| Objective:Mind Wandering（MW）is related to innovative learning ability,and rehabilitation relearning after stroke is itself a process of innovative learning（different from learning with normal neurological function）.Therefore,it is proposed to observe MW and routine cognitive function in patients with subacute stroke,evaluate MW-related evoked potentials combined with task-state EEG,and analyze the relationship between MW-related evoked potentials and short-term clinical outcomes.It is of great significance for a more comprehensive understanding of the neural mechanism of cognitive function involved in neural function reconstruction after stroke,judging the prognosis and making a reasonable rehabilitation plan.Methods:32 patients with subacute stroke（within 3 months）were divided into two groups:good prognosis group（≤2 points）and poor prognosis group（>2 points）according to modified Rankin Scale（mRS）score at discharge.After admission,the early visual evoked potentials P1/N1（representing visual signal input）and Event-related potential（ERP）P300（representing advanced cognitive processing）were collected by sustained attention response task（SART）test paradigm,and the clinical behavior scale was used to evaluate the overall cognitive function.The mini-mental state examination（MMS E）was used to evaluate the overall cognitive function.Mind-wandering:Deliberate（MW-D）and Mind-wandering:Spontaneous（MW-S）were used to evaluate the degree of freedom and consciousness of mind wandering state,and the National Institute of Health Stroke Scale（NIHSS）was used to evaluate the degree of neurological impairent.The upper limb motor function was evaluated by Fugl-Meyer Assessment Upper Extremity Scale（FMA-UE）,the daily functional outcome was evaluated by Modified Barthel Index（BI）,and the overall functional outcome was evaluated by mRS.All the patients were treated with routine rehabilitation intervention（10 times a course of treatment for 3 weeks）,and 2（intergroup factors:good prognosis group,poor prognosis group）×3（pole:P3,Pz,P4/O1,Oz,O2）were used to compare the differences of amplitude and latency of P1/N1 and P300 components among groups,and to observe the differences of topographic maps.Spearman correlation analysis was used to explore the correlation between MW scale,ERP components and clinical behavior scales,and the area under receiver operating characteristic curve（ROC）of the relevant parameters was calculated to predict the sensitivity and specificity of clinical outcomes.Results:1.Finally,there were 28 patients with stroke（17 cases of cerebral infarction and 11 cases of cerebral hemorrhage）,including 19 males and 9 females,aged from 34 to 75 years,with an average of（57.33±13.48）years,the average course of disease was（11.87±6.03）days,and rehabilitation intervention time of 17-30 days（mean 24.93±4.01）days;2.The frequency of MW after stroke was evaluated for the first time,and the frequency of MW in the group with good prognosis was significantly higher than that in the group with poor prognosis（Z=-2.95,P=0.03）,but there was no signifycant difference after rehabilitation intervention（Z=-0.71,P=0.476）;3.P1/N1 component:the peak latency of ERP-P1 in the good prognosis group was significantly longer than that in the poor prognosis group（F=7.60,P=0.016）,especially on the occipital side（O1）and the contralateral side（02）.There was no significant difference in the peak latency of ERP-N1 between the two groups（F=0.97,P=0.344）,and there was no significant difference in ERP-P1 amplitude between the two groups（F=0.99,P=0.338）.The amplitude of ERP-N1 in the good prognosis group was significantly higher than that in the poor prognosis group（F=4.78,P=-0.048）,especially on the occipital side（01）;4.P300 component:the peak latency of P300 in the good prognosis group was not significantly different from that in the poor prognosis group（F=3.51,P=0.083）,but only in the central parietal region（Pz）（378.86±65.97ms VS 315.75±38.95ms,P=0.046）.The amplitude of P300 in the group with good prognosis was significantly lower than t-hat in the group with poor prognosis（F=8.56,P=0.012）,especially in the central area of the parietal region（Pz）and the contralateral side of the lesion（P4）,and the amplitude in the central area of the two groups was lower than that of the contralateral side of the lesion（3.65±1.24uv VS 5.06±1.44uv,5.66±2.23uv VS 8.24±2.68uv,P<0.05）;5.The MW scale of stroke patients before rehabilitation intervention was significantly moderately to highly correlated with the NIHSS score（r=-0.545,P=0.035）,the BI score（r=0.661,P=0.007）and the FMA-UE score（r=0.654,P=0.008）,but MMSE had no significant correlation with the above parameters（P>0.05）.The P1 latency（O2-P1 latency）of O2 pole,the P300 amplitude（Pz-P300 amplitude）of Pz pole and the MW scale（r=0.764,P=0.001;r=-0.408,P=0.049）.There were significant moderate to high correlations among the scores of NIHSS（r=-0.572,P=0.026;r=0.661,P=0.007）,BI（r=0.676,P=0.006;r=0.769,P=0.001）,FMA-UE（r=0.657,P=0.008;r=-0.604,P=0.017）after rehabilitation intervention.6.Aiming at the clinical outcome,ROC curve analysis further showed that the area ratio under the curve of MW scale was（0.95±0.06）,the best cut-off point was 13 points（sensitivity 75%,specificity 100%）,the area ratio under O2-P1 latency curve was（0.89±0.10）,and the best cut-off point was 119.39ms（sensitivity 100%,specificity 86%）.The area ratio under the Pz-P300 amplitude curve is（0.84±0.11）,and the best cut-off point is 4.18 uv（sensitivity 86%,specificity 75%）.Conclusion:The frequency of MW after stroke will change,but the change is not obvious in the short time,and the short-term rehabilitation intervention does not cause obvious change in MW;In the SART task,there were significant differences in visual input signal processing speed and ability and the MW-related advanced cognitive processing ability in stroke patients with different prognosis;Higher frequency of MW,longer P1 latency in the occipital region,and lower P300 amplitude in the parietal region may indicate that stroke patients will have better upper extremity motor function,activities of daily living,and overall prognosis;The MW score,P1 latency in contralateral occipital area and central P300 amplitude in parietal region may be used as one of the biological markers for stroke rehabilitation prognosis. |
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