Clinical Study Of Transcranial Direct Current Stimulation In Patients With Executive Dysfunction After Stroke

Objective: To investigate the effect of transcranial direct current stimulation（tDCS）on post-stroke executive dysfunction（PSEI）and its possible mechanism,and to evaluate the therapeutic effect of event-related potential P300 in patients with stroke.Methods: 63 patients with PSEI were randomly divided into stimulation group（n=31）and control group（n=32）.Each group received routine cognitive rehabilitation training.The stimulation group was given tDCS stimulation,5 times a week,20 min each time,for a total of 4 weeks.Executive function was assessed using the Montreal Cognitive Assessment Scale（MoCA）,The Digit Span Task（DST）,Stroop Colour Word Test（SCWT）,and Frontal lobe function assessment scale（FAB）,and P300 was measured.Patients in both groups were evaluated at baseline and immediately after intervention.Results: There were no significant differences in MoCA,FAB,SCWT and DST scores between the two groups before treatment（all P > 0.05）.After 4 weeks’ treatment,Stimulus set of MoCA score（19.13 ± 3.01）,FAB score（11.80 ± 1.77）,SCWT score[ word color time（53.09 ± 14.40）s,word color error 2.00（2.00,4.00）,word meaning interference（25.60 ± 13.34）s ],DST score [ forwords 8.00（8.00,9.00）,backwards5.00（4.00,5.00）],P300 latency period（333.90 ± 22.96）ms,P300 amplitude（11.03 ±3.12）μV were better than those of the sham stimulation group [ MoCA score（16.83 ±3.25）,FAB score（10.30 ± 1.26）,SCWT score: word color time（61.27 ± 15.13）s,word color error 4.00（3.00,5.00）,word meaning interference（33.78±11.26）s,DST score:forwords 7.00（7.00,8.00）,backwards 3.00（3.00,4.00）,P300 latency period（354.34 ±24.15）ms,P300 amplitude（7.98 ± 2.66）μV ].The differences of scales and P300 parameters before and after treatment in the stimulus group were all better than those of the sham stimulus group [ MoCA score（6.20 ± 2.04）vs.（3.73 ± 1.66）,FAB score（3.90± 1.40）vs.（2.27 ± 1.17）,SCWT score: Word color time 11.13（8.36,16.45）s vs.2.94（2.16,5.22）s,word color error 3.00（2.00,3.00）vs.1.00（0,1.00）,word meaning interference 8.65（5.02,15.57）s vs.3.21（1.23,5.98）s,DST score: forwords 3.00（2.00,3.00）vs.1.50（1.00,2.00）,backwards 2.00（2.00,2.00）vs.1.00（1.00,1.00）,P300 latency period（47.62 ± 10.26）ms vs.（27.76 ± 7.24）ms,P300 amplitude（5.15 ± 2.06）μV vs.（2.81 ± 1.48）μV,all P < 0.05 ].Conclusions: tDCS can improve the executive function of PSEI patients,and the combination of routine rehabilitation training has a better effect on the rehabilitation of PSEI patients than single routine rehabilitation training.The event-related potential P300 has some correlation with executive function,which can be used as an objective indicator to evaluate the therapeutic effect of executive dysfunction.