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

项目摘要 血栓切除术显著改善了卒中结局。目前，我们诊所近80%的患者 小卒中和低NIH卒中量表（NIHSS）评分。然而，尽管“良好的复苏”， 40%的人认为注意力、集中力、执行功能、处理速度和 在恢复的亚急性期。这种功能障碍阻碍了个体完全重新融入 他们以前的家庭和工作环境，并可能导致提前退休或失去独立性， 特别是在老年人中。在6个月内观察到一定程度的恢复，但通常 不完整或为时已晚，无法扭转先前改变生活的决定。受损的执行功能和处理 速度似乎与中风大小、位置或共存抑郁无关。 脑磁图（MEG）是一种功能成像工具，能够评估神经生理过程， 真实的时间类似于EEG，但具有更好的空间分辨率。我们之前对脑磁图的研究表明， 激活模式不仅在完成任务的过程中变慢，而且在未成年人中更分散。 中风相比，控制，但有异常活动的额叶，即使在休息。不幸的是， 许多患者不符合康复条件，并且关于有效治疗选择的数据很少， 加快或加强复苏。 正念训练可能提供一个有吸引力的治疗选择。冥想身体 意识，瑜伽，正念减压（MBSR）是一个积极的过程，认为参与 额叶正念减压疗法已被证明可以改善慢性病患者的焦虑和抑郁 在一些慢性中风患者中也进行了评估 和创伤性脑损伤，其在执行功能任务期间表现出改善的性能。 我们建议研究正念减压疗法在中风恢复早期的作用，以确定这种干预是否 可以帮助预防中风后的发病率。将招募40名患者（NIHSS <8，mRS 0-2）的队列。 20人将被随机分配接受标准的8周正念减压课程，而对照组则相反 参加每周一次的中风支持小组（SSG）。抑郁、认知、患者对恢复的感知，以及 将在干预前后评估重新融入先前环境的程度，以确定 正念训练对亚急性卒中后抑郁（目标3）和认知（目标2）的影响。所有 参与者将在干预前后使用MEG进行神经成像，以确定 治疗的神经生理学效应（目的1）。 轻微中风患者有很大的潜力恢复到他们以前的功能水平;然而，许多人 无法重返工作岗位或成功重返社会。正念减压疗法将提供一种新的， 通过靶向神经影像学研究证实的异常区域可能有效的治疗。

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.