Mindfulness Matters: TheImpact of Mindfulness Based Stress Reduction on Post-Stroke Cognition

正念很重要：基于正念的减压对中风后认知的影响

• 批准号: 10040512
• 负责人: Elisabeth Breese Marsh
• 金额: $ 46.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10040512
• 关键词: Affect; Aftercare; Analysis of Covariance; Anxiety; Area; Attention; Attention Concentration; Awareness; Brain; Brain imaging; Cerebrum; Chronic Disease; Chronic Phase; Client satisfaction; Clinic; Cognition; Cognition Disorders; Cognitive; Control Groups; Data; Decision Making; Diabetes Mellitus; Diffuse; Elderly; Electroencephalography; Enrollment; Environment; Executive Dysfunction; Exhibits; Fatigue; Functional Imaging; Functional disorder; Fusiform gyrus; Home environment; Imaging Device; Impaired cognition; Impairment; Individual; Infarction; Intervention; Language Disorders; Life; Location; Magnetoencephalography; Measures; Meditation; Mental Depression; Migraine; Mindfulness Training; Minor; Mood Disorders; Moods; Morbidity - disease rate; Natural History; Neurons; Older Population; Outcome; Participant; Patients; Pattern; Perception; Performance; Phase; Population; Process; Quality of life; Randomized; Recovery; Recovery of Function; Regulation; Rehabilitation therapy; Resolution; Rest; Retirement; Series; Social Environment; Societies; Stroke; Support Groups; Testing; Therapeutic; Thrombectomy; Time; Traumatic Brain Injury; Treatment Effectiveness; United States National Institutes of Health; Visual; Work; Yoga; active lifestyle; affective disturbance; anxiety treatment; base; chronic stroke; cognitive function; cognitive task; cognitive testing; cohort; effective therapy; executive function; frontal lobe; functional status; group intervention; improved; indexing; mindfulness; mindfulness-based stress reduction; motor deficit; multitask; neuroimaging; neurophysiology; novel; post intervention; post stroke; post stroke cognitive impairment; post stroke depression; prevent; processing speed; professional atmosphere; recruit; stroke outcome; stroke patient; stroke recovery; tool; treatment effect

PROJECT SUMMARY Thrombectomy has significantly improved stroke outcomes. Nearly 80% of our clinic population now present with small strokes and low NIH Stroke Scale (NIHSS) scores. However, despite “good recoveries”, greater than 40% endorse significant problems with concentration, attention, executive function, processing speed, and mood during the subacute phase of recovery. This dysfunction prohibits individuals from fully reintegrating into their prior home and workplace environments and can result in early retirement or loss of independence, particularly in the older population. Some degree of recovery is observed by 6 months, but it is often incomplete or too late to reverse prior life-altering decisions. The impaired executive function and processing speed appear to occur independent of stroke size, location, or co-existing depression. Magnetoencephalography (MEG) is a functional imaging tool able to evaluate neurophysiologic processes in real time similar to EEG, but with better spatial resolution. Our prior work with MEG suggests that cerebral activation patterns are not only slowed and more dispersed during task completion in individuals with minor stroke compared to controls, but that there is abnormal activity in the frontal lobes, even at rest. Unfortunately, many patients do not qualify for rehabilitation and there is little data regarding effective treatment options to hasten or augment recovery. Mindfulness training may provide an attractive therapeutic option. A combination of meditation, body awareness, and yoga, Mindfulness Based Stress Reduction (MBSR) is an active process thought to engage the frontal lobes. MBSR has been shown to improve anxiety and depression in patients with chronic disease states like migraine and diabetes, and has also been evaluated in a small series of patients with chronic stroke and traumatic brain injury demonstrating improved performance during tasks of executive function. We propose to study the effect of MBSR in the early phase of stroke recovery to determine if this intervention can help to prevent post-stroke morbidity. A cohort of 40 patients (NIHSS <8, mRS 0-2) will be enrolled. Twenty will be randomized to a standard 8 week course of MBSR, while the control group will instead participate in a weekly Stroke Support Group (SSG). Depression, cognition, patient perception of recovery, and degree of re-integration into prior environments will be evaluated pre- and post-intervention to determine the impact of mindfulness training on subacute post-stroke depression (Aim 3) and cognition (Aim 2). All participants will undergo neuroimaging using MEG pre- and post-intervention to determine the neurophysiologic effect of treatment (Aim 1). Patients with minor stroke have tremendous potential to return to their prior level of function; however, many fail to return to work or successfully reintegrate into society. MBSR would provide a novel, non-pharmacologic treatment that is likely to be effective by targeting areas of abnormality confirmed by neuroimaging studies.

项目摘要 血栓切除术显着改善了中风结果。现在近80％的诊所人口 中风和低NIH中风量表（NIHSS）得分。但是，多皮特“良好恢复”大于 40％认可集中注意力，注意力，执行功能，处理速度和 在恢复亚急性阶段的情绪。这种功能障碍禁止个人完全重新整合到 他们以前的家和工作场所环境，可能会导致早期退休或失去独立性， 特别是在老年人中。在6个月之前观察到某种程度的恢复，但通常是 不完整或太晚，无法扭转先前改变生活的决定。执行功能和处理受损 速度外观要独立于中风大小，位置或共存的抑郁症。 磁脑电图（MEG）是一种功能成像工具，能够评估神经生理过程 实时类似于脑电图，但具有更好的空间分辨率。我们先前与梅格的工作表明大脑 激活模式不仅放缓，在任务完成期间的分散程度更多 与对照组相比，中风与对照组相比，但即使在静止状态也存在异常活动。很遗憾， 许多患者没有资格进行康复，并且关于有效治疗方案的数据很少 加速或增加恢复。 正念训练可以提供有吸引力的治疗选择。冥想，身体的结合 意识和瑜伽，基于正念的压力减轻（MBSR）是一个活跃的过程，被认为参与 额叶的爱。已显示MBSR可改善慢性疾病患者的焦虑和抑郁 偏头痛和糖尿病等状态，也已在一小片慢性中风患者中进行了评估 脑损伤表明执行功能任务期间的表现提高了。 我们建议研究MBSR在中风恢复的早期阶段的影响，以确定这种干预是否是否 可以帮助防止冲程后发病率。将招募40例患者（NIHSS <8，MRS 0-2）的队列。 二十个将随机分为MBSR的标准8周课程，而对照组将 参加每周中风支持小组（SSG）。抑郁，认知，患者对康复的看法和 将在干预前和干预后评估重新融合到先前环境中的程度，以确定 正念训练对亚急性后势抑郁症（AIM 3）和认知（AIM 2）的影响。全部 参与者将使用MEG前后干预后进行神经影像，以确定 治疗的神经生理效应（AIM 1）。 中风的患者具有重返先前功能水平的巨大潜力。但是，很多 无法重返工作岗位或成功地重新融入社会。 MBSR将提供一种新颖的非药物 通过靶向神经成像研究确认的绝对区域，可能是有效的。