经颅直流电刺激联合认知-运动双任务训练对脑卒中后认知障碍患者记忆和执行功能的影响

doi:10.11958/20250535

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 624-628.doi: 10.11958/20250535

经颅直流电刺激联合认知-运动双任务训练对脑卒中后认知障碍患者记忆和执行功能的影响

冉龙飞¹(), 郭军辉², 栾玲芹¹, 聂志强¹, 王彤宇³^,^△()

1 北大医疗海洋石油医院康复医学中心（邮编300452）
2 北京大学工学院
3 北大医疗海洋石油医院神经内科

收稿日期:2025-02-12 修回日期:2025-03-22 出版日期:2025-06-15 发布日期:2025-06-20
通讯作者: ^△E-mail：wangtongyu.hy@founder.com
作者简介:冉龙飞（1990），男，中级康复治疗师，主要从事神经系统疾病康复治疗研究。E-mail：564171630@qq.com
基金资助:
吴阶平医学基金会临床科研专项资助基金课题(320.6750.2023—15—12)

Effects of transcranial direct current stimulation combined with cognitive-motor dual task training on memory and executive function in patients with post-stroke cognitive impairment

RAN Longfei¹(), GUO Junhui², LUAN Lingqin¹, NIE Zhiqiang¹, WANG Tongyu³^,^△()

1 Rehabilitation Medicine Center, Peking University Medical Offshore Oil Hospital, Tianjin 300452, China
2 School of Engineering, Peking University
3 Department of Neurology, Peking University Medical Offshore Oil Hospital

Received:2025-02-12 Revised:2025-03-22 Published:2025-06-15 Online:2025-06-20
Contact: ^△E-mail: wangtongyu.hy@founder.com

冉龙飞, 郭军辉, 栾玲芹, 聂志强, 王彤宇. 经颅直流电刺激联合认知-运动双任务训练对脑卒中后认知障碍患者记忆和执行功能的影响[J]. 天津医药, 2025, 53(6): 624-628.

RAN Longfei, GUO Junhui, LUAN Lingqin, NIE Zhiqiang, WANG Tongyu. Effects of transcranial direct current stimulation combined with cognitive-motor dual task training on memory and executive function in patients with post-stroke cognitive impairment[J]. Tianjin Medical Journal, 2025, 53(6): 624-628.

摘要/Abstract

摘要：

目的探讨经颅直流电刺激（tDCS）联合认知-运动双任务（CMDT）训练对脑卒中后认知障碍患者记忆和执行功能的影响。方法将75例脑卒中患者随机分为tDCS组、CMDT组和联合组，每组25例。3组患者均予常规康复治疗，tDCS组采用tDCS刺激病灶背外侧前额叶（DLPFC），CMDT组进行认知-运动双任务训练，联合组在tDCS治疗的基础上增加CMDT训练。治疗前和治疗4周后，分别采用韦氏记忆量表第4版（WMS-Ⅳ）、威斯康星卡片测验（WCST）、蒙特利尔认知评估量表（MoCA）、改良Barthel指数（MBI）评估患者记忆功能、执行功能、认知功能和日常生活能力。结果治疗前3组各项评定指标差异无统计学意义（P>0.05）；治疗后，3组WCST、WMS-Ⅳ、MoCA、MBI评分较治疗前均有改善（P<0.05），且联合组显著优于tDCS组和CMDT组（P<0.05）。结论 tDCS联合CMDT训练可改善脑卒中后认知功能，同时对记忆和执行功能具有协同改善作用。

关键词: 卒中, 认知障碍, 记忆, 经颅直流电刺激, 认知-运动双任务训练, 执行功能

Abstract:

Objective To explore the influences of transcranial direct current stimulation (tDCS) in combination with cognitive-motor dual task training (CMDT) on memory and executive function in patients suffering from post-stroke cognitive impairment. Methods A total of 75 stroke patients were randomly divided into the tDCS group, the CMDT group and the combined group, each consisting of 25 cases. All patients in the three groups received routine rehabilitation treatment. The tDCS group underwent tDCS stimulation of dorsolateral prefrontal lobe (DLPFC）of the region, the CMDT group received CMDT and the combined group received CMDT on the basis of tDCS treatment. The fourth edition of the Wechsler Memory Scale (WMS-IV), Wisconsin Card Test (WCST), Montreal Cognitive Assessment (MoCA) and Modified Barthel Index (MBI) were used to evaluate the overall cognitive function, memory, executive function, and daily living ability of the patients before and 4 weeks after treatment, respectively. Results Before treatment, there were no significant differences in the evaluation indices between the three groups (P>0.05). After 4 weeks of treatment, the scores of WCST, WMS-IV, MoCA and MBI in the three groups were improved compared with those before the treatment (P<0.05), and the combined group was significantly superior to the tDCS group and the CMDT group (P<0.05). Conclusion The combination of tDCS and CMDT can improve the cognitive function after stroke, and at the same time exert a synergistic effect on memory and executive function.

Key words: stroke, cognition disorders, memory, transcranial direct current stimulation, cognitive-motor dual task training, executive function

中图分类号:

R493，R743.9

图/表 3

参考文献 22

[1]	《中国脑卒中防治报告2021》编写组. 《中国脑卒中防治报告2021》概要[J]. 中国脑血管病杂志, 2023, 20(11):783-793.
	Report on Stroke Prevention and Treatment in China Writing Group. Summary of China stroke prevention and treatment report 2021[J]. Chin J Cerebrovasc Dis, 2023, 20(11):783-793. doi:10.3969/j.issn.1672-5921.2023.11.009.
[2]	汪凯, 董强, 郁金泰, 等. 卒中后认知障碍管理专家共识2021[J]. 中国卒中杂志, 2021, 16(4):376-389.
	WANG K, DONG Q, YU J T, et al. Expert consensus on the management of post-stroke cognitive impairment 2021[J]. Chin J Stroke, 2021, 16(4):376-389. doi:10.3969/j.issn.1673-5765.2021.04.011.
[3]	张通, 王强. 卒中后认知障碍的康复治疗[J]. 华西医学, 2019, 34(5):481-486.
	ZHANG T, WANG Q. Rehabilitation treatment for post-stroke cognitive impairment[J]. West China Med J, 2019, 34(5):481-486. doi:10.7507/1002-0179.201903243.
[4]	LONGO V, BARBATI SA, RE A, et al. Transcranial direct current stimulation enhances neuroplasticity and accelerates motor recovery in a stroke mouse model[J]. Stroke, 2022, 53(5):1746-1758. doi:10.1161/STROKEAHA.121.034200.
[5]	张璐, 张卫, 袁长红, 等. 经颅直流电刺激联合右佐匹克隆治疗慢性失眠患者的临床研究[J]. 天津医药, 2023, 51(11):1227-1231.
	ZHANG L, ZHANG W, YUAN C H, et al. Clinical study of transcranial direct current stimulation combined with eszopiclone in the treatment of chronic insomnia[J]. Tianjin Med J, 2023, 51(11):1227-1231. doi:10.11958/20230429.
[6]	MULLICK A A, BANIÑA M C, TOMITA Y, et al. Obstacle avoidance and dual-tasking during reaching while standing in patients with mild chronic stroke[J]. Neurorehabil Neural Repair, 2021, 35(10):915-928. doi:10.1177/15459683211023190.
[7]	中国医师协会神经内科分会认知障碍专业委员会, 《中国血管性认知障碍诊治指南》编写组. 2019年中国血管性认知障碍诊治指南[J]. 中华医学杂志, 2019, 99(35):2737-2744.
	Professional Committee of Cognitive Impairment,Society of Neurology, Chinese Medical Doctor Association,Writing Group of Chinese Guidelines for diagnosis and treatment of vascular cognitive Impairment. Chinese guidelines for the diagnosis and treatment of vascular cognitive impairment,2019[J]. Natl Med J Chin, 2019, 99(35):2737-2744. doi:10.3760/cma.j.issn.0376-2491.2019.35.005.
[8]	KOPP B, LANGE F, STEINKE A. The reliability of the wisconsin card sorting test in clinical practice[J]. Assessment, 2021, 28(1):248-263. doi:10.1177/1073191119866257.
[9]	王健, 邹义壮, 崔界峰, 等. 韦克斯勒记忆量表第四版中文版(成人版)的修订[J]. 中国心理卫生杂志, 2015, 29(01):53-59.
	WANG J, ZOU Y Z, CUI J F, et al. Revision of the Wechsler memory scale-fourth edition chinese version(adult battery)[J]. Chin Ment Health J, 2015, 29(1):53-59. doi:10.3969/j.issn.1000-6729.2015.01.010.
[10]	黄菲芸, 王艳红, 李娟娟, 等. 蒙特利尔认知评估量表在中国中老年人群筛查轻度认知功能障碍中的截断值的系统评价[J]. 中国循证医学杂志, 2017, 17(4):450-457.
	HUANG F Y, WANG Y H, LI J J, et al. Systematic review of the cutoff values of the Montreal Cognitive Assessment Scale in screening for mild cognitive impairment among middle-aged and older adults in China[J]. Chin J Evid-Based Med, 2017, 17(4):450-457. doi:10.7507/1672-2531.201609052.
[11]	BHATTACHARYA A, MRUDULA K, SREEPADA S S, et al. An overview of noninvasive brain stimulation:basic principles and clinical applications[J]. Can J Neurol Sci, 2022, 49(4):479-492. doi:10.1017/cjn.2021.158.
[12]	刘秀贞, 胡洁, 朱琳, 等. 经颅直流电刺激调节执行功能的应用和研究进展[J]. 中华物理医学与康复杂志, 2024, 46(10):944-948.
	LIU X Z, HU J, ZHU L, et al. Applications and research progress of transcranial direct current stimulation in regulating executive function[J]. Chin J Phys Med Rehabil, 2024, 46(10):944-948. doi:10.3760/cma.j.issn.0254-1424.2024.10.015.
[13]	PATEL R, SILLA F, PIERCE S, et al. Cognitive functioning before and after repetitive transcranial magnetic stimulation (rTMS):a quantitative meta-analysis in healthy adults[J]. Neuropsychologia, 2020,141:107395. doi:10.1016/j.neuropsychologia.2020.107395.
[14]	何泽佳, 恽晓萍, 郭华珍, 等. 获得性脑损伤患者执行功能的影响因素研究[J]. 中华物理医学与康复杂志, 2021, 43(11):972-977.
	HE Z J, YUN X P, GUO H Z, et al. Factors influencing executive function in patients with acquired brain injury[J]. Chin J Phys Med Rehabil, 2021, 43(11):972-977. doi:10.3760/cma.j.issn.0254-1424.2021.11.003.
[15]	HARA T, SHANMUGALINGAM A, MCINTYRE A, et al. The effect of non-invasive brain stimulation(NIBS)on executive functioning,attention and memory in rehabilitation patients with traumatic brain injury:a systematic review[J]. Diagnostics(Basel), 2021, 11(4):627. doi:10.3390/diagnostics11040627.
[16]	CHEN T, WANG H, WANG X, et al. Transcranial direct current stimulation of the right dorsolateral prefrontal cortex improves response inhibition[J]. Int J Psychophysiol, 2021, 162:34-39. doi:10.1016/j.ijpsycho.2021.03.002.
[17]	MCKENDRICK R, FALCONE B, SCHELDRUP M, et al. Effects of transcranial direct current stimulation on baseline and slope of prefrontal cortex hemodynamics during a spatial working memory task[J]. Front Hum Neurosci, 2020,14:64. doi:10.3389/fnhum.2020.00064.
[18]	YEH T T, CHANG K C, WANG J J, et al. Neuroplastic changes associated with hybrid exercise-cognitive training in stroke survivors with mild cognitive decline:a randomized controlled trial[J]. Neurorehabil Neural Repair, 2023, 37(9):662-673. doi:10.1177/15459683231200220.
[19]	JOHANSSON H, FOLKERTS A K, HAMMARSTRÖM I, et al. Effects of motor-cognitive training on dual-task performance in people with Parkinson's disease:a systematic review and meta-analysis[J]. J Neurol, 2023, 270(6):2890-290. doi:10.1007/s00415-023-12057-1.
[20]	ZHOU Q, YANG H, ZHOU Q, et al. Effects of cognitive motor dual-task training on stroke patients:A RCT-based meta-analysis[J]. J Clin Neurosci, 2021, 92:175-182. doi:10.1016/j.jocn.2021.08.009.
[21]	SUN R, LI X, ZHU Z, et al. Effects of dual-task training in patients with post-stroke cognitive impairment:A randomized controlled trial[J]. Front Neurol, 2022,13:1027104. doi:10.3389/fneur.2022.1027104.
[22]	PENATI R, SCHIEPPATI M, NARDONE A. Cognitive performance during gait is worsened by overground but enhanced by treadmill walking[J]. Gait Posture, 2020, 76:182-187. doi:10.1016/j.gaitpost.2019.12.006.

组别	性别（男/女）	年龄/ 岁	病程/d	脑梗死/ 脑出血	受教育年限/年
tDCS组	15/10	58.45±8.82	89.54±38.48	19/6	10.63±4.26
CMDT组	16/9	57.63±8.70	86.56±39.57	21/4	10.48±4.05
联合组	18/7	59.15±9.18	85.64±32.46	15/10	10.37±4.13
χ²或t	1.025	5.327	1.539	2.562	1.754

组别	性别（男/女）	年龄/ 岁	病程/d	脑梗死/ 脑出血	受教育年限/年
tDCS组	15/10	58.45±8.82	89.54±38.48	19/6	10.63±4.26
CMDT组	16/9	57.63±8.70	86.56±39.57	21/4	10.48±4.05
联合组	18/7	59.15±9.18	85.64±32.46	15/10	10.37±4.13
χ²或t	1.025	5.327	1.539	2.562	1.754

组别	PR				CC					CR
组别	治疗前	治疗后	t		治疗前	治疗后		t		治疗前		治疗后		t
tDCS组	30.53±6.72	26.05±6.81	7.521^＊＊		3.02±1.51	3.82±1.35		6.373^＊＊		45.62±8.75		56.31±9.87		12.357^＊＊
CMDT组	31.06±5.98	25.43±6.49	8.763^＊＊		3.14±1.26	3.91±1.41		7.542^＊＊		46.78±8.96		58.18±9.13		14.582^＊＊
联合组	30.98±7.21	19.56±6.86^ab	14.685^＊＊		3.08±1.73	4.53±1.62^ab		12.354^＊＊		46.25±8.67		65.74±9.53^ab		26.684^＊＊
F	0.568	10.751^＊＊			0.283	18.357^＊＊				0.249		21.387^＊＊
组别	ER			PE							NPE
组别	治疗前	治疗后	t	治疗前			治疗后		t		治疗前		治疗后		t
tDCS组	52.41±6.75	41.23±5.12	15.946^＊＊	27.84±5.02			23.71±4.32		7.538^＊＊		23.63±9.36		21.27±8.64		4.637^＊＊
CMDT组	50.46±6.48	40.57±5.26	17.573^＊＊	28.43±5.24			25.09±4.65		8.647^＊＊		23.87±9.52		21.54±9.02		5.269^＊＊
联合组	51.87±6.38	32.89±4.27^ab	30.380^＊＊	28.58±5.94			20.16±4.08^ab		15.259^＊＊		23.59±9.73		19.21±8.47^ab		9.851^＊＊
F	0.647	20.421^＊＊		0.376			18.671^＊＊				0.523		11.472^＊＊

组别	PR				CC					CR
组别	治疗前	治疗后	t		治疗前	治疗后		t		治疗前		治疗后		t
tDCS组	30.53±6.72	26.05±6.81	7.521^＊＊		3.02±1.51	3.82±1.35		6.373^＊＊		45.62±8.75		56.31±9.87		12.357^＊＊
CMDT组	31.06±5.98	25.43±6.49	8.763^＊＊		3.14±1.26	3.91±1.41		7.542^＊＊		46.78±8.96		58.18±9.13		14.582^＊＊
联合组	30.98±7.21	19.56±6.86^ab	14.685^＊＊		3.08±1.73	4.53±1.62^ab		12.354^＊＊		46.25±8.67		65.74±9.53^ab		26.684^＊＊
F	0.568	10.751^＊＊			0.283	18.357^＊＊				0.249		21.387^＊＊
组别	ER			PE							NPE
组别	治疗前	治疗后	t	治疗前			治疗后		t		治疗前		治疗后		t
tDCS组	52.41±6.75	41.23±5.12	15.946^＊＊	27.84±5.02			23.71±4.32		7.538^＊＊		23.63±9.36		21.27±8.64		4.637^＊＊
CMDT组	50.46±6.48	40.57±5.26	17.573^＊＊	28.43±5.24			25.09±4.65		8.647^＊＊		23.87±9.52		21.54±9.02		5.269^＊＊
联合组	51.87±6.38	32.89±4.27^ab	30.380^＊＊	28.58±5.94			20.16±4.08^ab		15.259^＊＊		23.59±9.73		19.21±8.47^ab		9.851^＊＊
F	0.647	20.421^＊＊		0.376			18.671^＊＊				0.523		11.472^＊＊

组别	WMS-Ⅳ
组别	干预前	干预后	t
tDCS组	74.85±3.52	82.26±3.87	15.352^＊＊
CMDT组	75.13±3.67	83.14±3.57	16.439^＊＊
联合组	75.08±3.84	89.38±3.86^ab	31.547^＊＊
F	0.576	23.158^＊＊
组别	MoCA
组别	干预前	干预后	t
tDCS组	16.55±2.34	19.87±2.15	7.554^＊＊
CMDT组	17.24±2.58	19.36±2.49	8.739^＊＊
联合组	17.18±2.51	24.39±2.87^ab	13.158^＊＊
F	0.394	10.394^＊＊
组别	MBI
组别	干预前	干预后	t
tDCS组	41.42±4.51	56.53±5.88	18.356^＊＊
CMDT组	42.39±4.32	57.28±5.67	19.152^＊＊
联合组	41.94±4.86	65.57±8.25^ab	32.619^＊＊
F	0.487	26.852^＊＊

经颅直流电刺激联合认知-运动双任务训练对脑卒中后认知障碍患者记忆和执行功能的影响

Effects of transcranial direct current stimulation combined with cognitive-motor dual task training on memory and executive function in patients with post-stroke cognitive impairment

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 3

参考文献 22

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张在行, 汪宁, 张奇, 周静, 郭元展, 裴双, 郭仕乾, 孙军. 血清CysC、CD147水平对颅内动脉狭窄支架成形术后再狭窄的预测价值[J]. 天津医药, 2025, 53(6): 599-603.
[2]	刘鑫, 马宇, 路凯, 张桂成, 吴悦, 胡方梅, 崔友祥, 孙云川. CTP、CTA联合血清NSE对脑卒中偏瘫患者侧支循环状态及预后的评估价值[J]. 天津医药, 2025, 53(6): 629-633.
[3]	杨丽亚, 郑丽, 李利红, 李亚永, 马将. 多巴丝肼联合呼吸训练在卒中后吞咽困难中的效果评价[J]. 天津医药, 2025, 53(3): 257-261.
[4]	魏婵娟, 夏晓爽, 冯文军, 李新. 中性粒细胞与淋巴细胞比值对急性缺血性脑卒中患者静脉溶栓预后不良的预测价值[J]. 天津医药, 2025, 53(2): 135-140.
[5]	姚玉婷, 赵鹏, 李燕, 姚玉鑫, 刘敏肖. 星状神经节阻滞联合尼麦角林对脑卒中后吞咽困难的疗效观察[J]. 天津医药, 2025, 53(1): 57-60.
[6]	郑继青, 龙耀斌, 徐金. 辣椒素联合重复经颅磁刺激用于脑卒中后吞咽障碍患者的疗效观察[J]. 天津医药, 2024, 52(9): 950-953.
[7]	焦爱菊, 任宝龙, 张春花, 李文瑞, 赵玮婧. NIHSS评分联合血清BDNF、IL-6对脑卒中后抑郁的预测价值[J]. 天津医药, 2024, 52(9): 963-966.
[8]	薛晶, 元小冬, 邢爱君, 王连辉, 马倩, 符永山, 张萍淑. 急性缺血性脑卒中患者睡眠-觉醒生物节律变化与预后的关系研究[J]. 天津医药, 2024, 52(6): 614-619.
[9]	钱洪春, 张萍淑, 元小冬, 袁建新, 曹凌云, 段丽琴. 卒中伴阻塞性睡眠呼吸暂停患者认知功能损害与睡眠参数的关系[J]. 天津医药, 2024, 52(6): 619-624.
[10]	韩琴, 韩秀丽, 陈伟然. 老年脑卒中患者康复治疗后抑郁障碍的影响因素分析[J]. 天津医药, 2024, 52(6): 639-642.
[11]	张丽红, 李瑞青, 王艺莹, 梅紧紧, 苏凯奇, 顾昌宇, 黄梦玲. 督脉电针调控胱氨酸/谷氨酸反向转运体改善脑卒中后肢体痉挛的作用机制[J]. 天津医药, 2024, 52(5): 463-468.
[12]	王月, 权兴苗, 王玉, 宋春侠, 邵月, 徐立伟. 益气升清方调节HIF-1α/NLRP3信号通路对缺血性脑卒中大鼠神经元焦亡的影响[J]. 天津医药, 2024, 52(4): 350-355.
[13]	肖雨倩, 孙可心, 万俊, 陈淑颖, 陈丽敏, 王岩, 白艳杰. RNA m6A甲基化在卒中后认知障碍中的研究进展[J]. 天津医药, 2024, 52(3): 331-336.
[14]	丁波, 龚洁芹, 沈李奎. 急性缺血性脑卒中患者血清指标与病情和预后的关系[J]. 天津医药, 2024, 52(2): 172-176.
[15]	周秀芬, 刘晖, 陈虹, 赵宗波. SAP患者GLI与外周血各指标变化的临床意义[J]. 天津医药, 2024, 52(12): 1286-1291.