本研究得到了国家自然科学基金（编号：81804004、81902281）、中国博士后科学基金（编号：2018M643207）、深圳市卫健委项目（编号：SZBC2018005）、深圳市科技项目（编号：JCYJ20160428174825490）、广州市卫生与计划生育指导计划（编号：20211A010079、20211A011106）、广州市和大学基金（编号：202102010100）、 广州医科大学基金（编号：PX-66221494），广东省高等学校重点实验室[批准号：2021KSYS009]和广东省教育厅[批准号：2021ZDZX2063]。

该项目已获得广州医科大学附属第五医院医学伦理学会（编号：KY01-2020-08-06）批准，并已在中国临床试验注册中心注册（编号：ChiCTR2000036514）。在本研究中使用他们的数据获得了患者的知情同意。
1. 招聘
<ol><li>招募影像学检查确诊病情稳定的脑卒中患者，符合中华医学会神经内科分会脑血管病诊断标准（2005）。选择布伦斯特罗姆IV21期的卒中?...

<ol>
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作者没有什么可透露的。

在我们的研究中，高功能卒中患者的常规临床认知评估量表的结果没有显示任何显着的认知缺陷。然而，这些评估量表可能显示天花板效应，并且对识别高功能卒中患者的轻度认知缺陷不太敏感。因此，该协议在基于Stroop范式的双重任务评估中进一步选择了ACC和RT作为识别高功能中风患者认知缺陷的主要指标。结果表明，当高功能脑卒中患者进行双任务Stroop范式时，其RT明显长于健康年轻受试者，...

中风是人类残疾的主要原因1 ，可导致不同程度的运动、认知、情绪和其他功能缺陷2。一些预后较好且仅有轻微功能缺陷的脑卒中患者在日常活动中表现出更大的功能自主性，但其残疾的功能状态可能不足以支持他们重返工作岗位或以前的活动。这些患者被称为高功能中风患者3，4。由于功能缺陷轻微，很难通过功能量表的一般评估来识别其功能障碍，特别是在认知功能方面，例如蒙特利尔认知评估（MoCA）5 和临床痴呆评级（CDR）6，这些功能量表对识别高功能卒中患者的轻度功能缺陷具有上限效应和较差的敏感性。因此，有必要开发客观简单的方法来识别高功能脑卒中患者的认知功能障碍。
近年来，双任务范式在考核和培训中的优势逐渐被重视7，8。例如，患者可能在简单的认知单一任务（例如，计算）上表现正常，但是当添加额外的任务9，10（例如，边走边计数）时表现出不同程度的认知下降。Manaf等人发现，中风患者在执行认知运动双重任务时经常使用补偿策略，例如通过牺牲认知任务表现来维持稳定性11。因此，双任务评估在识别高功能卒中患者的认知缺陷方面可能具有优势。一方面，双任务评估的内容比单一任务更接近日常生活，例如边走边观察周围环境或说话和打电话。在以前的研究中，步行+命名任务和步行+穿越障碍物任务旨在模拟真实环境中的行走12。
另一方面，双重任务中的执行能力与注意力分配（属于高级认知功能范畴）密切相关13。注意力分配是同时处理多个任务并将注意力分配给两个或多个任务的能力14.这种认知技能对提高日常活动的效率具有重要意义。因此，双任务评估的结果可用于反映个体的注意力分配。通常，人们可以在日常生活中同时处理两个或多个简单的任务，并且不会被打扰。然而，当大脑功能受损时，面对简单的双重任务时，可能会有更多的双任务干扰;也就是说，在执行双重任务时，注意力分散的减少可能会导致一个或两个任务的性能受损15。结论是，双任务执行更有可能检测高功能卒中患者的晚期认知功能障碍。
斯特鲁普范式是研究斯特鲁普效应（也称为冲突效应）16的经典实验范式，已广泛应用于认知功能测试中的注意力评估，特别是在注意力抑制领域17。经典斯特鲁普效应是指由于显性反应的干扰，个体难以对非显性刺激做出快速准确的反应。这导致非显性刺激的响应时间更长，响应精度更低。显性和非显性反应之间的反应时间或准确率的差异是斯特鲁普效应18。因此，斯特鲁普需要高度关注19.较小的斯特鲁普效应表示较高的注意抑制，而较大的斯特鲁普效应表示注意抑制的下降18。
与传统的临床评估量表20相比，斯特鲁普范式可能更适合评估高功能卒中患者的认知功能障碍，并且对注意力评估具有更高的敏感性和特异性。因此，本研究设计了一种基于斯特鲁普范式的双任务评估，以识别高功能卒中患者的认知缺陷。该方案还包括对脑卒中患者的认知功能、下肢运动功能和平衡功能的临床评估，以确保患者能够完成双重任务评估。将功能近红外光谱（fNIRS）作为脑功能的客观评估工具，检测双重任务下高功能脑卒中患者脑功能的激活情况。从神经影像学的角度验证了基于Stroop范式的双任务评估方案的有效性和可行性，为临床实践提供了新的方面。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Balance Ball</td>
			<td>Shanghai Fanglian Industrial Co,&#160;China</td>
			<td>PVC-KXZ-EVA01-2015</td>
			<td>NA</td>
		</tr>
		<tr>
			<td>E-Prime 3.0</td>
			<td>Psychology softwares Tools</td>
			<td></td>
			<td>commercial stimulus presentation software</td>
		</tr>
		<tr>
			<td>fNIRS</td>
			<td>Hui Chuang, China</td>
			<td>NirSmart-500</td>
			<td>NA</td>
		</tr>
	</tbody>
</table>

dual-task stroop paradigm for detecting cognitive deficits in high-functioning stroke patients

一般临床认知评估量表对高功能卒中患者的认知障碍不够敏感。双任务评估对识别高功能脑卒中患者的认知缺陷具有优势，并已逐步应用于临床评估和认知训练。此外，与传统的临床认知评估量表相比，斯特鲁普范式对注意力评估具有更高的敏感性和特异性。因此，本研究提出了基于斯特鲁普范式的双任务评估，以识别高功能中风患者的认知缺陷。本研究展示了基于Stroop范式的单任务和双任务评估，并通过案例实验和同步功能近红外光谱评估证实了其可行性。斯特鲁普反应时间和正确率作为评价受试者认知水平的主要指标。本研究方案旨在为高功能卒中患者一般临床评估失败的天花板效应提供新思路。

这项研究展示了一名高功能中风患者的结果，该患者是一名 71 岁的男性，2 年前患有缺血性中风并伴有左偏瘫。磁共振成像 （MRI） 显示从基底神经节到放射冠的双侧慢性梗死。他能够在社区中独立行走和生活，但对自己的认知恢复并不满意。然而，功能评估都在正常范围内：FMA = 100，BBS = 56/56，TUGT = 6，MoCA = 26/30，CDR = 0.5，阿尔伯特检验 = 0。此外，我们还招募了一名年轻女性健康受试者作为对照...

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Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

临床评估量表对高功能卒中患者的认知功能障碍不够敏感。双任务范式在认知功能障碍的评估和认知训练中具有优势和潜力。这里的研究提出了一种双任务斯特鲁普范式来识别高功能中风患者的认知功能障碍。

检测高功能卒中患者认知缺陷的双任务斯特鲁普范式

General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task ...

我们的研究方案可用于识别高功能中风患者的认知缺陷，这些患者不容易被常规评估技能发现。本研究方案旨在为高功能脑卒中患者在一般临床评估失败中的影响提供新思路。该研究方案可以很容易地用于临床实践。例如，临床医生可以根据斯特鲁普反应时间和正确速率修改治疗策略。演示该程序的将是康复治疗师黄思琪;王思清，职业治疗师;张雅杰，物理治疗师，赵碧怡，我们实验室的职业治疗师。招募经影像学检查确认的 Brunnstrom 4 期病情稳定的中风患者。确保受试者自愿参加测试并签署知情同意书。记录参与者的信息，包括姓名、性别、出生日期、教育水平、体重指数、病史和用药史。对于认知评估，通过询问11个问题对参与者进行MoCA，这些问题涉及他们的注意力和注意力，执行功能，记忆力，语言，视觉结构技能，抽象思维，计算和方向。然后通过在与参与者及其家人的结构化访谈中收集信息来执行CDR，以评估参与者在记忆，定向，判断和解决问题，工作和社会互动，家庭生活，个人爱好和独立生活等方面的能力。进行阿尔伯特试验以检测卒中患者是否存在单侧空间忽视。要求受试者划掉一张纸上随机放置的所有线条。接下来，对参与者进行Fugl-Meyer评估，以评估中风后偏瘫患者的感觉，平衡，关节运动范围和关节疼痛。运动功能包括评估肩膀、肘部、前臂、手腕、手、臀部、膝盖和脚踝的运动、协调和反射动作的项目。同时对中风患者进行Berg平衡量表，从易到难共14个项目，包括坐姿平衡、站立平衡、身体转移、转身和单腿站立。执行定时测试。让受试者从椅子上站起来，走三米，转动身体，然后返回并坐在椅子上。同时，安排从发出出发令到坐在椅子上的整个过程。通过确保测试帽顶部的 CZ 位点（即从前额到枕叶的第四点）位于全帽的中线上，为参与者做好准备。确保连接的中点位于鼻根与枕骨突起下缘之间，双耳上耳窝之间的连接或从鼻根到枕突的连接点的交点。然后单击预采集按钮开始预采集并校准测试信号。执行与fNIRS同步的斯特鲁普单任务评估。然后执行与fNIRS同步的斯特鲁普双任务评估。首先，让患者坐在稳定的椅子上。运行商业刺激演示软件并选择全等测试试验。为患者制作新的个人资料。选择 Stroop 任务的全等检验试验并重复三个试验。在休息阶段，要求患者放松。当实验处于刺激阶段时，要求患者进行注意力相关测试，并在六秒内完成任务。患者应在 60 秒内完成 10 次。要求患者遵循两个测试试验的说明。选择全等检验试验。显示左侧时，单击左侧的箭头按钮。显示右侧时单击右侧的箭头按钮。选择不协调任务试验。当右箭头按钮显示在正方形的左侧时，请尽快单击左侧的箭头按钮。当左箭头显示在正方形的右侧时，请尽快单击右侧的箭头按钮。完成任务，保存数据并将数据导出到自建数据库。要进行斯特鲁普双重任务评估，请患者坐在平衡球上。让患者按照上一步所示的步骤完成斯特鲁普实验范式。当实验处于休息阶段时，要求患者保持平衡并在平衡球上放松。当实验在刺激时，要求患者在尽可能保持平衡球平衡的同时进行与注意力相关的测试。本研究对高功能卒中患者与健康受试者进行了认知评估。在双任务全等试验中，脑卒中患者的反应时间高于健康的年轻受试者，其准确性相对较低。这种差异在不一致测试试验中更大。脑功能结果表明，在执行双重任务Stroop时，脑卒中患者感兴趣区域的β值低于健康年轻受试者。显示大脑区域的血氧浓度。在双重任务表现期间，脑卒中患者的β值低于健康年轻受试者。在双重任务案件中，评估人员应保护参与者，以避免发生跌倒等意外伤害。我们的研究方案主要用于评估敏锐度功能。未来应该研究双重任务的不同类型和难度。在我们的研究方案中，双重任务评估可以识别高功能患者的认知缺陷，这将为制定个性化治疗计划铺平道路。

dual-task-stroop-paradigm-for-detecting-cognitive-deficits-high

Research

JoVE Journal

Neuroscience

2.6K Views.  Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital. Our study protocol could be used to identify cognitive deficit in high functioning stroke patients who are not easily detected by conventional assessment skills. This study protocol is to provide new ideas to figure out effect in general clinical assessment failure for high functioning stroke patients. This study protocol could be easily used in the clinical practice.For example, the clinician could modify the treatment strategy based on the Stroop reaction time and the correct rate. D...