AUTHOR=Wang Xin , Peng Yuan , Zhou Hongyu , Du Wanchun , Wang Junya , Wang JiaJin , Wu Tong , Tang Xiaojia , Lv Yichen , Gong Jianwei 

TITLE=The Effects of Enriched Rehabilitation on Cognitive Function and Serum Glutamate Levels Post-stroke

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.829090

DOI=10.3389/fneur.2022.829090

ISSN=1664-2295

ABSTRACT=Aim: The aim of this study was to explore the effect of enriched rehabilitation on cognitive function and serum glutamate levels in stroke patients.
Methods: Forty patients diagnosed with post-stroke cognitive impairment (PSCI) according to the inclusion criteria and undergoing inpatient rehabilitation were enrolled in the study. Patients were randomly assigned to receive 8 weeks of enriched rehabilitation treatment (ER group; n=20) or conventional medical treatment (CM group; n=20). In addition, 20 age-matched healthy subjects who were outpatients in our hospital during the same period formed the healthy control (HC) group. In- and between-group differences in cognitive function were assessed pre- and post-intervention based on the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Trail Making Test (TMT). The serum levels of glutamate, tumor necrosis factor (TNF), and malondialdehyde levels were also detected pre- and post-intervention. 
Results: Pre-intervention cognitive function and the levels of all the serum parameters assessed differed significantly between the HC group and the PSCI group ( both ER and CM groups) (p < 0.05), but not between the two groups of PSCI patients (p > 0.05). Significant improvements were observed in cognitive function in both the ER and CM groups post-intervention compared with pre-intervention as evidenced by the measured improvement in MoCA, SDMT, and TMT scores. Similar improvements were seen for serum glutamate, the degree of oxidative damage, and the level of inflammation in both treatment groups (p < 0.05). More enhancements in cognitive function, including MoCA, SDMT, TMT scores, and the serum levels of glutamate, the degree of oxidative damage, and the level of inflammation were shown in  ER group compared with CM group  post-intervention (p < 0.05). 
Conclusions: ER can improve cognitive function in patients with PSCI. The associated mechanism may be related to the negative regulatory effect of ER on serum glutamate, TNF, and malondialdehyde levels, which is likely to enhance synaptic plasticity and alleviate oxidative stress- and inflammation-related damage, at least to some extent.