脑卒中后执行功能障碍的评估与康复研究进展

doi:10.3969/j.issn.1006-9771.2020.07.010

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 788-792.doi: 10.3969/j.issn.1006-9771.2020.07.010

脑卒中后执行功能障碍的评估与康复研究进展

刘远文¹,罗婧¹,方杰²,潘翠环³()

1.中山大学附属第三医院康复医学科,广东广州市 510630
2.厦门弘爱康复医院,福建厦门市 361006
3.广州医科大学附属第二医院康复医学科,广东广州市 510260

收稿日期:2019-12-24 修回日期:2020-02-04 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 潘翠环 E-mail:pancuihuan@126.com
作者简介:刘远文(1990-),男,汉族,广东河源市人,硕士,治疗师,主要研究方向：认知障碍评估与康复治疗。|潘翠环(1957-),女,教授、主任医师,硕士生导师,主要研究方向：神经康复及康复治疗教育。
基金资助:
国家自然科学基金项目(81702232);广东省医学科学技术研究基金项目(A2016251);广东省自然科学基金项目(2017A030313586)

Advance in Evaluation and Rehabilitation for Post-stroke Executive Impairment (review)

LIU Yuan-wen¹,LUO Jing¹,FANG Jie²,PAN Cui-huan³()

1. Department of Rehabilitation Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
2. Xiamen Humanity Rehabilitation Hospital, Xiamen, Fujian 361006, China
3. Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China

Received:2019-12-24 Revised:2020-02-04 Published:2020-07-25 Online:2020-07-24
Contact: PAN Cui-huan E-mail:pancuihuan@126.com
Supported by:
National Natural Science Foundation of China(81702232);Guangdong Medical Science and Technology Foundation(A2016251);Natural Science Foundation of Guangdong(2017A030313586)

摘要/Abstract

摘要：

执行功能障碍是脑卒中常见后遗症之一,患者不能很好控制自己的思想、情感和行为,其病因学尚不明确,主要涉及额叶、前扣带回、脑桥等。目前尚无特异性测评工具,神经心理学评估是目前筛查和诊断的重要手段,可分为筛查法和专项检查法。筛查法可快速判断执行功能障碍,但不能作为诊断依据;专项检查法费时,难度偏大,不易获得受试者配合。康复策略包括恢复性、代偿性和适应性策略。药物治疗是主要方法,但疗效不理想。认识训练、计算机辅助认知训练、经颅直流电刺激等方法逐渐得到应用。影像学和神经电生理技术等客观评价方法会在未来得到更多应用。

关键词: 脑卒中, 执行功能障碍, 评估, 康复, 综述

Abstract:

Executive impairment is common after stroke, which causes in disabilities for controling thinking, emotion and behavior. The etiology is uncertain. There is no specific assessment tool for it. The psychological assessment is the main approach to screen and diagnose executive impairment, including screening and specific examination. There are still some advantages and disadvantages. The strategy for rehabilitation includes recovery, compulsory and adaptive treatment. Medication is the main treatment, but still unsatisfactory. Cognitive training, computer-assisted cognitive rehabilitation and transcranial direct current stimulation and so on are applied. Imaging and physiological electrical techniques are needed.

Key words: stroke, executive impairment, evaluation, rehabilitation, review

中图分类号:

R743.3

刘远文,罗婧,方杰,潘翠环. 脑卒中后执行功能障碍的评估与康复研究进展[J]. 《中国康复理论与实践》, 2020, 26(7): 788-792.

LIU Yuan-wen,LUO Jing,FANG Jie,PAN Cui-huan. Advance in Evaluation and Rehabilitation for Post-stroke Executive Impairment (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 788-792.

参考文献 46

[1]	Oveisgharan S, Hachinski V. Executive dysfunction is a strong stroke predictor[J]. J Neurol Sci, 2015, 349(1-2): 161-167. doi: 10.1016/j.jns.2015.01.010 pmid: 25614441
[2]	Middleton L E, Lam B, Fahmi H, et al. Frequency of domain-specific cognitive impairment in sub-acute and chronic stroke[J]. NeuroRehabilitation, 2014, 34(2): 305-312. doi: 10.3233/NRE-131030 pmid: 24401826
[3]	Brookes R L, Herbert V, Paul S, et al. Executive dysfunction, awareness deficits and quality of life in patients with cerebral small vessel disease: a structural equation model[J]. Neuropsychology, 2014, 28(2): 247-253. doi: 10.1037/neu0000015
[4]	Bour A, Rasquin S, Limburg M, et al. Depressive symptoms and executive functioning in stroke patients: a follow-up study[J]. Int J Geriatr Psychiatry, 2011, 26(7): 679-686. doi: 10.1002/gps.v26.7
[5]	Seo E H, Kim H, Lee K H, et al. Altered executive function in pre-mild cognitive impairment[J]. J Alzheimers Dis, 2016, 54(3): 933-940. doi: 10.3233/JAD-160052
[6]	Park S H, Sohn M K, Jee S, et al. The characteristics of cognitive impairment and their effects on functional outcome after inpatient rehabilitation in subacute stroke patients[J]. Ann Rehabil Med, 2017, 41(5): 734-742. doi: 10.5535/arm.2017.41.5.734 pmid: 29201811
[7]	Turunen K E, Laari S P, Kauranen T V, et al. Executive impairment is associated with impaired memory performance in working-aged stroke patients[J]. J Int Neuropsychol Soc, 2016, 22(5): 551-560. doi: 10.1017/S1355617716000205 pmid: 27019324
[8]	Gross A L, Xue Q L, Bandeen-Roche K, et al. Declines and impairment in executive function predict onset of physical frailty[J]. J Gerontol A Biol Sci Med Sci, 2016, 71(12): 1624-1630. doi: 10.1093/gerona/glw067
[9]	Park Y H, Jang J W, Park S Y, et al. Executive function as a strong predictor of recovery from disability in patients with acute stroke: a preliminary study[J]. J Stroke Cerebrovasc Dis, 2015, 24(3): 554-561. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.033
[10]	Yu F, Vock D M, Barclay T R. Executive function: responses to aerobic exercise in Alzheimer's disease.[J]. Geriatr Nurs, 2018, 39(2): 219-224. doi: 10.1016/j.gerinurse.2017.09.005
[11]	Al-Dughmi M, Al-Sharman A, Stevens S, et al. Executive function is associated with off-line motor learning in people with chronic stroke[J]. J Neurol Phys Ther, 2017, 41(2): 101-106. doi: 10.1097/NPT.0000000000000170 pmid: 28263253
[12]	Jankowska A M, Klimkiewicz R, Kubsik A, et al. Location of the ischemic focus in rehabilitated stroke patients with impairment of executive functions[J]. Adv Clin Exp Med, 2017, 26(5): 767-776. doi: 10.17219/acem/63138
[13]	Hayes S, Donnellan C, Stokes E. Executive dysfunction and balance function post-stroke: a cross-sectional study[J]. Physiotherapy, 2016, 102(1): 64-70. doi: 10.1016/j.physio.2015.03.3719 pmid: 26031841
[14]	Toledo J B, Bjerke M, Chen K, et al. Memory, executive, and multidomain subtle cognitive impairment: clinical and biomarker findings[J]. Neurology, 2015, 85(2): 144-153. doi: 10.1212/WNL.0000000000001738 pmid: 26085606
[15]	Sobreiro M F, Miotto E C, Terroni L, et al. Executive function and depressive symptoms of retardation in nonelderly stroke patients[J]. J Clin Exp Neuropsychol, 2014, 36(6): 636-647. doi: 10.1080/13803395.2014.925092
[16]	Lu D, Ren S, Zhang J, et al. Vascular risk factors aggravate cognitive impairment in first-ever young ischaemic stroke patients[J]. Eur J Neurol, 2016, 23(5): 940-947. doi: 10.1111/ene.12967 pmid: 26917058
[17]	Tay S Y, Davison J, Jin N C, et al. Education and executive function mediate engagement in advance care planning in early cognitive impairment[J]. J Am Med Dir Assoc, 2015, 16(11): 957-962. doi: 10.1016/j.jamda.2015.05.014
[18]	Hua P, Pan X P, Hu R, et al. Factors related to executive dysfunction after acute infarct[J]. PLoS One, 2014, 9(9): 1-6.
[19]	Farrar D C, Mian A Z, Budson A E, et al. Retained executive abilities in mild cognitive impairment are associated with increased white matter network connectivity[J]. Eur Radiol, 2018, 28(1): 340-347. doi: 10.1007/s00330-017-4951-4
[20]	Mikell C B, Banks G P, Frey H P, et al. Frontal networks associated with command following after hemorrhagic stroke[J]. Stroke, 2015, 46(1): 49-57. doi: 10.1161/STROKEAHA.114.007645
[21]	Cordova C A, Jackson D, Langdon K D, et al. Impaired executive function following ischemic stroke in the rat medial prefrontal cortex[J]. Behav Brain Res, 2014, 258(1): 106-111. doi: 10.1016/j.bbr.2013.10.022
[22]	Vataja R, Pohjasvaara T, Mäntylä R, et al. MRI correlates of executive dysfunction in patients with ischaemic stroke[J]. Eur J Neurol, 2003, 10(6): 625-631. pmid: 14641506
[23]	Conti J, Sterr A, Brucki S M, et al. Diversity of approaches in assessment of executive functions in stroke: limited evidence?[J]. eNeurologicalSci, 2015, 1(1): 12-20. doi: 10.1016/j.ensci.2015.08.002
[24]	Royall D R, Mahurin R K, Gray K F. Bedside assessment of executive cognitive impairment: the executive interview[J]. J Am Geriatr Soc, 1992, 40(12): 1221-1226. pmid: 1447438
[25]	Dubois B, Slachevsky A, Litvan I, et al. The FAB: a Frontal Assessment Battery at bedside[J]. Neurology, 2000, 55(11): 1621-1626. pmid: 11113214
[26]	Torralva T, Roca M, Gleichgerrcht E, et al. INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia[J]. J Int Neuropsychol Soc, 2009, 15(5): 777-786. doi: 10.1017/S1355617709990415 pmid: 19635178
[27]	Ohyama T, Kaga Y, Goto Y, et al. Developmental changes in autonomic emotional response during an executive functional task: a pupillometric study during Wisconsin Card Sorting Test[J]. Brain Dev, 2017, 39(3): 187-195. doi: 10.1016/j.braindev.2016.10.002
[28]	Jodzio K, Biechowska D. Wisconsin Card Sorting Test as a measure of executive function impairments in stroke patients[J]. Appl Neuropsychol, 2010, 17(4): 267-277. doi: 10.1080/09084282.2010.525104
[29]	Armentano C, Porto C S, Brucki S, et al. Study on the Behavioural Assessment of the Dysexecutive Syndrome (BADS) performance in healthy individuals, mild cognitive impairment and Alzheimer's disease: a preliminary study[J]. Dement Neuropsychol, 2009, 3(2): 101-107. doi: 10.1590/S1980-57642009DN30200006
[30]	Hilbert S, Nakagawa T T, Bindl M, et al. The spatial Stroop effect: a comparison of color-word and position-word interference[J]. Psychon Bull Rev, 2014, 21(6): 1509-1515. doi: 10.3758/s13423-014-0631-4
[31]	Muir R T, Lam B, Honjo K, et al. Trail Making Test elucidates neural substrates of specific poststroke executive dysfunctions[J]. Stroke, 2015, 46(10): 2755-2761. doi: 10.1161/STROKEAHA.115.009936
[32]	Tamez E, Myerson J, Morris L, et al. Assessing executive abilities following acute stroke with the trail making test and digit span[J]. Behav Neurol, 2011, 24(3): 177-185. doi: 10.1155/2011/139703
[33]	Leung J L M, Lee G T H, Lam Y H, et al. The use of the Digit Span Test in screening for cognitive impairment in acute medical inpatients[J]. Inter Psychogeriatr, 2011, 23(10): 1569-1574. doi: 10.1017/S1041610211000792
[34]	Tung L C, Yu W H, Lin G H, et al. Development of a tablet-based symbol digit modalities test for reliably assessing information processing speed in patients with stroke[J]. Disabil Rehabil, 2016, 38(19): 1952-1960. doi: 10.3109/09638288.2015.1111438 pmid: 26860823
[35]	Poulin V, Korner-Bitensky N, Bherer L, et al. Comparison of two cognitive interventions for adults experiencing executive dysfunction post-stroke: a pilot study[J]. Disabil Rehabil, 2017, 39(1): 1-13. doi: 10.3109/09638288.2015.1123303
[36]	Cumming T B, Marshall R S, Lazar R M. Stroke, cognitive deficits, and rehabilitation: still an incomplete picture[J]. Int J Stroke, 2013, 8(1): 38-45. doi: 10.1111/j.1747-4949.2012.00972.x pmid: 23280268
[37]	Huang J, McCaskey M A, Yang S, et al. Effects of acupuncture and computer-assisted cognitive training for post-stroke attention deficits: study protocol for a randomized controlled trial[J]. Trials, 2015, 16(2): 546. doi: 10.1186/s13063-015-1054-x
[38]	Cho H Y, Kim K T, Jung J H. Effects of computer assisted cognitive rehabilitation on brain wave, memory and attention of stroke patients: a randomized control trial[J]. J Phys Ther Sci, 2015, 27(4): 1029-1032. doi: 10.1589/jpts.27.1029
[39]	Kazuta T, Takeda K, Osu R, et al. Transcranial direct current stimulation improves audioverbal memory in stroke patients[J]. Am J Phys Med Rehabil, 2017, 96(8): 565-571. doi: 10.1097/PHM.0000000000000686
[40]	Yun G J, Chun M H, Kim B R. The effects of transcranial direct-current stimulation on cognition in stroke patients[J]. J Stroke, 2015, 17(3): 354-358. doi: 10.5853/jos.2015.17.3.354
[41]	Jeon S Y, Han S J. Improvement of the working memory and naming by transcranial direct current stimulation[J]. Ann Rehabil Med, 2012, 36(5): 585-595. doi: 10.5535/arm.2012.36.5.585
[42]	Antonenko D, Flöel A. Non-invasive brain stimulation in neurology: transcranial direct current stimulation to enhance cognitive functioning[J]. Nervenarzt, 2016, 87(8): 838-845. doi: 10.1007/s00115-016-0115-z pmid: 27167887
[43]	Inoue Y. Repetitive transcranial magnetic stimulation (rTMS) for higher brain function deficits[J]. Brain Nerve, 2016, 68(12): 1459-1470.
[44]	刘远文, 潘翠环, 胡楠, 等. 重复经颅磁刺激治疗脑卒中后执行功能障碍的研究进展[J]. 中国康复理论与实践, 2016, 22(10): 1132-1136.
	Liu Y W, Pan C H, Hu N, et al. Advance in repetitive transcranial magnetic stimulation for post-stroke executive impairment (review)[J]. Chin J Rehabil Theory Pract, 2016, 22(10): 1132-1136.
[45]	Rektorova I, Megova S, Bares M, et al. Cognitive functioning after repetitive transcranial magnetic stimulation in patients with cerebrovascular disease without dementia: a pilot study of seven patients[J]. J Neurol Sci, 2005, 229-230: 157-161.
[46]	刘远文, 方杰, 姜荣荣, 等. 高频重复经颅磁刺激对脑卒中患者执行功能的影响[J]. 中华神经科杂志, 2017, 50(10): 745-750.
	Liu Y W, Fang J, Jiang R R, et al. Effects of high frequency repetitive transcranial magnetic stimulation on executive function in patients after stroke[J]. Chin J Neurol, 2017, 50(10): 745-750.

脑卒中后执行功能障碍的评估与康复研究进展

Advance in Evaluation and Rehabilitation for Post-stroke Executive Impairment (review)

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 46

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	邵伟婷, 雷江华. 反应中断再定向干预孤独症谱系障碍儿童刻板语言的效果：Scoping综述[J]. 《中国康复理论与实践》, 2024, 30(1): 10-20.
[2]	罗丽华, 王雨生, 李剑锋, 董继革. 术后早期综合康复对儿童青少年肱骨髁上骨折伴尺神经损伤的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 105-110.
[3]	王子豪, 李昕华, 蒋慧萍, 郭赛男, 梁秋曼, 史婷奇. 全膝关节置换术后短期膝关节功能及其影响因素[J]. 《中国康复理论与实践》, 2024, 30(1): 111-118.
[4]	王航宇, 葛可可, 范永红, 都丽露, 邹敏, 封磊. 基于ICD-11和ICF主动式音乐疗法改善认知障碍老年人认知功能的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 36-43.
[5]	闻嘉宁, 金秋艳, 张琦, 李杰, 司琦. 认知参与型身体活动对发展儿童青少年执行功能的效果：基于ICF的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 44-53.
[6]	葛可可, 范永红, 王航宇, 都丽露, 李长江, 邹敏. 失眠老年人正念干预健康效益的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 54-60.
[7]	林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.
[8]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[9]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[10]	胡永林, 马颖, 窦超, 陆安民, 江小鸽, 宋新建, 肖玉华. 肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 81-86.
[11]	张婧雅, 邹敏, 孙宏伟, 孙昌隆, 朱峻同. 听障儿童青少年焦虑或抑郁情绪心理干预效果的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1004-1011.
[12]	王俊宇, 杨永, 袁逊, 谢婷, 庄洁. 高强度间歇训练对健康儿童青少年执行功能效果的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1012-1020.
[13]	魏晓微, 杨剑, 魏春艳. 特殊教育学校孤独症谱系障碍儿童参与适应性瑜伽活动的心理与行为效益的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1021-1028.
[14]	杨亚茹, 杨剑. 基于WHO-HPS架构学校身体活动相关健康服务及其健康效益：系统综述的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1040-1047.
[15]	王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.