| Background:Cognitive function is the advanced features of the brain, including memory, attention, language, visual spatial skill, summarize, calculate, judge with the ability to solve the problem. It is the people to adapt to the surrounding environment to the survival of the necessary conditions for the main race, cultural background, experience and so on. Therefore, the cognitive function of modern rehabilitation medicine is the focus of the study.Cognitive function impairment of cerebral infarction is the most common manifestation. Reported in 1994 acute cerebral infarction after one week, the incidence of cognitive impairment is 61%.After 6 months 37% of patients are still left over from cognitive impairment. Cerebral infarction leads to a series of physical, cognitive, behavioral and affective disorders. Cognitive impairment is a higher rate of incidence of patients and it is serious more than the physical barriers themselves from the perspective of long-term effect. It is difficult to live independently and work. Cognitive function impairment becomes a very unfavorable factor in the overall rehabilitation. Cerebral infarction about cerebral hemisphere damage can also produce different clinical symptoms. Moreover,cognitive function impairment and brain damage is relevant, but also with the age and other social factors. Patients with cerebral infarction were generally believed that the cognitive function impairment mainly related to the following factors: (1) age (2) infarction station (3) educational level. However,the relationship between gender or stroke hemisphere and cognitive impairment is still controversial.Early assessment of cognitive status contribute to accurate feedback to the patients and their families, to help determine the prognosis of patients with efficacy and prediction, and the doctors can timely intervention and rehabilitation. At present, the diagnosis of cognitive impairment and assessment methods include: neuropsychological examination ,neuroimaging examination, electrophysiology inspection. Clinical neuropsychology can not be replaced by other methods because of their clear and quantitative analysis of the role of cognitive function and it is still the most direct assessment of cognitive impairment and effective method. Therefore, the use of NCSE and CLOX , combined with P300 not only the early comprehensive and objective reflection of the characteristics of patients with cognitive impairment, but also to quantify the cognitive function of each single score and they have a better judge of value on the efficacy evaluation, observation of disease development and recovery and treatment. Barthel Index assessment is simple, high reliability, high sensitivity, the use of wide-ranging and can be used to predict the treatment effects, duration of hospitalization and prognosis. Barthel Index assessment has been widely used to assess the level of patients. European stroke score (ESS) is the world recognized the degree of neurological deficit evaluation indicators . European stroke score(ESS) has good correlation if combinate with the Barthel index.The above scale is currently being recognized by most experts.At present, some drugs have been applicated on treatment of cognitive function impairment of cerebral infarction and vascular dementia. Clinical study results show different levels of these drugs to improve cognitive function and daily living skills, but the effect is not very satisfactory. Recently,the United States University of Virginia study report that ginkgo biloba extract(GBE) should not reduce the occurrence of dementia, but can improve short-term memory. The effect of ginkgo biloba extract on cognitive function impairment of cerebral infarction is still controversial. Cognitive training can improve cognitive impairment but doctor must develop an appropriate program in accordance with patient conditions .And cognitive training early can promote the improvement of cognitive function and recovery. It is reported that hyperbaric oxygen treatment of the language barrier has made a very good efficacy, but it is significantly positive effects for vascular dementia patients .At present, it is fewer reported that the efficacy assessment of drugs and cognitive function training and hyperbaric oxygen and conventional approach treat cognitive function impairment of cerebral infarction .Therefore,with a random approach,we treat for 82 patients with cognitive function impairment of acute cerebral infarction of internal carotid system by Ginkgo biloba extract or cognitive training or hyperbaric oxygen and conventional approach and we adopt NCSE, CLOX and P300 Early to observe the characteristics of cognitive function impairment and take the degree of neurological deficit score, motor function and daily living skill assessment score, which synthetically assess various treatment programs. we may look for a practical, feasible and effective treatment programs.Purpose:1.To investigate the influence of the Hyperbaric and cognitive function training and ginkgo biloba extract(GBE) on cognitive function impairment of cerebral infarction with NCSE and CLOX and ESS and FAM and Barthel index.2 To evaluate the combination treatment's clinical efficacy and effect for quality of life in patients with cerebral infarction.3. At the same time to explore the impact of post-stroke cognitive factors.Materials and methods:1. ObjectFrom September 2007 -2008 year in December, Department of Neurology in our hospital 82 patients with acute cerebral infarction of internal carotid system were randomly divided into control group, treatment 1 group, treatment 2 group .2. Treatment2.1 Patients in the control group were given conventional therapy (symptomatic,anti-platelet aggregation, lowering intracranial pressure , dehydration drugs and physical therapy, occupational therapy).2.2 Patients in the treatment 1 group were given the ginkgo biloba extract and cognitive function training based on control group . Treatment group 2 used ginkgo biloba extract(Shuxuening), 10ml or 20ml/day,total 21 days. In accordance with cognitive function impairment in the field, we gave specific interventions. Therapists used the card method or in-kind operating method or computer software for the patients with "one-on-one training". The training followed , from easy to difficut,from simple to complex, from partial to whole, from a single item to the relevant principles of the project, training 30 minutes / day, 5 times / week, total 12 weeks.2.3 Patients in the treatment 2 group were given hyperbaric oxygen based on Treatment 1 group. Patients in the treatment 2 group applicated hyperbaric oxygen plant in Zhejiang production NG280-900-type high-pressure oxygen chamber. Pressure hyperbaric oxygen therapy for 2ATA, each time for 90 minutes. Boost 0.1ATA / minute,step-up time was 10 minutes; decompression 0.1ATA / minutes, decompression time 10 minutes After steady pressure ,each time 30-minute oxygen mask,10-minute rest between,total2 times. Each case are 15 times as a unified course of treatment, interval between each course of three days, a total of 3 treatment courses, 45 times.3. Evaluating methods:All patients were assessed before and after3 months treatment. The evaluating items included : NCSE and CLOX and P300 cognitive scale for cognitive function ;ESS scale for neurological deficit; Fugl-Meyer measurement for the motor function; Barthel index scales for ability of daily life.4. statistical analysisEXCEL software would be applied to dispose the result of assessment. The normal distribution measurement material expressed with the mean value additionand subtraction standard deviation (x±s) .Before treatment and after 3 months treatment,the results of three groups adopts T-test or single factors variance analyses and SNK multiple comparisons method. For variance uneven, the result of assessment adopts the adjustment T-test. The classified material adopts the chi-square test. Takeα=0.05 as the examination standard. The data of patient who failed to follow-up or to finish test were excluded.Results:There are not statistical significant difference among the three group patient indicators before treatment (P> 0.05).1.cognitive function score, ESS score, FAM score, P300 latency (PL): There are significant difference before and after treatment in three groups own (P <0.05).After treatment,there are significant difference between control group and treatment group (P <0.05)and there are statistically significant difference between the two treatment group (P <0.05).2. Significant relationships were found among cognitive function, the motor function and ability of daily life, (r = 0.9365-0.9887, P <0.05))3 . Poststroke cognitive function was relate to the age,level of education,location and volume of the brain lesions.The incidence may correlated with gender.Conclusion:1. Ginkgo biloba extract(GBE), cognitive training, hyperbaric oxygen combine with conventional therapy in a certain extent,which can increase the speed of the reconstruction of brain tissue. Thus they can improve obviously the cognitive function and motor function and activities of daily living,but motor function improvement is obvious.It may be related to follow-up time or a small sample size, and in the future research work should be expanded sample size for further study.2. There were significant relationships among cognitive function, the motor function and ability of daily life of the stroke patients.It indicated that the improvement of cognitive function is benefit to the motor function and ability of daily life of stroke paitients.3. P300PL is a sensitive index on assessing cognitive function.4. Cognitive impairment results from multiple risk factors.Innovation1. In the treatment, the pure cognitive training advance the brain's functional reorganization by means of repeated audio-visual stimulation .In theory,hyperbaric oxygen and drug conventional therapy may have enhanced neural reflex and the effect of functional reorganization;and cognitive function training can make up for the lack of specific functions to read andwrite and audio-visual stimulation of hyperbaric oxygen and drugs.so, hyperbaric oxygen, cognitive training and drug treatment of stroke is an ideal approach .2. Patients with cognitive function impairment of cerebral infarction who have poor compliance and understanding of the capacity. At a certain extent cognitive training rely on the patient's self-efforts and actively cooperate .Thus,the Cognitive rehabilitation training should not usually play a good effect. Hyperbaric oxygen and drug therapy can be said to be passive treatment,and can make up for the disadvantage of cognitive training.In this topic , patients with cognitive impairment were treated by the means of Ginkgo biloba extract and cognitive training and hyperbaric oxygen and conventional approch, so that they have advantages of fully integrated and make up for their disadvantage.
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