Objective. We investigated combined cognitive and exercise interventions in the literature and summarized their effectiveness in improving poststroke cognitive impairment (PSCI). Data Sources. Electronic databases and trial registries were searched from their inception until July 2020. Study Selection. Trials were collected with the following study inclusion criteria: (1) patients over 18 years of age who were diagnosed with PSCI; (2) combined cognitive-exercise interventions, regardless of the order of the two types of interventions or whether they were administered simultaneously; (3) any control group studied at the same time that was deemed acceptable, including no intervention/routine care, delayed intervention, sham intervention, and passive training; (4) the use of any validated cognitive neuropsychological test to evaluate cognitive function; and (5) clinically administered random trials with controls. Data Extraction. Five randomized controlled trials met the inclusion criteria. Two reviewers independently assessed the eligibility of the full texts and methodological quality of the included studies using the Cochrane risk of bias tool. Inconsistent results were resolved by additional discussion or decided by a third examiner, if necessary. Data Analysis. Meta-analysis demonstrated that the combined interventions had a significant effect on executive function and working memory [Stroop test (time), standardized mean difference SMD = 0.42 , 95% confidence interval (CI): 0.80–0.04, p = 0.02 ; Trail Making Test, SMD = 0.49 , 95% CI: 0.82–0.16, p = 0.004 ; Forward Digit Span Test, SMD = 0.91 , 95% CI: 0.54–1.29, p ≤ 0.001 ]. While it was impossible to conduct a meta-analysis of global cognitive function and other cognitive domains, individual experiments demonstrated that the combined interventions played a significant role in global cognition, reasoning ability, logical thinking, and visual-spatial memory function. Conclusions. Our analyses demonstrated that the combined interventions had a significant effect on the improvement of PSCI, particularly in terms of executive function. However, the moderate risk of bias in the included trials and the small number of relevant studies indicated a need for more uniform diagnostic and evaluation criteria, and larger trials would provide stronger evidence to better understand the effectiveness of the combined interventions. This trial is registered with trial registration number INPLASY202160090.
Background: Aging induces degenerative changes in the body and causes cognitive dysfunction, which has a significant negative impact on the daily lives of older adults. At present, there are limited effective interventions to slow the incidence of Aging-related cognitive impairment or even dementia. Among them, exercise and cognitive training are worthy of further research, especially the research on mechanisms. Studies have shown that LncRNA and miRNA play an important role in the occurrence, development, and rehabilitation of aging-related cognitive impairment. We aimed to identify the effect of cognitive-exercise dual-task training on cognitive function in naturally aged rats and to investigate the mechanism by which the LncRNA NEAT1/miR124-3p/caveolin-1-PI3K/Akt/GSK3β pathway plays a role in the improvement of cognitive function with dual-task training. Methods: Forty SD rats at 18 months of age were randomly divided into four groups (n=10 for each group): exercise training group, cognitive training group, cognitive-exercise dual-task training group, and aging control group. Each group underwent 12 weeks of intervention according to their corresponding training protocols. New object recognition tests were performed on all rats after the completion of the intervention. The expressions of related pathway proteins, LncRNA, and miRNA in the hippocampus were examined by Western blotting (WB) and/or Quantitative real-time polymerase chain reactions (qRT-PCR) after euthanasia of the rats. HT22 mouse hippocampal neuronal cells were cultured and miR-124-3p and lncRNA NEAT1 were over-expressed/down-expressed, respectively. WB and/or qRT-PCR were used to determine the levels of caveolin-1-PI3K/Akt/GSK3 pathway, miR-124-3p, and lncRNA NEAT1 expression in the neurons. Results: The results showed that compared with the aging control group, the cognitive-exercise dual-task training group had better performance on novelty recognition (P < 0.01), and their expressions of lncRNA NEAT1, caveolin-1, and p-GSK3β were significantly decreased (P < 0.05), while miR124-3p, p-PI3K, and p-Akt were significantly increased (P < 0.05). Conclusion: Our study showed that cognitive-exercise dual-task training improved cognitive function in aging rats better than no training or single training. The mechanism of cognitive function improvement could be related to the regulation of LncRNA NEAT1/miR124-3p- caveolin1/PI3K/Akt/GSK3β pathway.
Review question / Objective: To investigate the cognitiveexercise the combined interventions reported in the research literature, and synthesize their effectiveness in improving cognitive function poststroke. Information sources: We systematically searched the PubMed and Cochrane Library electronic databases and clinical trial registration websites, and screened clinical randomized controlled trials published in peer-reviewed journals. INPLASY registration number: This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 23 June 2021 and was last u p d a t e d o n 2 3 J u n e 2 0 2 1 ( r e g i s t r a t i o n n u m b e r INPLASY202160090).
BackgroundEvidence for the efficacy of cognitive-motor dual-task (CMDT) training in patients with post-stroke cognitive impairment (PSCI) and no dementia is still lacking. More importantly, although some studies on the cognitive effect of CMDT training show an improvement in cognitive performance, the results are still controversial, and the intervention mechanism of CMDT training on cognitive function improvement is not clear. The main purpose of this study was to analyze the effects of CMDT training on cognitive function, neuron electrophysiology, and frontal lobe hemodynamics in patients with PSCI.MethodsHere we tested the effects of CMDT training on cognitive function in PSCI patients. Forty subjects who met the criteria of PSCI were randomly assigned to control and experimental groups. CMDT training or cognitive task (CT) training was administered to each patient in the experimental and control groups, respectively. All subjects performed Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scale before and after the intervention, and the event-related potentials (ERP) and functional near-infrared spectroscopy (fNIRS) were used to evaluate the changes in neuron electrophysiology and hemodynamics.ResultsForty patients were randomized across Beijing Rehabilitation Hospital Capital Medical University in Beijing. At the end of the intervention, 33 subjects completed the experimental process. The CMDT group showed significant improvement in the MMSE (P = 0.01) and MoCA (P = 0.024) relative to the CT group. The results of ERP and fNIRS showed that CMDT training could shorten the latency of P300 (P = 0.001) and the peak time of oxygenated hemoglobin (P = 0.004). The results showed that CMDT training shortened the response time of central neurons and significantly increased the rate of oxygen supply to the frontal lobe.ConclusionCMDT training in patients with PSCI improved global cognitive function, which was supported by the improved neural efficiency of associated brain areas.Clinical trial registrationhttp://www.chictr.org.cn, identifier ChiCTR2000034862.
Introduction:The objective was to investigate the risk factors for poor pain control in patients with herpes zoster (HZ)-associated neuropathic pain treated with drugs combined with nerve block therapy. Neuropathic pain commonly follows HZ. Nerve block therapy is the most commonly used clinical treatment for such pain, combining anti-inflammation and analgesia to prevent peripheral sensitization of nerve. Methods: Using clinical practice data from a cohort study at our research center, we established a multivariate logistic regression model to investigate potential risk factors for poor control of zoster-associated pain (ZAP) treated with drugs plus nerve block therapy, including demographic characteristics, complications, laboratory tests, and characteristics of HZ attacks. Results: Of the 429 patients with ZAP who received drugs plus nerve block therapy, 95 (22.14%) had poor pain control after treatment. The risk of poor pain control was closely related to presence of cancer (odds ratio (OR) 4.173, 95% confidence interval (CI) 1.342-12.970), numerical rating scale score on admission (OR 1.929, 95% CI 1.528-2.434), and red blood cell count (OR 0.560, 95% CI 0.328-0.954). Area under the receiver operator characteristic curve was 0.730. Goodness of fit (Hosmer-Lemeshow) was 0.874. Conclusions: The risk of poor pain control in patients with ZAP increased as a result of certain patient characteristics and complications, especially severe pain before treatment and cancer.
Background After stroke, an abnormal gait pattern gradually leads to knee pain and joint lesions, resulting the gait instability. However, the correlation between the knee hyperextension and gait pattern, the meniscus volume, and the water content of meniscus in paretic and non-paretic legs has not been fully investigated. Moreover, most of physicians tend to ignore this knee hyperextension. This study attempted to emphasize the importance of knee hyperextension using gait analysis and Magnetic resonance imaging (Trial registration number ChiCTR2000039641, date of registration 04/11/2020). Methods Eight patients with chronic hemiplegic (6 male, 2 female) volunteered to participate in this study. Participants was recruited if they had a hemiplegia following a stroke occurring more than 6 months, had an ability to walk 10 m without aids, had a Function Ambulation Category level at least 3 and above, and had a hemiplegic lower extremity identified as Brunnstrom state III or above identification. The spatial–temporal gait parameters and kinematic parameters in the paretic and the non-paretic legs and the percentage of free water content in deep and shallow layers. Results Longer time since hemiplegia led to larger angles of knee hyperextension (R = 0.56, p = 0.016), larger angles of knee hyperextension led to more tears in meniscus (R = − 0.53, − 0,57 and − 0.70), and larger angles of knee hyperextension decreased water content of the lateral meniscus in the non-paretic leg (R = − 0.91) but increased water content of the medial meniscus (R = 0.53 and 0.63). Conclusions The knee hyperextension could not be ignored by physicians and needed to be diagnosed and treated as early as possible, the time since hemiplegia could be an indicator of sign of knee hyperextension.
Background: After stroke, an abnormal gait pattern gradually leads to knee pain and joint lesions, resulting the gait instability. However, the correlation between the knee hyperextension and gait pattern, the meniscus volume, and the water content of meniscus in paretic and non-paretic legs has not been fully investigated. Moreover, most of physicians tend to ignore this knee hyperextension. This study attempted to emphasize the importance of knee hyperextension using gait analysis and Magnetic resonance imaging (Trial registration number ChiCTR2000039641, date of registration 04/11/2020).Methods: Eight patients with chronic hemiplegic (6 male, 2 female) volunteered to participate in this study. Participants was recruited if they had a hemiplegia following a stroke occurring more than 6 months, had an ability to walk 10 meters without aids, had a Function Ambulation Category level at least 3 and above, and had a hemiplegic lower extremity identified as Brunnstrom state III or above identification. The spatial-temporal gait parameters and kinematic parameters in the paretic and the non-paretic legs and the percentage of free water content in deep and shallow layers.Results: Longer time since hemiplegia led to larger angles of knee hyperextension (R = 0.56, p = 0.016), larger angles of knee hyperextension led to more tears in meniscus (R = - 0.53, -0,57 and -0.70), and larger angles of knee hyperextension decreased water content of the lateral meniscus in the non-paretic leg (R = -0.91) but increased water content of the medial meniscus (R = 0.53 and 0.63).Conclusions: The knee hyperextension could not be ignored by physicians and needed to be diagnosed and treated as early as possible, the time since hemiplegia could be an indicator of sign of knee hyperextension. https: //doi.org/10.1101/2022.02.18.22271154
Stroke is a disease with high morbidity and disability rate. After stroke, slower walking velocity, shorter step length, higher cadence, larger step width, and longer stance phase duration can be apparently observed. Additionally, these abnormal gait parameters eventually lead to knee hyperextension, known as genu recurvatum. Walking with such knee hyperextension usually induces knee pain and joint lesions, leading to cumulative damage and degenerative changes and further decreasing the standing phase's stability. However, do higher angles of knee hyperextension have any correlation between the gait parameters, the kinematics, the kinetic parameters, the meniscus volume, and the water content of meniscus in paretic and non-paretic legs? This study attempted to answer these questions. The results revealed that 1) longer time since hemiplegia led to larger angles of knee hyperextension , 2) larger angles of knee hyperextension led to more tears in medial/lateral meniscus, and 3) larger angles of knee hyperextension decreased water content of the lateral meniscus in the non-paretic leg but increased water content of the medial meniscus. This was the first study to demonstrate these three above-mentioned observations through magnetic resonance imaging and motion capture system. These results suggested that 1) the knee hyperextension needed to be diagnosed and treated as early as possible; 2) the time since hemiplegia could be an indicator of sign of knee hyperextension; and 3) it might be not effective to identify the knee hyperextension by using spatial-temporal gait parameters.
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