Computer-aided Cognitive Training Combined with tDCS Can Improve Cognitive Function and Cerebrovascular Reactivity After Ischemic Stroke: A Randomized Controlled Trial

Abstract

Background Cognitive impairment after stroke is one of the main functional disorders after stroke, with an incidence of up to 80%, which is the focus and difficulty of poststroke rehabilitation intervention. Computer-aided cognitive training (CACT) refers to the use of smartphones, tablet computers and other electronic devices to provide targeted training content for different cognitive function impairments. Transcranial direct current stimulation (tDCS), as a noninvasive brain stimulation technique, has shown some efficacy in the rehabilitation of cognitive impairment after stroke. This study examined the effectiveness of computer-assisted cognitive training and tDCS in the treatment of poststroke cognitive dysfunction and explored whether the combination of the two is better than any single therapy. Methods A total of 72 patients with PSCI admitted to the Department of Rehabilitation Medicine, West China Hospital, Sichuan University from November 2021 to September 2022 were randomly divided into the control group (n=18) that patients received conventional cognitive training, tDCS group (n=18), CACT group (n=18), and CACT plus tDCS group (n=18). All four groups were given conventional drugs and rehabilitation treatment. Each group received corresponding 20-minute treatment 15 times a week for 3 consecutive weeks. The main outcome was the Montreal Cognitive Assessment (MoCA) to assess patients' cognitive function, and the secondary outcomes were the Instrumental Activities of Daily Living Scale (IADL) to assess activities of daily living and cerebral vesselfunction tested by transcranial Doppler ultrasound (TCD). Assessment is at baseline and posttreatment. Results Compared with baseline, the MoCA and IADL scores significantly increased after treatment (P<0.01) in all groups, but thecombined group showed better improvement than the other three groups (P=0.006, 0.002, 0.011), and there were no significant differences within the control group, CACT group and tDCS group. Only CACT combined with tDCS group showed an advantage in improving vasomotor reactivity (p ≤ 0.05). Conclusion The combination of CACT and tDCS could more effectively improve PSCI and the ability of daily living in patients with cognitive impairment after stroke, and that may be associated with cerebrovascular function. Trial registration number The study was registered in Chinese Registry of Clinical Trials (ChiCTR2100054063). Registration date: 12/08/2021.