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Aim: This study aimed to explore the effect of enriched rehabilitation (ER) on cognitive function and serum glutamate levels in patients with stroke. Methods: Forty patients diagnosed with post-stroke cognitive impairment (PSCI), according to the inclusion criteria, and undergoing inpatient rehabilitation were enrolled in the study. Patients were randomly assigned to receive 8 weeks of ER treatment (ER group; n = 20) or conventional medical treatment (CM group; n = 20). In addition, 20 age-matched healthy subjects who were outpatients in our hospital during the same period formed the healthy control (HC) group. In- and between-group differences in cognitive function were assessed during pre-intervention and post-intervention based on the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Trail Making Test (TMT). The serum levels of glutamate, tumor necrosis factor (TNF), and malondialdehyde (MDA) levels were also detected pre-intervention and post-intervention. Results: Pre-intervention cognitive function and the levels of all the serum parameters assessed significant difference between the HC group and the PSCI group (both ER and CM groups) (p < 0.05), but not between the two groups of patients with PSCI (p > 0.05). Significant improvements were observed in cognitive function in both the ER and the CM groups post-intervention compared with pre-intervention, as evidenced by the measured improvement in MoCA, SDMT, and TMT scores. Similar improvements were seen for serum glutamate, the degree of oxidative damage, and the level of inflammation in both the treatment groups (p < 0.05). More enhancements in cognitive function, including MoCA, SDMT, TMT scores, and the serum levels of glutamate, the degree of oxidative damage, and the level of inflammation were shown in the ER group compared with the CM group post-intervention (p < 0.05). Conclusions: ER can improve cognitive function in patients with PSCI. The associated mechanism may be related to the negative regulatory effect of ER on serum glutamate, TNF, and MDA levels, which is likely to enhance synaptic plasticity and alleviate oxidative stress- and inflammation-related damage, at least to some extent.
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Objective:To observe the effect of enriched rehabilitation on dual-task gait disorder after a transient ischemic attack (TIA) and explore its mechanism.Methods:Sixty TIA patients were randomly divided into a control group and an observation group, each of 30. Another 30 healthy counterparts were selected to form a healthy control group. All of the TIA patients were given routine medication to lower blood pressure and improve brain function, while the observation group was additionally provided with enriched rehabilitation training for 12 weeks. Before and after the intervention, the gait and cognitive functioning of all of the subjects were quantified and their event-related potentials (P300s) and serum brain-derived neurotrophic factor (BDNF) levels were also measured.Results:Before the treatment there were significant differences between the TIA groups and healthy controls in all of the measurements, but there were no significant differences between the control and observation groups. After the treatment, no significant improvement was observed in any of the control group′s results, but there was significant improvement in the observation group′s gait parameters, cognitive functioning, average serum BDNF concentration and in the average latency and amplitude of its P300 signals.Conclusions:Enriched rehabilitation can improve the gait of TIA patients, perhaps through increasing their serum BDNF concentration and improving their cognition.
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Background: Studies on non-pharmacological strategies for improving gait performance and cognition in Parkinson's disease (PD) are of great significance. We aimed to investigate the effect of and mechanism underlying enriched rehabilitation as a potentially effective strategy for improving gait performance and cognition in early-stage PD. Methods: Forty participants with early-stage PD were randomly assigned to receive 12 weeks (2 h/day, 6 days/week) of enriched rehabilitation (ER; n = 20; mean age, 66.14 ± 4.15 years; 45% men) or conventional rehabilitation (CR; n = 20; mean age 65.32 ± 4.23 years; 50% men). In addition, 20 age-matched healthy volunteers were enrolled as a control (HC) group. We assessed the general motor function using the Unified PD Rating Scale-Part III (UPDRS-III) and gait performance during single-task (ST) and dual-task (DT) conditions pre- and post-intervention. Cognitive function assessments included the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Trail Making Test (TMT), which were conducted pre- and post-intervention. We also investigated alteration in positive resting-state functional connectivity (RSFC) of the left dorsolateral prefrontal cortex (DLPFC) in participants with PD, mediated by ER, using functional magnetic resonance imaging (fMRI). Results: Compared with the HC group, PD participants in both ER and CR groups performed consistently poorer on cognitive and motor assessments. Significant improvements were observed in general motor function as assessed by the UPDRS-III in both ER and CR groups post-intervention. However, only the ER group showed improvements in gait parameters under ST and DT conditions post-intervention. Moreover, ER had a significant effect on cognition, which was reflected in increased MoCA, SDMT, and TMT scores post-intervention. MoCA, SDMT, and TMT scores were significantly different between ER and CR groups post-intervention. The RSFC analysis showed strengthened positive functional connectivity between the left DLPFC and other brain areas including the left insula and left inferior frontal gyrus (LIFG) post-ER. Conclusion: Our findings indicated that ER could serve as a potentially effective therapy for early-stage PD for improving gait performance and cognitive function. The underlying mechanism based on fMRI involved strengthened RSFC between the left DLPFC and other brain areas (e.g., the left insula and LIFG).
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Objective:To observe the effects of enriched rehabilitation on cognitive function and serum arginine in stroke patients. Methods:From January, 2017 to June, 2018, 40 patients in our department were randomly divided into conventional group (n = 20) and enriched group (n = 20). The conventional group received cognitive rehabilitation, and the enriched group received enriched rehabilitation, once a day, six times a week for three months. Before treatment and three months after treatment, the cognitive function was assessed with Montreal Cognitive Assessment (MoCA), Digit Span Test and Stroop Color Word Test, and the levels of serum arginine and malondialdehyde were detected. Results:Finally, all the patients completed the experiment. There was no significant difference in the scores of MoCA, Digit Span Test and Stroop Color Word Test, and the level of serum arginine and malondialdehyde before treatment (t < 1.243, P > 0.05). Three months after treatment, all the above indexes improved (t > 2.170, P < 0.05), and were better in the enriched group than in the conventional group (t > 2.278, P < 0.05). Conclusion:Enriched rehabilitation could improve the cognitive function of patients after stroke, which might be related to the significant reduction of the elevated serum arginine and reduction of oxidative damage after stroke.
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Stroke is the second leading cause of death and the preeminent cause of neurological disability. Attempts to limit brain injury after ischemic stroke with clot-dissolving drugs have met with great success but their use remains limited due to a narrow therapeutic time window and concern over serious side effects. Unfortunately, the neuroprotective strategy failed in clinical trials. A more promising approach is to promote recovery of function in people affected by stroke. Following stroke, there is a heightened critical period of plasticity that appears to be receptive to exogenous interventions (e.g., delivery of growth factors) designed to enhance neuroplasticity processes important for recovery. An emerging concept is that combinational therapies appear much more effective than single interventions in improving stroke recovery. One of the most promising interventions, with clinical feasibility, is enriched rehabilitation, a combination of environmental enrichment and task-specific therapy.
