Rehabilitation of post-stroke cognitive impairment_West China Medical Journal

Authors：

 ZHANG Tong ^1,2 , WANG Qiang ^1,2

1. Neurorehabilitation Centre, Beijing Bo’ai Hospital, China Rehabilitation Research Centre, Beijing 100068, P. R. China;
2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, P. R. China;

Corresponding author：

ZHANG Tong, Email: tom611@126.com

Keywords：

Stroke; Cognitive impairment; Rehabilitation

DOI：

10.7507/1002-0179.201903243

Video：

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Post-stroke cognitive impairment (PSCI) which has been a barrier to the rehabilitation, could be prevented and treated. Early assessment of cognitive impairment, as well as diagnosis and comprehensive interventions of PSCI would improve rehabilitation of stroke patients. The rehabilitation, as an important component of the comprehensive intervention, could improve cognitive function, delay disease progression, and optimize the daily life. The widely-used rehabilitation methods include cognitive intervention, exercise training, music therapy, and neuromodulation techniques, etc. Comprehensive cognitive training covering multiple cognitive domains and multimodal intervention can significantly improve the overall cognitive function of patients. The research in the PSCI field is still in its infancy in China. Thus, It is necessary to pay more attention to the PSCI clinically, and unveil the unkown area in PSCI.

Citation： ZHANG Tong, WANG Qiang. Rehabilitation of post-stroke cognitive impairment. West China Medical Journal, 2019, 34(5): 481-486. doi: 10.7507/1002-0179.201903243 Copy

1.	王陇德, 刘建民, 杨弋, 等. 我国脑卒中防治仍面临巨大挑战—《中国脑卒中防治报告 2018》概要. 中国循环杂志, 2019, 34(2): 105-119.
2.	董强, 郭起浩, 罗本燕, 等. 卒中后认知障碍管理专家共识. 中国卒中杂志, 2017, 12(6): 519-531.
3.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association, 2013: 621-624.
4.	World Health Organization. International classification of diseases 10th Revision. 5th ed. Geneva: World Health Organization, 2016: 148-159.
5.	Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2011, 42(9): 2672-2713.
6.	Sachdev P, Kalaria R, O’Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord, 2014, 28(3): 206-218.
7.	Qu Y, Zhuo L, Li N, et al. Prevalence of post-stroke cognitive impairment in China: a community-based, cross-sectional study. PLoS One, 2015, 10(4): e0122864.
8.	曲艳吉, 卓琳, 詹思延. 中国脑卒中后认知障碍流行病学特征的系统评价. 中华老年心脑血管病杂志, 2013, 15(12): 1294-1301.
9.	Nys GM, van Zandvoort MJ, van der Worp HB, et al. Early cognitive impairment predicts long term depressive symptoms and quality of life after stroke. J Neurol Sci, 2006, 247(2): 149-156.
10.	Cumming TB, Churilov L, Linden T, et al. Montreal cognitive assessment and mini-mental state examination are both valid cognitive tools in stroke. Acta Neurol Scand, 2013, 128(2): 122-129.
11.	Koski L. Validity and applications of the Montreal cognitive assessment for the assessment of vascular cognitive impairment. Cerebrovasc Dis, 2013, 36(1): 6-18.
12.	巩尊科, 陈伟, 韩良, 等. 洛文斯顿作业疗法认知评定量表在脑卒中认知评定中的临床应用. 中华物理医学与康复杂志, 2012, 34(9): 661-664.
13.	Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 1969, 9(3): 179-186.
14.	Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke, 2006, 37(9): 2220-2241.
15.	Ylikoski R, Jokinen H, Andersen P, et al. Comparison of the Alzheimer’s Disease Assessment Scale Cognitive Subscale and the Vascular Dementia Assessment Scale in differentiating elderly individuals with different degrees of white matter changes. Dement Geriatr Cogn Disord, 2007, 24(2): 73-81.
16.	Hill NT, Mowszowski L, Naismith SL, et a1. Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. Am J Psychiatry, 2017, 174(4): 329-340.
17.	Ylvisaker M, Hanks R, Johnson-Greene D. Perspectives on rehabilitation of individuals with cognitive impairment after brain injury: rationale for reconsideration of theoretical paradigms. J Head Trauma Rehabil, 2002, 17(3): 191-209.
18.	Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: a review. Neuropsyehol Rehabil, 2004, 14(4): 385-401.
19.	Cha YJ, Kim H. Effect of computer-based cognitive rehabilitation (CBCR) for people with stroke: a systematic review and meta-analysis. NeuroRehabilitation, 2013, 32(2): 359-368.
20.	Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016, 47(6): e98-e169.
21.	De Luca R, Leonardi S, Spadaro L, et al. Improving cognitive function in patients with stroke: can computerized training be the future? . J Stroke Cerebrovasc Dis, 2018, 27(4): 1055-1060.
22.	Gamito P, Oliveira J, Coelho C, et al. Cognitive training on stroke patients via virtual reality-based serious games. Disabil Rehabil, 2017, 39(4): 385-388.
23.	Park JY, Kim YH, Chang WH, et al. Significance of longitudinal changes in the default-mode network for cognitive recovery after stroke. Eur J Neurosci, 2014, 40(4): 2715-2722.
24.	Lin ZC, Tao J, Gao YL, et al. Analysis of central mechanism of cognitive training on cognitive impairment after stroke: resting-state functional magnetic resonance imaging study. J Int Med Res, 2014, 42(3): 659-668.
25.	Faria AL, Andrade A, Soares L, et al. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil, 2016, 13(1): 96.
26.	Spector A, Orrell M, Woods B. Cognitive stimulation therapy (CST): effects on different areas of cognitive function for people with dementia. Int J Geriatr Psychiatry, 2010, 25(12): 1253-1258.
27.	Yuill N, Hollis V. A systematic review of cognitive stimulation therapy for older adults with mild to moderate dementia: an occupational therapy perspective. Oecup Ther Int, 2011, 18(4): 163-186.
28.	Prince M, Bryce R, Ferri C, et al. World Alzheimer report 2011: the benefits of early diagnosis and intervention. Alzheimer’s Disease international, 2011. [2019-03-21]. https://www.alz.co.uk/research/WorldAlzheimerReport2011.pdf.
29.	Oberlin LE, Waiwood AM, Cumming TB, et al. Effects of physical activity on poststroke cognitive function: a meta-analysis of randomized controlled trials. Stroke, 2017, 48(11): 3093-3100.
30.	García-Soto E, López de Munaín ML, Santibáñez M. Effects of combined aerobic and resistance training on cognition following stroke: a systematic review. Rev Neurol, 2013, 57(12): 535-541.
31.	Marzolini S, Oh P, Mcllroy W, et al. The effects of an aerobic and resistance exercise training program on cognition following stroke. Neurorehabil Neural Repair, 2013, 27(5): 392-402.
32.	Moore SA, Hallsworth K, Jakovljevic DG, et al. Effects of community exercise therapy on metabolic, brain, physical, and cognitive function following stroke: a randomized controlled pilot trial. Neurorehabil Neural Repair, 2015, 29(7): 623-635.
33.	Groot C, Hooghiemstra AM, Raijmakers PG, et al. The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Res Rev, 2016, 25: 13-23.
34.	Boss HM, Van Schaik SM, Deijle IA, et al. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol. BMJ Open, 2014, 4(12): e007065.
35.	Choi DH, Lee KH, Lee J. Effect of exercise-induced neurogenesis on cognitive function deficit in a rat model of vascular dementia. Mol Med Rep, 2016, 13(4): 2981-2990.
36.	贺旭, 刘英飞, 王伟, 等. 丰富环境在血管性痴呆中的作用. 湘南学院(医学版), 2017, 19(3): 68-71.
37.	Lancioni GE, Singh NN, O’Reilly MF, et al. Self-regulated music stimulation for persons with Alzheimer’s disease: impact assessment and social validation. Dev Neurorehabil, 2013, 16(1): 17-26.
38.	张诗琪, 赖锦玉, 黄金月. 音乐干预在痴呆症患者中的应用研究. 中华护理杂志, 2011, 46(10): 1042-1045.
39.	吕继辉, 高天, 李沫, 等. 音乐治疗对轻度阿尔茨海默病患者记忆、语言和精神症状的作用. 中华神经科杂志, 2014, 47(12): 831-835.
40.	高天, 王茜茹. 国外音乐治疗在老年痴呆症中的研究与应用. 医学与哲学(临床决策论坛版), 2007, 28(345): 17-21.
41.	孟涛, 张敏, 马骞, 等. 音乐疗法对非痴呆型血管性认知功能障碍患者的治疗和观察. 癫痫与神经电生理学杂志, 2018, 27(4): 198-201.
42.	王鑫, 孙彩花, 施伟, 等. 音乐疗法对卒中后认知障碍的临床疗效. 实用临床医药杂志, 2014, 18(19): 10-13, 16.
43.	Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol, 2000, 527(Pt 3): 633-639.
44.	Siebner HR, Rothwell J. Transcranial magnetic stimulation: new insights into representational cortical plasticity. Exp Brain Res, 2003, 148: 1-16.
45.	Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review. J Neural Tranam (Vienna), 2010, 117(1): 105-122.
46.	曲斯伟, 宋为群. 经颅直流电刺激在卒中后认知功能障碍康复中的研究进展. 中国脑血管病杂志, 2016, 13(4): 219-224.
47.	恽晓平. 认知康复的发展方向与趋势. 中国康复理论与实践, 2016, 22(5): 497-498.

1. 王陇德, 刘建民, 杨弋, 等. 我国脑卒中防治仍面临巨大挑战—《中国脑卒中防治报告 2018》概要. 中国循环杂志, 2019, 34(2): 105-119.
2. 董强, 郭起浩, 罗本燕, 等. 卒中后认知障碍管理专家共识. 中国卒中杂志, 2017, 12(6): 519-531.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association, 2013: 621-624.
4. World Health Organization. International classification of diseases 10th Revision. 5th ed. Geneva: World Health Organization, 2016: 148-159.
5. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2011, 42(9): 2672-2713.
6. Sachdev P, Kalaria R, O’Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord, 2014, 28(3): 206-218.
7. Qu Y, Zhuo L, Li N, et al. Prevalence of post-stroke cognitive impairment in China: a community-based, cross-sectional study. PLoS One, 2015, 10(4): e0122864.
8. 曲艳吉, 卓琳, 詹思延. 中国脑卒中后认知障碍流行病学特征的系统评价. 中华老年心脑血管病杂志, 2013, 15(12): 1294-1301.
9. Nys GM, van Zandvoort MJ, van der Worp HB, et al. Early cognitive impairment predicts long term depressive symptoms and quality of life after stroke. J Neurol Sci, 2006, 247(2): 149-156.
10. Cumming TB, Churilov L, Linden T, et al. Montreal cognitive assessment and mini-mental state examination are both valid cognitive tools in stroke. Acta Neurol Scand, 2013, 128(2): 122-129.
11. Koski L. Validity and applications of the Montreal cognitive assessment for the assessment of vascular cognitive impairment. Cerebrovasc Dis, 2013, 36(1): 6-18.
12. 巩尊科, 陈伟, 韩良, 等. 洛文斯顿作业疗法认知评定量表在脑卒中认知评定中的临床应用. 中华物理医学与康复杂志, 2012, 34(9): 661-664.
13. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 1969, 9(3): 179-186.
14. Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke, 2006, 37(9): 2220-2241.
15. Ylikoski R, Jokinen H, Andersen P, et al. Comparison of the Alzheimer’s Disease Assessment Scale Cognitive Subscale and the Vascular Dementia Assessment Scale in differentiating elderly individuals with different degrees of white matter changes. Dement Geriatr Cogn Disord, 2007, 24(2): 73-81.
16. Hill NT, Mowszowski L, Naismith SL, et a1. Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. Am J Psychiatry, 2017, 174(4): 329-340.
17. Ylvisaker M, Hanks R, Johnson-Greene D. Perspectives on rehabilitation of individuals with cognitive impairment after brain injury: rationale for reconsideration of theoretical paradigms. J Head Trauma Rehabil, 2002, 17(3): 191-209.
18. Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: a review. Neuropsyehol Rehabil, 2004, 14(4): 385-401.
19. Cha YJ, Kim H. Effect of computer-based cognitive rehabilitation (CBCR) for people with stroke: a systematic review and meta-analysis. NeuroRehabilitation, 2013, 32(2): 359-368.
20. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016, 47(6): e98-e169.
21. De Luca R, Leonardi S, Spadaro L, et al. Improving cognitive function in patients with stroke: can computerized training be the future? . J Stroke Cerebrovasc Dis, 2018, 27(4): 1055-1060.
22. Gamito P, Oliveira J, Coelho C, et al. Cognitive training on stroke patients via virtual reality-based serious games. Disabil Rehabil, 2017, 39(4): 385-388.
23. Park JY, Kim YH, Chang WH, et al. Significance of longitudinal changes in the default-mode network for cognitive recovery after stroke. Eur J Neurosci, 2014, 40(4): 2715-2722.
24. Lin ZC, Tao J, Gao YL, et al. Analysis of central mechanism of cognitive training on cognitive impairment after stroke: resting-state functional magnetic resonance imaging study. J Int Med Res, 2014, 42(3): 659-668.
25. Faria AL, Andrade A, Soares L, et al. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil, 2016, 13(1): 96.
26. Spector A, Orrell M, Woods B. Cognitive stimulation therapy (CST): effects on different areas of cognitive function for people with dementia. Int J Geriatr Psychiatry, 2010, 25(12): 1253-1258.
27. Yuill N, Hollis V. A systematic review of cognitive stimulation therapy for older adults with mild to moderate dementia: an occupational therapy perspective. Oecup Ther Int, 2011, 18(4): 163-186.
28. Prince M, Bryce R, Ferri C, et al. World Alzheimer report 2011: the benefits of early diagnosis and intervention. Alzheimer’s Disease international, 2011. [2019-03-21]. https://www.alz.co.uk/research/WorldAlzheimerReport2011.pdf.
29. Oberlin LE, Waiwood AM, Cumming TB, et al. Effects of physical activity on poststroke cognitive function: a meta-analysis of randomized controlled trials. Stroke, 2017, 48(11): 3093-3100.
30. García-Soto E, López de Munaín ML, Santibáñez M. Effects of combined aerobic and resistance training on cognition following stroke: a systematic review. Rev Neurol, 2013, 57(12): 535-541.
31. Marzolini S, Oh P, Mcllroy W, et al. The effects of an aerobic and resistance exercise training program on cognition following stroke. Neurorehabil Neural Repair, 2013, 27(5): 392-402.
32. Moore SA, Hallsworth K, Jakovljevic DG, et al. Effects of community exercise therapy on metabolic, brain, physical, and cognitive function following stroke: a randomized controlled pilot trial. Neurorehabil Neural Repair, 2015, 29(7): 623-635.
33. Groot C, Hooghiemstra AM, Raijmakers PG, et al. The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Res Rev, 2016, 25: 13-23.
34. Boss HM, Van Schaik SM, Deijle IA, et al. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol. BMJ Open, 2014, 4(12): e007065.
35. Choi DH, Lee KH, Lee J. Effect of exercise-induced neurogenesis on cognitive function deficit in a rat model of vascular dementia. Mol Med Rep, 2016, 13(4): 2981-2990.
36. 贺旭, 刘英飞, 王伟, 等. 丰富环境在血管性痴呆中的作用. 湘南学院(医学版), 2017, 19(3): 68-71.
37. Lancioni GE, Singh NN, O’Reilly MF, et al. Self-regulated music stimulation for persons with Alzheimer’s disease: impact assessment and social validation. Dev Neurorehabil, 2013, 16(1): 17-26.
38. 张诗琪, 赖锦玉, 黄金月. 音乐干预在痴呆症患者中的应用研究. 中华护理杂志, 2011, 46(10): 1042-1045.
39. 吕继辉, 高天, 李沫, 等. 音乐治疗对轻度阿尔茨海默病患者记忆、语言和精神症状的作用. 中华神经科杂志, 2014, 47(12): 831-835.
40. 高天, 王茜茹. 国外音乐治疗在老年痴呆症中的研究与应用. 医学与哲学(临床决策论坛版), 2007, 28(345): 17-21.
41. 孟涛, 张敏, 马骞, 等. 音乐疗法对非痴呆型血管性认知功能障碍患者的治疗和观察. 癫痫与神经电生理学杂志, 2018, 27(4): 198-201.
42. 王鑫, 孙彩花, 施伟, 等. 音乐疗法对卒中后认知障碍的临床疗效. 实用临床医药杂志, 2014, 18(19): 10-13, 16.
43. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol, 2000, 527(Pt 3): 633-639.
44. Siebner HR, Rothwell J. Transcranial magnetic stimulation: new insights into representational cortical plasticity. Exp Brain Res, 2003, 148: 1-16.
45. Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review. J Neural Tranam (Vienna), 2010, 117(1): 105-122.
46. 曲斯伟, 宋为群. 经颅直流电刺激在卒中后认知功能障碍康复中的研究进展. 中国脑血管病杂志, 2016, 13(4): 219-224.
47. 恽晓平. 认知康复的发展方向与趋势. 中国康复理论与实践, 2016, 22(5): 497-498.

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