ischemic stroke.Methods:In this cross-section study, 36 patients diagnosed with acute ischemic stroke and post stroke cognitive impairment (PSCI) admitted to the Department of Vascular Neurology of Beijing Tiantian Hospital Affiliated to Capital Medical University from June 1, 2022 to September 30, 2022 were selected as the PSCI group. And one to one matching was performed for patients without PSCI (PSNCI group) with an age±1 year and same gender admitted to the hospital during the same period (as control, 36 cases). Basic clinical data of the two groups were collected, the laboratory and imaging examinations were completed. Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were used for cognitive evaluation by neuropsychologists. Hypothesis testing was used to compare the differences in basic data, laboratory tests and lesion sites between the two groups. Multi-factor conditional logistic regression was performed to analyze the influencing factors of PSCI, and Spearman correlation analysis was carried out to analyze the correlation between influencing factors of PSCI and the cognitive scores.Results:Compared with those in PSNCI group, the proportion of patients with stroke/transient ischemic attack history, hyperhomocysteinemia (HHcy), apolipoprotein E(ApoE) ε4 carriers and the ratio of temporal lobe and thalamus infarction were higher in PSCI group (41.7% vs 13.9%, 36.1% vs 2.8%, 30.6% vs 5.6%, 22.3% vs 2.8%, 25.0% vs 5.6%), the MMSE and MoCA scores were lower in PSCI group [16.50 (8.25, 19.00) vs 28.00 (27.00, 30.00), 10.00 (4.25, 14.50) vs 27.00 (25.00, 28.00)] (all P<0.05). Logistic regression analysis showed that HHcy was a positive correlation factor for PSCI ( OR=2.342, 95% CI=1.186-4.622, P=0.014). Spearman correlation analysis showed that MMSE ( r=-0.415) and MoCA ( r=-0.417) scores were negatively correlated with homocysteine (Hcy) (both P<0.05). Conclusion:HHcy is an important factor affecting the occurrence and development of PSCI in patients with acute ischemic stroke, and Hcy level is negatively correlated with cognitive scores in those patients.
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OBJECTIVE@#To observe the effects of moxibustion at Yongquan（KI 1） on the cognitive function and lower limb motor function in patients with post-stroke cognitive impairment of kidney essence deficiency.@*METHODS@#Eighty-four patients with post-stroke cognitive impairment of kidney essence deficiency were randomly divided into an observation group（42 cases，1 case dropped off）and a control group（42 cases，1 case dropped off）.The control group was treated with medication，electroacupuncture，rehabilitation training and repetitive transcranial magnetic stimulation（rTMS）；on the basis of the treatment as the control group，moxibustion at bilateral Yongquan（KI 1）was adopted in the observation group.Both groups were treated once a day，5 days a week with 2-day interval，4 weeks were required. The Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, Fugl-Meyer assessment-lower extremity (FMA-LE) score, Berg balance scale (BBS) score, functional independence measure (FIM) score, modified fall efficacy scale (MFES) score and scale for the differentiation of syndromes of vascular dementia (SDSVD) score before and after treatment were observed in the two groups.@*RESULTS@#After treatment，the MoCA, MMSE, FMA-LE, BBS, FIM and MFES scores were higher than those before treatment in both groups (P<0.05), and the scores in the observation group were higher than those in the control group (P<0.05). After treatment，the SDSVD scores were lower than those before treatment in both groups (P< 0.05), and the SDSVD score in the observation group was lower than that in the control group (P< 0.05).@*CONCLUSION@#Moxibustion at Yongquan（KI 1） can improve the cognitive function and motor and balance function of lower limbs in patients with post-stroke cognitive impairment of kidney essence deficiency，reduce the risk of fall and improve the quality of life.
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Humans , Cognition , Cognitive Dysfunction/therapy , Dementia, Vascular , Kidney , Lower Extremity , Moxibustion , Quality of Life , Stroke/complicationsABSTRACT
ObjectiveTo observe the effect of music therapy on cognitive function, motor function, and activities of daily living (ADL) of patients with post-stroke cognitive impairment. MethodsFrom December, 2020 to July, 2022, 48 patients with post-stroke cognitive impairment in Beijing Bo'ai Hospital were enrolled and randomly divided into control group (n = 24) and experimental group (n = 24). Both groups received conventional medication, nursing, and conventional rehabilitation, while the experimental group received music therapy additionally, for eight weeks. Before and after intervention, the cognitive function was assessed by Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and motor function and ADL were assessed with Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI), respectively. ResultsSix cases in the control group dropped down. The increase in the scores of LOTCA and FMA was more in the experimental group than in the control group (t > 2.665, P < 0.05), however, no significant difference was found in the increase of MBI score between two groups. ConclusionMusic therapy could improve the cognitive function and motor function of patients with post-stroke cognitive impairment.
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OBJECTIVE@#To analyze the acupoint selection rules of post-stroke cognitive impairment (PSCI) treated with acupuncture by ancient and modern medical record cloud platform (V1.5).@*METHODS@#The published randomized controlled trial (RCT) literature of PSCI treated with acupuncture was retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library and Web of Science, and the data was extracted to establish prescription database. The ancient and modern medical record cloud platform (V1.5) was used to analyze the data.@*RESULTS@#A total of 185 articles was included, involving 91 acupoints, the total using frequency was 1174 times. The top 5 acupoints in frequency of PSCI treated with acupuncture were Baihui (GV 20, 151 times), Shenting (GV 24, 97 times), Sishencong (EX-HN 1, 83 times), Neiguan (PC 6, 69 times) and Sanyinjiao (SP 6, 64 times); the most involved meridian was the governor vessel, and the generally used acupoints were mainly distributed in the head, face and neck. The top 5 acupoint combinations in frequency were Baihui (GV 20)-Shenting (GV 24, 89 times), Baihui (GV 20)-Sishencong (EX-HN 1, 79 times), Baihui (GV 20)-Neiguan (PC 6, 59 times), Baihui (GV 20)-Sanyinjiao (SP 6, 56 times) and Baihui (GV 20)-Zusanli (ST 36, 51 times). The acupoint combination with the strongest association was Shenting (GV 24)→Baihui (GV 20). There were 6 acupoint cluster groups according to the cluster analysis, and the main core prescription was Baihui (GV 20), Shenting (GV 24), Sishencong (EX-HN 1), Zusanli (ST 36), Neiguan (PC 6) and Sanyinjiao (SP 6).@*CONCLUSION@#Acupoints on the governor vessel, and distributed in head, face and neck are the main acupoints for PSCI treated with acupuncture, Baihui (GV 20), Shenting (GV 24), Sishencong (EX-HN 1), Zusanli (ST 36), Neiguan (PC 6) and Sanyinjiao (SP 6) can be used as the main acupoints, but it is still necessary to combine with syndrome differentiation.
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Humans , Acupuncture Points , Acupuncture Therapy , Cloud Computing , Cognitive Dysfunction , Medical RecordsABSTRACT
Post-stroke cognitive impairment （PSCI） refers to a series of syndromes from mild cognitive impairment to dementia caused by stroke. The mitogen-activated protein kinases （MAPK）signaling pathway is a key pathway for transmitting cellular signals in mammals ，and p 38 is a classic branch of it. p 38 MAPK signaling pathway is involved in various pathophysiological processes such as cell growth ，differentiation，apoptosis and inflammatory response in central nervous system diseases. At present ，great progress has been made in clinical and basic experimental studies on prevention and treatment of PSCI by traditional Chinese medicine （TCM），but there is a lack of relevant systematic summary. Therefore ，this article summarizes the role of p 38 MAPK signaling pathway in PSCI and the pharmacological research progress of TCM in prevention and treatment of PSCI through p 38 MAPK signaling pathway.
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Objective:To evaluate the efficacy and safety of traditional Chinese medicine (TCM) in the treatment of post stroke cognitive impairment (PSCI). Method:Seven databases, including CNKI, WanFang, VIP, CBM, PubMed, The Cochrane library and ClinicalTrials.gov, were electronically searched for relevant randomized controlled trials (RCTs) of TCM in the treatment of PSCI. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies, descriptive analysis was carried out on the included studies, and the Meta quantitative analysis was carried out with RevMan 5.3 software. Result:A total of 16 RCTs were included with 1 296 participants, and they were assigned to the intervention group (n=649) and the control group (n=647). The results showed that TCM combined with western medicine group and TCM group were better than western medicine group in improving the scores of Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Barthel Index (BI), Activity of Daily Living (ADL), Chinese stroke scale (CSS) and National Institutes of Health stroke scale (NIHSS) of PSCI patients, and no serious adverse events were observed. Conclusion:TCM has potential advantages in improving the cognitive function of patients with PSCI, and it also has certain efficacy in improving the daily living ability and neurological impairment symptoms, and no serious adverse events have been observed. Due to the low quality of methodology included in the studies, in order to provide reliable basis for clinical decision-making, high-quality of RCTs are still needed to study the efficacy and safety of TCM for PSCI.
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Objective::To explore the clinical efficacy of Tongqiao Huoxuetang plus acupuncture on post-stroke cognitive impairment (PSCI) and its effect on neurotransmitters and neurological function of patients. Method::Totally 122 PSCI patients admitted in our hospital from January 2017 to March 2019 were randomly divided into observation group and control group by simple random number table method, with 61 patients in each group. Both groups were given oral donepezil hydrochloride tablets. The control group was given acupuncture treatment, while the observation group was given Tongqiao Huoxuetang plus acupuncture in addition to therapy of control group. All patients were treated continuously for 4 weeks. The clinical efficacy was compared between two groups. Before and after treatment, the general cognitive function of two groups was tested by mini-mental state examination (MMSE), changes of their neurologic impairment and daily living ability were evaluated by National institutes of health stroke scale (NIHSS) and Barthel index (BI) respectively, and euzymelinked immunosorbent assay was adopted to test the levels of neurotransmitters [acetyl choline (ACh), dopamine (DA), noradrenaline (NE), 5-hydroxytryptamine (5-HT)] and neurologic impairment markers [neuronspecific enolase (NSE), visinin-like protein-1 (VILIP-1), myelin basic protein (MBP)]. And the occurrence of adverse reactions was recorded. Result::The overall effective rate of the observation group was 91.8% (56/61), which was much higher than 78.7% (48/61) of control group (P<0.05). After treatment, both groups saw much higher MMSE and BI scores but lower NIHHS scores than before treatment (P<0.05), and above indicators in observation group were improved more significantly than those in control group over the same period after treatment (P<0.05). The levels of serum ACh, DA, NE and 5-HT after treatment were obviously higher than those before treatment (P<0.05), and observation group had significantly higher ACh, DA, NE and 5-HT levels than control group over the same period (P<0.05). After treatment, both groups witnessed a great decrease in NSE, VILIP-1, MBP (P<0.05), while the observation group saw dramatically lower NSE, VILIP-1, MBP levels than control group over the same period after treatment (P<0.05). Neither of two groups saw serious adverse reactions. Conclusion::In treating PSCI, Tongqiao Huoxuetang plus acupuncture can significantly improve neurological function of the patients, which may be due to increase of neurotransmitters. Besides, Tongqiao Huoxuetang plus acupuncture is proved to be generally effective in promoting the recovery of patients' neurological function and enhancing their abilities in daily life, with a good tolerance among patients.
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Objective:To observe the effect of cognitive training based on PASS theory on cognition in patients with post-stroke cognitive impairment (PSCI). Methods:From August, 2018 to June, 2019, 42 patients with PSCI were randomly divided into control group (n = 21) and intervention group (n = 21). The intervention group accepted computer-assisted cognitive training based on the PASS theory, and the control group accepted routine computer-assisted cognitive training, for four weeks. They were assessed with Mini-Mental State Examination (MMSE) and Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) before and after training. Results:There were 18 patients in each group finishing the trail. After training, the scores of MMSE and LOTCA increased in both groups (t > 8.831, P < 0.001), and increased more in the intervention group than in the control group (t > 2.198, P < 0.05). For the LOTCA factors scores, it increased in orientation, visual perception, spatial perception, motion praxis, visuomotor organization and thinking operations in both groups (t > 2.122, P < 0.05) after training, and increased more in the intervention group than in the control group in visual perception, spatial perception and thinking operations (t > 2.356, P < 0.05), and the differences of visuomotor organization was more in the intervention group than in the control group (t = 2.354, P < 0.05). Conclusion:Cognitive training based on PASS theory can improve cognition for patients with PSCI, especially for visual perception, spatial perception, thinking operations and visuomotor organization.
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Objective: To discuss the clinical efficacy of modified Tongqiao Huoxuetang combined with ‘Huiyang Jiuzhen’ in treating post-stroke cognitive impairment (PSCI) and its mechanisms in resisting inflammation and oxidant stress and ameliorating hemorheology. Method: One hundred and twenty-two patients were randomly divided into control group (61 cases) and observation group (61 cases) by random number table. Both groups got Donepezil tablets, 10 mg/time, 1 time/day, and Nicergoline tablets, 20 mg/time, 3 times/days. Patients in control group got ‘Huiyang Jiuzhen’, 1 time/day, 6 times/week. In addition to the therapy in control group, patients in observation group got modified Tongqiao Huoxuetang, 1 dose/day. And a course of treatment was 8 weeks. Before treatment and at the 4th week and 8th week after treatment, scores of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were discussed. And activity of daily living scale (ADL), syndrome of blood stasis and cerebral collaterals were graded. And levels of Interleukin-6 (IL-6) before and after treatment, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), oxidized low density lipoprotein (Ox-LDL), superoxide dismutase (SOD), malondialdehyde (MDA), hemorheology were detected. Result: According to the rank sum test, the clinical efficacy in observation group was better than that in control group (Z=1.976, Pth week and 8th week after treatment, score of MMSE and MoCA were higher than that in control group (PPPα, CRP, DA and Ox-LDL were lower than those in control group (PPPConclusion: In addition to the routine therapy of western medicine, modified Tongqiao Huoxuetang combined with ‘Huiyangjiuzhen’ can improve patients cognitive function and daily life ability, have effects in resisting inflammation and oxidation and ameliorating hemorheology, and can promote the recovery of cognitive function.
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Objective To explore the effect of continuing nursing care based on narrative family therapy for elderly patients with post-stroke cognitive impairment non-dementia (PSCIND). Methods One hundred elderly patients with PSCIND were firstly diagnosed in Sandun Hospital District of Zhejiang Hospital from January to December 2017, the patients discharged between January and June were set as a control group, and the patients discharged between July and December were arranged in an experimental group, 50 cases in each group. Finally, 46 cases in control group and 48 cases in experimental group completed the study. The control group was given routine continuing nursing; while the experimental group was given continuing nursing based on narrative family therapy. The differences of Montreal Cognitive Assessment Scale (MoCA), Modified Barthel Index (MBI) score and Caregiver Load Scale (ZBI) score between the two groups after 12 weeks of intervention were compared. Results There were no statistical significant differences in the scores of MoCA, MBI and ZBI between the two groups before intervention (all P > 0.05). After intervention, the MoCA score of experimental group was significantly higher than that of control group (24.61±2.03 vs. 22.98±2.34, P < 0.05), and the ZBI score was obviously lower than that of control group (34.89±7.12 vs. 38.17±6.53, P < 0.05). But, there was of no statistical significant difference in MBI score between experimental group and control group (54.65±6.32 vs. 52.33±7.36, P < 0.05). Conclusion Narrative family therapy in continuing nursing care can effectively improve the cognitive function of elderly patients with PSCIND and reduce the burden of caregivers.
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Objective To investigate the relationship between serum markers β amyloid (Aβ), tau and thyroid hormone levels and post-stroke cognitive impairment (PSCI) in the acute phase of cerebral infarction. Methods A total of 214 patients with acute cerebral infarction were enrolled. The baseline data and serological indicators were collected and the cognitive function of patients was evaluated. All patients were divided into cognitive impairment group and normal group based on follow-up results. The differences of Aβ1-42, tau protein and thyroxine levels between the two groups and their relationship with disease progression were analyzed. The Cox regression analysis and ROC curve were used to compare the above parameters to predict the development of PSCI. Results The total protein level of Tau (210.6 ±98.9 pg/mL) was higher and Aβ1-42 (426.1 ±123.5 pg/mL) and triiodothyronine (T3) (1.43 ±0.57 nmol/L), free thyroxine (FT4) (13.15±2.23 pmol/L) was significantly lower in the cognitive impairment group than in the normal group (P<0.05). Tau protein (r=-0.457), Aβ1-42 (r=0.348), T3 (r=0.211), and FT4 (r=0.306) were all associated with disease progression (P<0.05). Cox regression analysis showed that Aβ1-42 and T3 were important influencing factors in the occurrence of PSCI. The area under the curve of Aβ1-42 combined with T3 was 0.841. The specificity and the sensitivity were 74.8% and 85.3%, respectively, with a diagnostic cutoff value of 0.572. Conclusion Aβ1-42 and T3 levels in the acute phase of cerebral infarction may predict the progression of PSCI.
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Objective To explore the predictive value of short term cognitive assessment in the acute phase of ischemic stroke for 3-6 months after stroke.Methods The demographic data,vascular risk factors,clinical and imaging data of 254 patients with acute ischemic stroke from August 2016 to December 2017 were prospectively registered.The cognitive function was assessed by Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) 3 weeks after stroke onset.Comprehensive cognitive function assessment was performed after 3-6 months of stroke.Multiple factor Logistic regression was used to screen the independent risk factors of cognitive domain and overall cognitive function in 3-6 months.Results Totally 254 consecutive patients with acute ischemic stroke were enrolled.Combined with the inclusion and exclusion criteria,161 patients completed the baseline cognitive assessment,and 138 completed the comprehensive cognitive assessment in 3-6 months after stroke.Logistic regression analysis showed that 3 weeks baseline cognitive status was an independent factor affecting memory (P＜0.05,OR =62.47,95％CI=13.00-205.00),execution (P＜0.05,OR=38.29,95％CI=8.00-170.00),language (P＜0.05,OR=6.46,95％CI=2.31-18.04) and information processing speed (P＜0.05,OR=5.88,95％CI=2.24-15.41) in 3-6 months after stroke.According to the number of impaired cognitive domains,the overall cognitive function was defined.There were 61 cases of no or mild cognitive dysfunction group and 77 cases of moderate or severe cognitive impairment group.Multifactor logistic analysis showed that baseline cognitive status was independent of the overall cognitive function of 3-6 months after apoplexy adjusting for the age and education level (P＜0.05,OR=25.32,95％ CI =7.52-85.39).Conclusion Short cognitive assessment in early apoplexy can predict the short-term functional status of cognitive domains such as memory,execution,language and information processing speed after stroke,and can also predict the overall cognitive level.
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Objective To observe the change of histone acetylation homeostasis of the central cholinergic circuits in mice with post-stroke cognitive impairment (PSCI). Methods The male ICR mice were divided into sham group (n=60) and PSCI group (n=60). The middle cerebral artery occlusion (MCAO) model was established. The Morris water maze test was used to test the cognitive function, and the changes of function and the histone acetylation homeostasis of the central cholinergic circuits of unaffected side were detected by molec-ular biology methods. Results Compared with the sham group, the scores of Morris water maze test decreased in PSCI group (t>29.412, P26.227, P28.593, P24.126, P25.634, P24.704, P<0.05). Conclusion Transient MCAO could cause PSCI. The function of the central cholinergic circuits was impaired, especially the his-tone acetylation homeostasis of the central cholinergic circuits, such as the acetylated histone level of ChAT promoter decreased. All of that might be related with the decline of p-CREB and CBP level in the corresponding brain regions induced by stroke.
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Objective To investigate the relationship between Post stroke depression (PSD) and Post stroke cognitive impairment (PSCI) using proton magnetic resonance spectroscopy.Methods 82 patients of acute stroke,which were met with the third edition of the Chinese Classification of Mental Disorders (CCMD-Ⅲ) and expert consensus of cognitive impairment since January 2012 to December 2012,Select continuously 82 patients who are hospitalized in our hospital due to acute stroke from January 2012 to December 2012 from Zhongnan Hospital of Wuhan University,were examined by 1H-MRS in one month.They were divided into PSD and PSCI simultaneously (n =19),PSD (n =21),PSCI (n =22) and control group (n =20).Results The differences between PSD and PSCI was not significant.On hippocampus japonicas,the Cho/Cr ratio in patients of A group (left (1.05 ± 0.10),right(1.18 ± 0.15)),showed higher than those in B group (left (0.84 ± 0.10),right (0.88 ± 0.08)),C group (left(0.88 ±0.08),right (0.87 ±0.07)),D group(left(0.87 ±0.06),right(0.89 ±0.06)).The difference was statistically significant.PSD and PSCI promoted each other in influencing Cho/Cr ratio.Conclusion There is no significant relationship between PSD and PSCI in the produce of disease,and they can promote each other in hippocampus japonicas Cho/Cr ratio.
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VCI represents a spectrum of cognitive impairments associated with stroke, vascular brain injury, or subclinical disease ranging from the least to most severe manifestations. Few studies are available on the prevalence of post-stroke VCI and none have been conducted in Brazil. Objective: To determine the prevalence rates of VCI and associated risk factors in a sample of ischemic stroke patients. Methods: We evaluated 172 patients with ischemic stroke for cognitive impairment one year after ictus. Results: Patients comprised 81 women (47.1%) and had a mean age of 67.77 (7.86) years, schooling of 3.52 (2.99) years, and MMSE score of 24.94 (3.59) points. After cognitive evaluation, 4.6% were diagnosed as CIND(cognitive impairment no dementia) and 12.2% had a diagnosis of dementia (probable vascular dementia in 20 patients and one subject with cerebrovascular disease and Alzheimers disease). Conclusion: The prevalence of dementia was lower than previous reports but our sample had a lower age than others, while a 12 month-period of follow-up prevented interference from associated neurodegenerative disorders.
CCV representa um espectro de comprometimento cognitivo associado ao AVC, lesão cerebral vascular ou doença subclínica que vai desde as manifestações menos graves às mais graves. Há poucos estudos sobre a prevalência de CCV pós AVC e nenhum no Brasil. Objetivo: Determinar a prevalência de VCI em uma amostra de pacientes com AVC isquêmico e fatores de risco associados. Métodos: Foram avaliados 172 pacientes com AVC isquêmico após um ano do ictus, em relação ao comprometimento cognitivo. Resultados: Os pacientes foram compostos por 81 mulheres (47,1%) e tinham idade média de 67,77 (7,86) anos, a escolaridade de 3,52 (2,99) anos, a pontuação do MEEM de 24,94 (3,59)pontos. Após a avaliação cognitiva, 4,6% foram diagnosticados como CCSD (comprometimento cognitivo sem demência) e 12,2% tiveram diagnóstico de demência (demência vascular provável em 20 pacientes e um com doença cerebrovascular e doença de Alzheimer). Conclusão: A prevalência de demência na nossa população está entre as mais baixas, porém,nossos pacientes são mais jovens e foram acompanhados por um período de 12 meses, o que evita a contaminação por doenças neurodegenerativas associadas.