Abstract:

Objective To explore the effects of repetitive transcranial magnetic stimulation（rTMS） combined with cognitive training on apathy symptoms in patients with apathy after ischemic stroke. Methods From January to December 2021，96 patients with ischemic stroke complicated with apathy in a tertiary A Hospital in Haikou City were randomly divided into a control group （n=24），r group （n=24），s group （n=24） and a combined group （n=24）. Using 2×2 factorial experimental design，the control group was given routine treatment，rehabilitation and nursing care. On the basis of interventions in the control group，the r group was treated with rTMS，and the s group was treated with card Stroop paradigm cognitive training，and the combined group was treated with rTMS combined with card Stroop paradigm cognitive training. The intervention cycle was 15 days. The apathy evaluation scale-informant（AES-I） was used to evaluate the improvement of apathy level. Results （1）87 patients completed the intervention，and there was no significant difference in baseline balance among the 4 groups（P>0.05）. （2）rTMS had a main effect on reducing the total score of AES-I and each dimension（P<0.001）. Card-based Stroop paradigm cognitive training had a main effect on reducing the total score of AES-I and the dimensions of interest，cognition and behavior（P<0.05）. Combined application had no interactive effect on improving apathy AES-I and all dimensions（P>0.05）.（3）The improvement of the total score of AES-I in the intervention groups were more effective than that in the control group（P<0.05），and the improvement effect was from large to small in the combined group，r group and s group，and the effect of the combined group was best in interest，cognition and behavior（P<0.05）. Conclusion rTMS combined with cognitive training or single training can reduce the level of apathy in PSA patients. The effect of combined application was most obvious，but there was no interaction between rTMS and cognitive training. The effect of combined application may only be the superposition of the effect of a single measure.

Key words: Apathy, Stroke, Repetitive Transcranial Magnetic Stimulation, Cognitive Training, Rehabilitation Nursing

摘要：

目的 探讨重复经颅磁刺激（repeat transcranial magnetic stimulation，rTMS）联合认知训练对缺血性脑卒中患者淡漠症状的影响。方法 采用便利抽样法，选取2021年1月—12月在海口市某三级甲等医院神经内科、康复科住院的96例缺血性脑卒中伴淡漠的患者为研究对象。采用2 × 2析因试验设计，计算机随机分组，将研究对象分为r组、s组、联合组、对照组，每组24例。在对照组干预措施的基础上，r组行rTMS治疗，s组行卡片式Stroop范式认知训练，联合组行rTMS联合卡片式Stroop范式认知训练，对照组给予缺血性脑卒中常规治疗、康复及护理干预措施，干预周期均为15 d，使用淡漠评定量表-知情者版（Apathy Evaluation Scale-Informant，AES-I）评估干预后患者淡漠水平改善情况。结果 87例完成干预，4组基线均衡，差异无统计学意义（P>0.05）。rTMS对降低AES-I总分及各维度得分有主效应（P<0.001），卡片式Stroop范式认知训练对降低AES-I总分及兴趣、认知、行为维度得分有主效应（P<0.05），联合应用对改善AES-I总分及各维度得分无交互作用（P>0.05）。两两比较，3个试验组AES-I总分改善均好于对照组（P<0.05），改善效果从大到小为联合组、r组、s组，且联合组在兴趣、认知、行为维度比r组、s组改善效果更显著（P<0.05）。结论 rTMS与认知训练联合应用或单一训练均能降低卒中患者淡漠水平，联合应用效果更加明显，但rTMS与认知训练无交互作用，联合应用的效果可能仅为单一措施效果的叠加。

关键词: 淡漠, 卒中, 重复经颅磁刺激, 认知训练, 康复护理