认知-运动双重任务训练对卒中后认知障碍的影响

doi:10.3877/cma.j.issn.1673-9248.2025.02.002

目的

探讨认知-运动双重任务训练（DTT）对卒中后认知障碍（PSCI）患者不同维度的认知功能及日常生活能力的影响。

方法

纳入2023 年8 月至2024 年9 月在首都医科大学附属北京天坛医院康复医学科住院的符合入排标准的28 例PSCI 患者，随机分为对照组和观察组，每组14 例。对照组给予单纯的认知训练，每周5 次，每次30 min，持续2 周，观察组给予认知-运动DTT，次数、时间及频率同对照组。比较2 组患者Stroop 色词测验（SCWT）、Rey-Osterrieth 复杂图形测验（ROCF）、数字符号转换测试（DSST）、阿尔茨海默病评定量表-认知部分（ADAS-Cog）在训练前后的评分差异，以及入组1 个月后蒙特利尔认知功能评定量表（MoCA）、改良Barthel 指数（MBI）、功能独立性评测量表（FIM）与训练前的评分差异。

结果

观察组DSST、入组1 个月随访的MBI 指数及FIM 量表评分高于对照组，ADAS-Cog 量表评分低于对照组，差异均有统计学意义（P＜0.05）。2 组患者在训练后ROCF 及入组1 个月后的MoCA 量表评分较训练前升高，SCWT 完成时间较训练前减少，但差异均无统计学意义（P＞0.05）。

结论

认知-运动DTT 可以改善PSCI 患者注意、记忆等维度的认知功能，并提高患者的日常生活能力，其长期有效性有待进一步研究。

关键词: 双重任务训练, 卒中后认知障碍, 康复

Objective

To investigate the effects of cognitive-motor dual-task training (DTT)on multidimensional cognitive function and activities of daily living (ADL) in patients with post-stroke cognitive impairment (PSCI).

Methods

A total of 28 eligible patients with PSCI admitted to the Department of Rehabilitation Medicine at Beijing Tiantan Hospital, Capital Medical University, from August 2023 to September 2024 were enrolled and randomly assigned to a control group (n=14) and an intervention group (n=14).The control group received cognitive training alone (5 sessions/week, 30 minutes/session, for 2 weeks),while the intervention group underwent cognitive-motor DTT with identical training frequency and duration.Pre- and post-training scores on the Stroop color-word test (SCWT), Rey-Osterrieth complex figure test (ROCF),digit symbol substitution test (DSST), and Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog)were compared between groups.Additionally, differences in Montreal cognitive assessment (MoCA),modified Barthel index (MBI), and functional independence measure (FIM) scores at 1-month follow-up were analyzed relative to baseline.

Results

Compared with the control group, the intervention group showed significantly higher scores in DSST (P＜0.05), MBI (P＜0.05), and FIM (P＜0.05), and lower ADAS-Cog scores (P＜0.05) at 1-month follow-up.Both groups exhibited improved ROCF and MoCA scores after training, without statistical significance.SCWT completion time decreased post-training, without statistical significance (P＞0.05).

Conclusion

Cognitive-motor DTT may cognitive functions related to attention and memory, as well as improve ADL capabilities in PSCI patients.Further research is needed to validate its long-term efficacy.

Key words: Dual-task training, Post-stroke cognitive impairment, Rehabilitation

表1 2 组缺血性脑卒中患者基线临床资料比较

基础资料	对照组（14 例）	观察组（14 例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	68.00±6.78	70.21±7.08	t=0.845	0.406
性别[ 例（%）]			χ ²=0.622	0.693
男	10（71.4）	8（57.1）
女	4（28.6）	6（42.9）
既往史[ 例（%）]
高血压	13（92.9）	10（71.4）	χ ²=2.191	0.139
糖尿病	8（57.1）	9（64.3）	χ ²=0.150	0.699
高脂血症	3（21.4）	7（50）	χ ²=2.489	0.237
冠心病	5（35.7）	2（14.3）	χ ²=1.714	0.383
卒中半球[ 例（%）]			χ ²=2.333	0.127
左侧	4（28.6）	8（57.1）
右侧	10（71.4）	6（42.9）
发病时间（月， $\overset{ˉ}{x}$ ± s ）	0.82±0.80	0.92±0.76	t=0.341	0.736

表1 2 组缺血性脑卒中患者基线临床资料比较

基础资料	对照组（14 例）	观察组（14 例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	68.00±6.78	70.21±7.08	t=0.845	0.406
性别[ 例（%）]			χ ²=0.622	0.693
男	10（71.4）	8（57.1）
女	4（28.6）	6（42.9）
既往史[ 例（%）]
高血压	13（92.9）	10（71.4）	χ ²=2.191	0.139
糖尿病	8（57.1）	9（64.3）	χ ²=0.150	0.699
高脂血症	3（21.4）	7（50）	χ ²=2.489	0.237
冠心病	5（35.7）	2（14.3）	χ ²=1.714	0.383
卒中半球[ 例（%）]			χ ²=2.333	0.127
左侧	4（28.6）	8（57.1）
右侧	10（71.4）	6（42.9）
发病时间（月， $\overset{ˉ}{x}$ ± s ）	0.82±0.80	0.92±0.76	t=0.341	0.736

表2 2 组缺血性脑卒中患者认知功能、日常生活能力量表评分比较（± s ）

量表	对照组（14 例）				观察组（14 例）				t值^*	P值^*
量表	训练前	训练后	t值	P值	训练前	训练后	t值	P值	t值^*	P值^*
认知功能量表
MoCA（分）	20.36±2.37	20.91±2.75	1.473	1.165	18.50±4.57	20.07±3.99	1.973	0.070	1.153	0.264
SCWT 完成时间（s）	139.86±105.34	126.66±83.05	0.912	0.378	138.44±78.84	120.14±68.95	2.019	0.065	0.561	0.580
ROCF（分）	15.96±10.40	18.50±10.27	2.645	0.020	16.694±10.59	23.00±9.23	3.825	0.002	1.896	0.069
DSST（分）	16.00±7.35	17.42±7.86	1.652	0.123	12.32±6.86	17.42±7.50	6.543	0.000	2.979	0.006
ADAS-Cog（分）	15.64±3.88	14.43±3.84	2.518	0.026	19.21±6.74	16.21±6.83	5.408	0.000	2.163	0.040
日常生活能力量表
MBI（分）	84.64±12.48	83.80±12.93	0.770	0.455	81.07±13.33	84.29±12.84	2.090	0.057	2.148	0.041
FIM（分）	106.14±11.97	106.14±12.00	＜0.999	1.000	103.36±12.13	106.50±11.23	2.914	0.012	2.176	0.039

表2 2 组缺血性脑卒中患者认知功能、日常生活能力量表评分比较（± s ）

量表	对照组（14 例）				观察组（14 例）				t值^*	P值^*
量表	训练前	训练后	t值	P值	训练前	训练后	t值	P值	t值^*	P值^*
认知功能量表
MoCA（分）	20.36±2.37	20.91±2.75	1.473	1.165	18.50±4.57	20.07±3.99	1.973	0.070	1.153	0.264
SCWT 完成时间（s）	139.86±105.34	126.66±83.05	0.912	0.378	138.44±78.84	120.14±68.95	2.019	0.065	0.561	0.580
ROCF（分）	15.96±10.40	18.50±10.27	2.645	0.020	16.694±10.59	23.00±9.23	3.825	0.002	1.896	0.069
DSST（分）	16.00±7.35	17.42±7.86	1.652	0.123	12.32±6.86	17.42±7.50	6.543	0.000	2.979	0.006
ADAS-Cog（分）	15.64±3.88	14.43±3.84	2.518	0.026	19.21±6.74	16.21±6.83	5.408	0.000	2.163	0.040
日常生活能力量表
MBI（分）	84.64±12.48	83.80±12.93	0.770	0.455	81.07±13.33	84.29±12.84	2.090	0.057	2.148	0.041
FIM（分）	106.14±11.97	106.14±12.00	＜0.999	1.000	103.36±12.13	106.50±11.23	2.914	0.012	2.176	0.039

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Effects of cognitive-motor dual-task training on post-stroke cognitive impairment

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Effects of cognitive-motor dual-task training on post-stroke cognitive impairment