| ObjectiveThis research aims to explore the effect of internet-based cognitive training for patients with post-stroke cognitive impairment(PSCI)and observes the clinical efficacy,to test the universality of computer-assisted cognitive training in the rehabilitation of PSCI,provide a new rehabilitation mode for cognitive impairment after stroke and promote the clinical application of internet-based online cognitive rehabilitation.Diffusion Tensor Imaging(DTI)was used to investigate the possible neural mechanisms by which computer-assisted cognitive training improves cognitive function.MethodsFourty-five patients with post-stroke cognitive impairment who met the inclusion criteria were randomly divided into control group(n=15),general computer group(n=15)and internet group(n=15).Three groups received traditional cognitive training.The general computer group was given general computer-assisted cognitive training additionally and internet group was given internet-based cognitive training additionally.All patients in three groups were scanned with DTI and the Mini-mental State Examination(MMSE),the Montreal Cognitive Assessment(MoCA),the Non-Language-Based Cognitive Assessment(NLCA)were used to evaluate the cognitive function before and after training.Results1.After the training,the total MMSE score,orientation and language in control group were significantly higher than before training,with statistically significant differences(P<0.05);the total MoCA score,naming,and orientation were significantly higher than those before training,with statistically significant differences(P<0.05);the total NLCA score,memory and attention were significantly higher than those before training,with statistically significant differences(P<0.05);the FA values of infarct side and mirror site of the patients were significantly increased,with statistically significant differences(P<0.05).2.After the training,the total MMSE score and orientation in general computer group were significantly higher than before training,with statistically significant differences(P<0.05);the total MoCA score and naming were significantly higher than those before training,with statistically significant differences(P<0.05);the total NLCA score,memory,visuospatial and attention were significantly higher than those before training,with statistically significant differences(P<0.05);the FA value of the infarct side in the patients was significantly higher than that before training,with astatistically significant difference(P<0.05),while the FA value of mirror site was not significantly higher than that before training(P>0.05).3.After the training,the total MMSE score,orientation,attention and calculation,recall and language in internet group were significantly higher than those before training,with statistically significant differences(P<0.05);the total MoCA score,visual space and executive function,attention and calculation,language,abstraction,delayed recall and orientation were significantly higher than those before training,with statistically significant differences(P<0.05);the total NLCA score and score of each item were significantly higher than those before training,with statistically significant differences(P<0.05);the FA value of infarct side in the patients was significantly higher than that before training,with a statistically significant difference(P<0.05),while the FA value of mirror site was not significantly higher than that before training(P>0.05).4.After the training,the total MMSE score,attention and calculation,recall in internet group were significantly higher than that in general computer group,with statistically significant differences(P<0.05),and the total MMSE score was significantly higher than that of the control group,with statistically significant differences(P<0.05);the total MoCA score and delayed recall were significantly higher than that of the control group,with statistically significant differences(P<0.05),while there was no statistically significant difference in total MoCA score of general computer group(P>0.05),but there were significant differences in attention,calculation,abstraction and delayed recall(P<0.05);the total NLCA score and memory were significantly higher than that of general computer group,with statistically significant differences(P<0.05),while there was no statistically significant difference between the total scores of internet group and control group(P>0.05),but there were statistically significant differences in memory and visuospatial(P<0.05).The scores of MMSE,MoCA and NLCA in general computer group were not significantly different from that of control group(P>0.05).5.The FA value of infarct side significantly decreased compared with that of mirror site in the three groups,with statistically significant differences(P<0.05).6.There was an interaction between time and intervention on the FA value of infarct side in three groups,and the difference was statistically significant(P<0.05).Before training,there was no statistically significant difference in the effect of intervention on the FA value of infarct side(P>0.05),and no statistically significant difference in pairwise comparison(P>0.05);after training,there was a statistically significant difference in the effect of intervention on the FA value of infarct side(P<0.05)and pairwise comparison results showed that FA value of infarct side in internet group was significantly improved compared with the control group,and the difference was statistically significant(P<0.05),while there was no statistically significant difference compared with general computer group(P>0.05).The influence of time factor on the FA value of infarct side in three groups were statistically significant(P<0.05).7.There was no interaction between time and intervention on the FA value of mirror site in three groups,and the difference was not statistically significant(P>0.05).There was no statistically significant difference in the influence of intervention factors on the FA value of mirror site(P>0.05),and pairwise comparison results showed no statistically significant difference(P>0.05).The influence of time on FA value of mirror site was statistically significant(P<0.05);the FA value of mirror site in control group after training were significantly different from those before training(P<0.05),while those in general computer group and internet group were not significantly different from those before training(P>0.05).ConclusionInternet-based cognitive training can effectively improve PSCI and the treatment effect of traditional cognitive training combined with internet-based cognitive training is significantly better than that of single traditional cognitive training and traditional cognitive training combined with general computer-assisted cognitive training.The mechanism of the improvement of cognitive function may be related to the enhancement of the integrity of cerebral white matter fiber tracts after cognitive training.This provides a new training mode for cognitive rehabilitation of PSCI patients,which is worthy of clinical application. |
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