Explore combined use of transcranial direct current stimulation and cognitive training on executive function after stroke

Yuan-Wen Liu, Zhong-Hua Chen, Jing Luo, Ming-Yu Yin, Li-Li Li, Yu-De Yang, Hai-Qing Zheng, Zhen-Hong Liang, Xi-Quan Hu, Yuan-Wen Liu, Zhong-Hua Chen, Jing Luo, Ming-Yu Yin, Li-Li Li, Yu-De Yang, Hai-Qing Zheng, Zhen-Hong Liang, Xi-Quan Hu

Abstract

Objective: To explore the effects of transcranial direct current stimulation combined with cognitive training on executive function and activities of daily living performance among stroke patients.

Methods: A total of 50 subjects were enrolled and randomly allocated into 2 groups of 25 each. The real-transcranial direct current stimulation group was simultaneously subjected to transcranial direct current stimulation and cognitive training, while the sham-transcranial direct current stimulation group was simultaneously subjected to sham transcranial direct current stimulation and cognitive training. At baseline, and after treatment, each subject was assessed with the Wisconsin Card Sorting Test (WCST), Stroop Color-Word Test (SCWT), Digital Symbol Test (DST), Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Activities of Daily Living Scale (ADLs).

Results: After treatment, the gains in most indices of WCST, SCWT, DST, MMSE, MoCA and ADLs in the real-transcranial direct current stimulation group were significantly higher than those in the sham-transcranial direct current stimulation group (p<0.05). Nonetheless, no significant differences were noted in the gains in SCWT (including only Part A time and error, and Part B time) and activities of daily living (including only basic activities of daily living) between the 2 groups (p>>0.05).

Conclusion: Transcranial direct current stimulation combined with cognitive training was found to significantly enhance executive function and instrumental activities of daily living performance among stroke patients.

Keywords: activities of daily living; cognitive training; executive function; stroke; transcranial direct current stimulation.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) study flow diagram. tDCS: transcranial direct current stimulation.

References

    1. Gittler M, Davis AM. Guidelines for adult stroke rehabilitation and recovery. JAMA 2018; 319: 820–821.
    1. Laakso HM, Hietanen M, Melkas S, Sibolt G, Curtze S, Virta M, et al. . Executive function subdomains are associated with post-stroke functional outcome and permanent institutionalization. Eur J Neurol 2019; 26: 546–552.
    1. Rike PO, Eriksen LA, Schanke AK. Associations between self and informant ratings of executive functioning and driver behaviour following acquired brain injury. J Rehabil Med 2018; 50: 589–597.
    1. van Rooij FG, Plaizier NO, Vermeer SE, Goraj BM, Koudstaal PJ, Richard E, et al. . Executive function declines in the first 6 months after a transient ischemic attack or transient neurological attack. Stroke 2017; 48: 3323–3328.
    1. Chung CS, Pollock A, Campbell T, Durward BR, Hagen S. Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage. Cochrane Database Syst Rev 2013: CD008391.
    1. Lindenmayer JP, Kulsa MKC, Sultana T, Kaur A, Yang R, Ljuri I, et al. . Transcranial direct-current stimulation in ultra-treatment-resistant schizophrenia. Brain Stimul 2019; 12: 54–61.
    1. Ahn YH, Sohn HJ, Park JS, Ahn TG, Shin YB, Park M, et al. . Effect of bihemispheric anodal transcranial direct current stimulation for dysphagia in chronic stroke patients: A randomized clinical trial. J Rehabil Med 2017; 49: 30–35.
    1. Kang EK, Kim DY, Paik NJ. Transcranial direct current stimulation of the left prefrontal cortex improves attention in patients with traumatic brain injury: a pilot study. J Rehabil Med 2012; 44: 346–350.
    1. Shaker HA, Sawan SAE, Fahmy EM, Ismail RS, Elrahman S. Effect of transcranial direct current stimulation on cognitive function in stroke patients. Egypt J Neurol Psychiatr Neurosurg 2018; 54: 32.
    1. Fehring DJ, Illipparampil R, Acevedo N, Jaberzadeh S, Fitzgerald PB, Mansouri FA. Interaction of task-related learning and transcranial direct current stimulation of the prefrontal cortex in modulating executive functions. Neuropsychologia 2019; 131: 148–159.
    1. Schwippel T, Papazova I, Strube W, Fallgatter AJ, Hasan A, Plewnia C. Beneficial effects of anodal transcranial direct current stimulation (tDCS) on spatial working memory in patients with schizophrenia. Eur Neuropsychopharmacol 2018; 28: 1339–1350.
    1. Ishikuro K, Dougu N, Nukui T, Yamamoto M, Nakatsuji Y, Kuroda S, et al. . Effects of transcranial direct current stimulation (tDCS) over the frontal polar area on motor and executive functions in Parkinson’s disease; a pilot study. Front Aging Neurosci 2018; 10: 231.
    1. Nelson JT, McKinley RA, Golob EJ, Warm JS, Parasuraman R. Enhancing vigilance in operators with prefrontal cortex transcranial direct current stimulation (tDCS). Neuroimage 2014; 85: 909–917.
    1. Coffman BA, Trumbo MC, Flores RA, Garcia CM, van der Merwe AJ, Wassermann EM, et al. . Impact of tDCS on performance and learning of target detection: interaction with stimulus characteristics and experimental design. Neuropsychologia 2012; 50: 1594–1602.
    1. Yeh TT, Chang KC, Wu CY. The Active Ingredient of Cognitive Restoration: a multicenter randomized controlled trial of sequential combination of aerobic exercise and computer-based cognitive training in stroke survivors with cognitive decline. Arch Phys Med Rehabil 2019; 100: 821–827.
    1. Nejati V, Salehinejad MA, Nitsche MA, Najian A, Javadi AH. Transcranial direct current stimulation improves executive dysfunctions in ADHD: implications for inhibitory control, interference control, working memory, and cognitive flexibility. J Atten Disord 2020; 24: 1928–1943.
    1. Farrar DC, Mian AZ, Budson AE, Moss MB, Koo BB, Killiany RJ. Retained executive abilities in mild cognitive impairment are associated with increased white matter network connectivity. Eur Radiol 2018; 28: 340–347.
    1. Cordova CA, Jackson D, Langdon KD, Hewlett KA, Corbett D. Impaired executive function following ischemic stroke in the rat medial prefrontal cortex. Behav Brain Res 2014; 258: 106–111.
    1. Wang J, Wen JB, Li XL. No effect of transcranial direct current stimulation of the dorsolateral prefrontal cortex on short-term memory. CNS Neurosci Ther 2018; 24: 58–63.
    1. Withiel TD, Wong D, Ponsford JL, Cadilhac DA, New P, Mihaljcic T, et al. . Comparing memory group training and computerized cognitive training for improving memory function following stroke: a phase II randomized controlled trial. J Rehabil Med 2019; 51: 343–351.
    1. Lange F, Bruckner C, Knebel A, Seer C, Kopp B. Executive dysfunction in Parkinson’s disease: a meta-analysis on the Wisconsin Card Sorting Test literature. Neurosci Biobehav Rev 2018; 93: 38–56.
    1. Ramos-Goicoa M, Galdo-Alvarez S, Diaz F, Zurron M. Effect of normal aging and of mild cognitive impairment on event-related potentials to a stroop color-word task. J Alzheimers Dis 2016; 52: 1487–1501.
    1. Tung LC, Yu WH, Lin GH, Yu TY, Wu CT, Tsai CY, et al. . Development of a Tablet-based symbol digit modalities test for reliably assessing information processing speed in patients with stroke. Disabil Rehabil 2016; 38: 1952–1960.
    1. Roalf DR, Moore TM, Mechanic-Hamilton D, Wolk DA, Arnold SE, Weintraub DA, et al. . Bridging cognitive screening tests in neurologic disorders: a crosswalk between the short Montreal Cognitive Assessment and Mini-Mental State Examination. Alzheimers Dement 2017; 13: 947–952.
    1. Hsu JL, Fan YC, Huang YL, Wang J, Chen WH, Chiu HC, et al. . Improved predictive ability of the Montreal Cognitive Assessment for diagnosing dementia in a community-based study. Alzheimers Res Ther 2015; 7: 69.
    1. Tulliani N, Bissett M, Bye R, Chaudhary K, Fahey P, Liu KPY. The efficacy of cognitive interventions on the performance of instrumental activities of daily living in individuals with mild cognitive impairment or mild dementia: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8: 222.
    1. Metzuyanim-Gorlick S, Mashal N. The effects of transcranial direct current stimulation over the dorsolateral prefrontal cortex on cognitive inhibition. Exp Brain Res 2016; 234: 1537–1544.
    1. Doruk D, Gray Z, Bravo GL, Pascual-Leone A, Fregni F. Effects of tDCS on executive function in Parkinson’s disease. Neurosci Lett 2014; 582: 27–31.
    1. Orlov ND, O’Daly O, Tracy DK, Daniju Y, Hodsoll J, Valdearenas L, et al. . Stimulating thought: a functional MRI study of transcranial direct current stimulation in schizophrenia. Brain 2017; 140: 2490–2497.
    1. Hill AT, Rogasch NC, Fitzgerald PB, Hoy KE. Impact of concurrent task performance on transcranial direct current stimulation (tDCS)-Induced changes in cortical physiology and working memory. Cortex 2019; 113: 37–57.
    1. Cumming TB, Tyedin K, Churilov L, Morris ME, Bernhardt J. The effect of physical activity on cognitive function after stroke: a systematic review. Int Psychogeriatr 2012; 24: 557–567.
    1. Rozental-Iluz C, Zeilig G, Weingarden H, Rand D. Improving executive function deficits by playing interactive videogames: secondary analysis of a randomized controlled trial for individuals with chronic stroke. Eur J Phys Rehabil Med 2016; 52: 508–515.

Source: PubMed

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