Effectiveness of theta and gamma electroacupuncture for post-stroke patients on working memory and electrophysiology: study protocol for a double-center, randomized, patient- and assessor-blinded, sham-controlled, parallel, clinical trial
Tóm tắt
Practitioners of complementary and alternative medicine have suggested that electroacupuncture (EA) could improve post-stroke cognitive impairment, based on the clinical evidence. This study protocol is aimed at showing the effectiveness of theta and gamma EA for post-stroke patients on working memory (WM) and electrophysiology. After assessing their eligibility, 66 patients with stroke will be enrolled from two Chinese medicine hospitals and randomly divided into theta frequency EA group, gamma frequency EA group, and sham-EA group according to the ratio of 1:1:1. All patients will receive 20 sessions of EA procedures for 4 weeks. Patients in three groups will receive EA at two same acupoints in the head: Baihui (GV20) and Shenting (GV24). The frequency of the three groups of EA is set as follows: 6 Hz (theta-EA group), 40 Hz (gamma-EA group), and no current through the electrodes (sham EA). Patients and assessors will be blinded throughout the entire study. The primary outcome is the performance accuracy of 1-back task which is a frequently used measure of WM in cognitive neuroscience research contexts. Secondary outcome measures will include the response time of 1-back task, the Rivermead Behavioral Memory Test, Trail Making Test, Loewenstein Occupational Therapy Cognitive Assessment Scale, modified Barthel Index, and electroencephalogram (EEG) signals during 1-back tasks. A blinding index will be assessed. Data will be statistically analyzed by one-way ANOVA, at 5% of significance level. We expect this double-center, randomized, patient- and assessor-blinded, sham-controlled, parallel, clinical trial to explore the effectiveness of theta and gamma EA therapy, compared with sham EA, for post-stroke WM. Chinese Clinical Trial Registry,
ChiCTR2000031995
. Registered on 17 April 2020.
Tài liệu tham khảo
Van der Flier WM, Skoog I, Schneider JA, et al. Vascular cognitive impairment. Nat Rev Dis Primers. 2018;4:18003.
Hochstenbach JB, Anderson PG, van Limbeek J, et al. Is there a relation between neuropsychologic variables and quality of life after stroke? Arch Phys Med Rehabil. 2001;82:1360–6.
D'Esposito M, Postle BR. The cognitive neuroscience of working memory. Annu Rev Psychol. 2015;66:115–42.
Jaillard A, Naegele B, Trabucco-Miguel S, et al. Hidden dysfunctioning in subacute stroke. Stroke. 2009;40(7):2473–9.
Ziermans T, Dumontheil I, Roggeman C, et al. Working memory brain activity and capacity link MAOA polymorphism to aggressive behavior during development. Transl Psychiatry. 2012;2(2):e85.
Devinsky O, D’Esposito M. The neurology of cognitive and behavioral disorders. New York: Oxford University Press; 2003.
Karlsgodt KH, Bachman P, Winkler AM, et al. Genetic influence on the working memory circuitry: behavior, structure, function and extensions to illness. Behav Brain Res. 2011;225(2):610–22.
Brodziak A, Brewczyński A, Bajor G. Clinical significance of knowledge about the structure, function, and impairments of working memory. Med Sci Monit. 2013;19:327–38.
Al-Dughmi M, Al-Sharman A, Stevens S, et al. Executive function is associated with off-line motor learning in people with chronic stroke. J Neurol Phys Ther. 2017;41(2):101–6.
Pohjasvaara T, Leskelä M, Vataja R, et al. Post-stroke depression, executive dysfunction and functional outcome. Eur J Neurol. 2002;9(3):269–75.
Chung C, Pollock A, Campbell T, et al. Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult nonprogressive acquired brain damage. Stroke. 2013;44(7):e77–8.
Huang J, McCaskey MA, Yang S, et al. Effects of acupuncture and computer-assisted cognitive training for post-stroke attention deficits: study protocol for a randomized controlled trial. Trials. 2015;16:546.
Zhang ZQ, Li KP, He J, et al. Acupuncture of fascia points to relieve hand spasm after stroke: a study protocol for a multicenter randomized controlled trial. Trials. 2020;21:69.
Li H, Long D, Li B, Liu H, et al. A clinical study to assess the influence of acupuncture at “Wang’s Jiaji” acupoints on limb spasticity in patients in convalescent stage of ischemic stroke: study protocol for a randomized controlled trial. Trials. 2019;20:419.
Shen Z, Zhu Y, Liu B, et al. Effects of electroacupuncture on pain memory-related behaviors and synchronous neural oscillations in the rostral anterior cingulate cortex in freely moving rats. Neural Plast. 2019;2019:2057308.
Liu F, Li ZM, Jiang YJ, et al. A meta-analysis of acupuncture use in the treatment of cognitive impairment after stroke. J Altern Complement Med. 2014;20(7):535–44.
Röhner F, Breitling C, Rufener KS, et al. Modulation of working memory using transcranial electrical stimulation: a direct comparison between TACS and TDCS. Front Neurosci. 2018;12:761.
Hoy KE, Bailey N, Arnold S, et al. The effect of γ-tACS on working memory performance in healthy controls. Brain Cogn. 2015;101:51–6.
Pahor A, Jaušovec N. The effects of theta and gamma tACS on working memory and electrophysiology. Front Hum Neurosci. 2018;11:651.
Kleinert ML, Szymanski C, Müller V. Frequency-unspecific effects of θ-tACS related to a visuospatial working memory task. Front Hum Neurosci. 2017;11:367.
Reinhart RMG, Nguyen JA. Working memory revived in older adults by synchronizing rhythmic brain circuits. Nat Neurosci. 2019 May;22(5):820–7.
Mizuhara H, Yamaguchi Y. Human cortical circuits for central executive function emerge by theta phase synchronization. Neuroimage. 2007;36:232–44.
Maurer U, Brem S, Liechti M, et al. Frontal midline theta reflects individual task performance in a working memory task. Brain Topogr. 2015;28:127–34.
Honkanen R, Rouhinen S, Wang SH, et al. Gamma oscillations underlie the maintenance of feature-specific information and the contents of visual working memory. Cereb Cortex. 2015;25:3788–801.
Roux F, Uhlhaas PJ. Working memory and neural oscillations: alpha-gamma versus theta-gamma codes for distinct WM information? Trends Cogn Sci. 2014;18:16–25.
Khader PH, Jost K, Ranganath C, et al. Theta and alpha oscillations during working-memory maintenance predict successful long-term memory encoding. Neurosci Lett. 2010;468:339–43.
Howard MW, Rizzuto DS, Caplan JB, et al. Gamma oscillations correlate with working memory load in humans. Cereb Cortex. 2003;13:1369–74.
Altman DG, Bland JM. How to randomise. BMJ. 1999;319:703–4.
Bang H, Ni L, Davis CE. Assessment of blinding in clinical trials. Control Clin Trials. 2004;25:143–56.
Chen ZX, Li Y, Zhang XG, et al. Sham electroacupuncture methods in randomized controlled trials. Sci Rep. 2017;20:40837.
Fraga FJ, Mamani GQ, Johns E, et al. Early diagnosis of mild cognitive impairment and Alzheimer's with event-related potentials and event-related desynchronization in N-back working memory tasks. Comput Methods Prog Biomed. 2018;164:1–13.
Wilson BA, Cockburn J, Baddeley A. The Rivermead Behavioural Memory Test Second Edition. London: Thames Valley Test Company; 2003.
Hua-zhen GUO, Xiao-ping YUN. Introduction of Rivermead Behavioral Memory Test second edition. Chin J Rehabil Theor Pract. 2007;10:909–10.
Lu L, Bigler ED. Performance on original and a Chinese version of Trail Making Test Part B: a normative bilingual sample. Appl Neuropsychol. 2000;7:243–6.
Giovagnoli AR, Del PM, Mascheroni S, et al. Trail making test: normative values from 287 normal adult controls. Ital J Neurol Sci. 1996;17:305–9.
Rojo-Mota G, Pedrero-Pérez EJ, Ruiz-Sánchez de León JM, et al. Loewenstein occupational therapy cognitive assessment to evaluate people with addictions. Occup Ther Int. 2017;2017:2750328.
Jansa J, Pogacnik T, Gompertz P. An evaluation of the extended Barthel Index with acute ischemic stroke patients. Neurorehabil Neural Repair. 2004;18:37–41.
Deng W, He J. Design and statistical analysis of clinical trials, vol. 12. Beijing: People’s Medical Publishing House; 2012. p. 130–1.
Haatveit BC, Sundet K, Hugdahl K, et al. The validity of d prime as a working memory index: results from the “Bergen n-back task”. J Clin Exp Neuropsychol. 2010;32:871–80.
Cicerone KD, Mott T, Azulay J, et al. A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Arch Phys Med Rehabil. 2008;89:2239–49.
Spikman JM, Boelen DHE, Lamberts KF, et al. Effects of a multifaceted treatment program for executive dysfunction after acquired brain injury on indications of executive functioning in daily life. J Int Neuropsychol Soc. 2010;16:118–29.
Liu A-J, Li J-H, Li H-Q, et al. Electroacupuncture for acute ischemic stroke: a meta-analysis of randomized controlled trials. Am J Chin Med. 2015;43:1541–66.
Liu R, Yu X, Wang J, Liu Y, et al. Evaluation of the efficacy and safety of the use of acupuncture for the adjuvant treatment of patients with post-stroke cognitive impairment: protocol for a randomized controlled trial. Trials. 2020;21:753.
Jiang C, Yang S, Tao J, et al. Clinical Effificacy of acupuncture treatment in combination with RehaCom cognitive training for improving cognitive function in stroke: a 2 *2 factorial design randomized controlled trial. J Am Med Dir Assoc. 2016;17:1114–22.
Cheong YC, Dix S, Hung Yu Ng E, et al. Acupuncture and assisted reproductive technology. Cochrane Database Syst Rev. 2013;(7):CD006920.
Wang WW, Xie CL, Lu L, et al. A systematic review and meta-analysis of Baihui (GV20)-based scalp acupuncture in experimental ischemic stroke. Sci Rep. 2014;4:3981.
Dong H, Fan YH, Zhang W, et al. Repeated electroacupuncture preconditioning attenuates matrix metalloproteinase-9 expression and activity after focal cerebral ischemia in rats. Neurol Res. 2009;31:853–8.
Hwang IK, Chung JY, Yoo DY, et al. Effects of electroacupuncture at Zusanli and Baihui on brain-derived neurotrophic factor and cyclic AMP response element binding protein in the hippocampal dentate gyrus. J Vet Med Sci. 2010;72:1431–6.
Lin R, Yu K, Li X, et al. Electroacupuncture ameliorates post-stroke learning and memory through minimizing ultrastructural brain damage and inhibiting the expression of MMP-2 and MMP-9 in cerebral ischemia-reperfusion injured rats. Mol Med Rep. 2016;14:225–33.
Kim JH, Choi KH, Jang YJ, et al. Electroacupuncture acutely improves cerebral blood flow and attenuates moderate ischemic injury via an endothelial mechanism in mice. PLoS One. 2013;2:e56736.
Lin R, Wu Y, Tao J, et al. Electroacupuncture improves cognitive function through rho GTPases and enhances dendritic spine plasticity in rats with cerebral ischemia-reperfusion. Mol Med Rep. 2016;13:2655–60.
Lin R, Lin Y, Tao J, et al. Electroacupuncture ameliorates learning and memory in rats with cerebral ischemia-reperfusion injury by inhibiting oxidative stress and promoting p-CREB expression in the hippocampus. Mol Med Rep. 2015;12:6807–14.
Lamichhane B, Westbrook A, Cole MW. Exploring brain-behavior relationships in the N-back task. NeuroImage. 2020;15:116683.
Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135–68.
Bopp KL, Verhaeghen P. Aging and verbal memory span: a meta-analysis. J Gerontol Ser B Psychol Sci Soc Sci. 2005;60:223–33.
Miyake A, Friedman NP, Emerson MJ, et al. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol. 2000;41:49–100.
Sanders A, Lamers J. The Eriksen flanker effect revisited. Acta Psychol. 2002;109:41–56.
Verhaeghen P, Basak C. Ageing and switching of the focus of attention in working memory: results from a modified N-back task. Q J Exp Psychol A. 2005;58:134–54.
Vilà-Balló A, Salmi J, Soveri A, et al. Neural signatures for active maintenance and interference during working memory updating. Biol Psychol. 2018;132:233–43.
Dong S, Reder LM, et al. Individual differences in working memory capacity are reflected in different ERP and EEG patterns to task difficulty. Brain Res. 2015;1616:146–56.
Daffner KR, Chong H, Sun X, et al. Mechanisms underlying age- and performance-related differences in working memory. J Cogn Neurosci. 2011;23:1298–314.
Leung AW, Lam LC, Kwan AK, et al. Electroacupuncture for older adults with mild cognitive impairment: study protocol for a randomized controlled trial. Trials. 2015;16:232.
Peng W, Zhou J, Xu M, et al. The effect of electroacupuncture combined with donepezil on cognitive function in Alzheimer s disease patients: study protocol for a randomized controlled trial. Trials. 2017;18:301.
Youn JC, Lee DY, Kim KW, et al. Development of the Korean version of Alzheimer s Disease Assessment Scale (ADAS-K). Int J Geriatr Psychiatry. 2002;17:797–803.
