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背景脑卒中后几个月为自主回复最大程度期,实施康复疗法以减少脑卒中后明显失能病人的数目。目的调查依他普仑对认知结果的作用。我们假设与接受安慰剂或实施解决问题疗法的病人相比,用依他普仑的病人可更好地完成用于评估记忆力和执行功能神经心理测试。设计随机试验。设施脑卒中中心。参试者脑卒中后3个月内接受治疗的129例病人。12个月试验包括3种方法 :双盲安慰剂对照试验,用依他普仑(n=43)与安慰剂(n=45)对照、解决问题疗法(n=41)非盲法。结果测量用于评估神经心理状况的重复成套量表(repeatable battery for the assessment of neuropsychological status,RBANS)和轨迹描绘、口头语言流畅、W echsler氏成人智力量表第3版和Stroop测试从基线水平到治疗末的分数变化。结果我们发现3个治疗组RBANS总分(P<0.01)和RBANS延迟记忆分(P<0.01)存在差异。经对可能混杂成分校对后,依他普仑对改变RBANS总分作用明显(P<0.01,校正均数分:依他普仑组10.0;而非依他普仑组3.1),RBANS延迟记忆分改变(P<0.01,校正均数分:依他普仑组11.3;而非依他普仑组2.5)。对其他神经心理测量我们未做治疗效果观察。结论与用安慰剂或解决问题疗法比较,用依他普仑脑卒中病人总体认知功能得到了改善,特别是言语和视觉记忆功能。依他普仑的这种良好作用不依赖于其抗抑郁作用。关于脑卒中后抗抑郁有效性应做进一步研究。
Background After a few months of stroke, the maximum period of spontaneous recovery was achieved, and rehabilitation therapy was implemented to reduce the number of patients with significant disability after stroke. Objective To investigate the effect of escitalopram on cognitive outcome. We hypothesized that patients with escitalopram may be better able to complete neuropsychological tests for assessing memory and performing functional functioning than patients receiving placebo or implementing problem-solving therapies. Design a randomized trial. Facilities Stroke Center. 129 patients who received treatment within 3 months after their stroke. The 12-month trial included three approaches: a double-blind placebo-controlled trial of problem-free therapy (n = 41) with a non-blinded approach with escitalopram (n = 43) versus placebo (n = 45). Results Measurement The repeatable battery for the assessment of neuropsychological status (RBANS) and trajectory mapping, verbal fluent, Weschler’s Adult Intelligence Scale Version 3 and the Stroop test ranged from baseline Changes in the end of treatment scores. Results We found differences in RBANS scores (P <0.01) and RBANS delayed memory scores (P <0.01) for the three treatment groups. The effect of escitalopram on alteration of the RBANS score was significant (p <0.01, adjusted mean score: 10.0 for escitalopram instead of 3.1 for escitalopram) after proofreading possible mixed components, RBANS delayed memory (P <0.01, adjusted mean scores: 11.3 for the escitalopram group; 2.5 for the escitalopram group). We did not treat other neuropsychological measures. Conclusion Compared with placebo or problem-solving therapies, overall cognitive function in patients with escitalopram stroke has been improved, especially speech and visual memory. This good effect of escitalopram does not depend on its antidepressant effect. The effectiveness of antidepressant after stroke should be further studied.