A double-blind, sham-controlled, pilot study to assess the effects of the concomitant use of transcranial direct current stimulation with the computer assisted cognitive rehabilitation to the prefrontal cortex on cognitive functions in patients with stroke

See-Hyun Park, Eun-Jeong Koh, Ha-Young Choi, Myoung-Hwan Ko, See-Hyun Park, Eun-Jeong Koh, Ha-Young Choi, Myoung-Hwan Ko

Abstract

Objective: To examine the synergistic effects of both computer-assisted cognitive rehabilitation (CACR) and transcranial direct current stimulation (tDCS) on cognitive function in patients with stroke.

Methods: The current double-blind, sham-controlled study enrolled a total of 11 patients who were newly diagnosed with stroke. The patients of the tDCS group (n=6) completed sessions of the Korean computer-assisted cognitive rehabilitation program five times a week for 30 minutes a session during a mean period of 18.5 days concomitantly with the anodal tDCS over the bilateral prefrontal cortex combined with the CACR. The patients of the control group (n=5) also completed sessions of the sham stimulation during a mean period of 17.8 days. Anodal tDCS over bilateral prefrontal cortex (F3 and F4 in 10-20 EEG system) was delivered for 30 minutes at an intensity of 2 mA. Cathode electrodes were applied to the non-dominant arm. All the patients were evaluated using the Seoul Computerized Neuropsychological Test (SCNT) and the Korean Mini-Mental State Examination.

Results: Mann-Whitney U test revealed a significant difference between the two groups. The patients of the tDCS group achieved a significant improvement in the post/pre ratio of auditory continuous performance test and visual continuous performance test on the SCNT items.

Conclusion: Our results indicate that the concomitant use of the tDCS with CACR to the prefrontal cortex may provide additional beneficial effects in improving the cognitive dysfunction for patients with stroke.

Keywords: Brain polarization; Cognitive function; Computer-assisted cognitive rehabilitation; Prefrontal cortex; Transcranial direct current stimulation.

References

    1. Andrews SC, Hoy KE, Enticott PG, Daskalakis ZJ, Fitzgerald PB. Improving working memory : the effect of combining cognitive activity and anodal transcranial direct current stimulation to the left dorsolateral prefrontal cortex. Brain Stimul. 2011;4:84–89.
    1. Baddeley A. Working memory. Science. 1992;255:556–559.
    1. Bloch Y, Harel EV, Aviram S, Govezensky J, Ratzoni G, Levkovitz Y. Positive effects of repetitive transcranial magnetic stimulation on attention in ADHD Subjects : a randomized controlled pilot study. World J Biol Psychiatry. 2010;11:755–758.
    1. Boggio PS, Ferrucci R, Rigonatti SP, Covre P, Nitsche M, Pascual-Leone A. Effects of transcranial direct current stimulation on working memory in patients with Parkinson's disease. J Neurol Sci. 2006;249:31–38.
    1. Constantinidis C, Procyk E. The primate working memory networks. Cogn Affect Behav Neurosci. 2004;4:444–465.
    1. Daffner KR, Mesulam MM, Scinto LF, Acar D, Calvo V, Faust R. The central role of the prefrontal cortex in directing attention to novel events. Brain. 2000;123(Pt 5):927–939.
    1. Desmond DW, Moroney JT, Sano M, Stern Y. Recovery of cognitive function after stroke. Stroke. 1996;27:1798–1803.
    1. Diamond PT, Felsenthal G, Macciocchi SN, Butler DH, Lally-Cassady D. Effect of cognitive impairment on rehabilitation outcome. Am J Phys Med Rehabil. 1996;75:40–43.
    1. Fregni F, Boggio PS, Nitsche M, Bermpohl F, Antal A, Feredoes E. Anodal transcranial direct current stimulation of prefrontal cortex enhances working memory. Exp Brain Res. 2005;166:23–30.
    1. Gazzaley A, Rissman J, D'Esposito M. Functional connectivity during working memory maintenance. Cogn Affect Behav Neurosci. 2004;4:580–599.
    1. Glisky EL, Schacter DL, Tulving E. Computer learning by memory-impaired patients : acquisition and retention of complex knowledge. Neuropsychologia. 1986;24:313–328.
    1. Jo JM, Kim YH, Ko MH, Ohn SH, Joen B, Lee KH. Enhancing the working memory of stroke patients using tDCS. Am J Phys Med Rehabil. 2009;88:404–409.
    1. Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997;15:300–308.
    1. Kim YH, Ko MH, Seo JH, Park SH, Kim KS, Jang EH, et al. Effect of computer-assisted cognitive rehabilitation program for attention training in brain injury. J Korean Acad Rehabil Med. 2003;27:830–839.
    1. Kim YH, Shin SH, Park SH, Ko MH. Cognitive Assessment for Patient with Brain Injury by Computerized Neuropsychological Test. J Korean Acad Rehabil Med. 2001;25:209–216.
    1. Knight RT, Grabowecky MF, Scabini D. Role of human prefrontal cortex in attention control. Adv Neurol. 1995;66:21–34. discussion 34-36.
    1. Ko MH, Han SH, Park SH, Seo JH, Kim YH. Improvement of visual scanning after DC brain polarization of parietal cortex in stroke patients with spatial neglect. Neurosci Lett. 2008;448:171–174.
    1. Kotila M, Waltimo O, Niemi ML, Laaksonen R, Lempinen M. The profile of recovery from stroke and factors influencing outcome. Stroke. 1984;15:1039–1044.
    1. Miller EK, Cohen JD. An integrative theory of prefrontal cortex function. Annu Rev Neurosci. 2001;24:167–202.
    1. Miniussi C, Cappa SF, Cohen LG, Floel A, Fregni F, Nitsche MA, et al. Efficacy of repetitive transcranial magnetic stimulation/transcranial direct current stimulation in cognitive neurorehabilitation. Brain Stimul. 2008;1:326–336.
    1. Ohn SH, Park CI, Lee BH, Kim YH. Effect of prefrontal repetitive transcranial magnetic stimulationon the enhancement of working memory. J Korean Acad Rehabil Med. 2008;32:501–505.
    1. Owen AM, McMillan KM, Laird AR, Bullmore E. N-back working memory paradigm : a meta-analysis of normative functional neuroimaging studies. Hum Brain Mapp. 2005;25:46–59.
    1. Patel M, Coshall C, Rudd AG, Wolfe CD. Natural history of cognitive impairment after stroke and factors associated with its recovery. Clin Rehabil. 2003;17:158–166.
    1. Pohjasvaara T, Erkinjuntti T, Ylikoski R, Hietanen M, Vataja R, Kaste M. Clinical determinants of poststroke dementia. Stroke. 1998;29:75–81.
    1. Rasquin SM, Lodder J, Ponds RW, Winkens I, Jolles J, Verhey FR. Cognitive functioning after stroke : a one-year follow-up study. Dement Geriatr Cogn Disord. 2004;18:138–144.
    1. Wade DT, Parker V, Langton Hewer R. Memory disturbance after stroke : frequency and associated losses. Int Rehabil Med. 1986;8:60–64.
    1. Wassermann EM, Grafman J. Recharging cognition with DC brain polarization. Trends Cogn Sci. 2005;9:503–505.
    1. Yamasaki H, LaBar KS, McCarthy G. Dissociable prefrontal brain systems for attention and emotion. Proc Natl Acad Sci U S A. 2002;99:11447–11451.

Source: PubMed

3
订阅