Hyperbaric oxygen therapy combined with computerized cognitive training improves global cognition and functional independence post-stroke: a randomized controlled trial

Post-stroke cognitive impairment (PSCI) is prevalent following stroke. Both hyperbaric oxygen therapy (HBOT) and cognitive training have demonstrated efficacy in the treatment of PSCI; however, it remains unclear whether combining HBOT with cognitive training has a synergistic effect on global cognition and functional independence in PSCI. We aimed to investigate the effects of HBOT combined with computerized cognitive training (CCT) on global cognition and functional independence in patients with PSCI, and to explore associated neural correlates. In this single-center, randomized controlled clinical trial, 116 patients with PSCI (39 ischemic, 77 hemorrhagic) were randomly assigned to four groups who received HBOT+standard treatment, CCT+standard treatment, combined HBOT + CCT+standard treatment, or standard treatment alone. All groups received 20 treatment sessions over 4 weeks (five sessions/week). Global cognition was assessed before and after treatment using the Mini-Mental State Examination (MMSE). Functional independence in basic activities of daily living (ADLs) was assessed using the Barthel Index (BI). Resting-state functional connectivity (FC) was assessed using functional near-infrared spectroscopy. Patients in the HBOT + CCT group showed significantly greater improvements in MMSE total scores, several MMSE subscores, including orientation, registration, attention, recall, and visuospatial, and BI scores, than the other groups (all ts(112) ≥ 2.74, all Bonferroni-corrected ps ≤ 0.043). Resting-state FC between the left dorsolateral prefrontal cortex and left pars triangularis of Broca’s area was significantly higher in the HBOT + CCT group than in the control group (t(111) = 2.93; Bonferroni-corrected p = 0.025). The change in FC was also significantly correlated with MMSE improvement (r(113) = 0.552, p < 0.001). Combined HBOT and CCT may represent a beneficial intervention for patients with PSCI and could be associated with changes in global cognition, functional independence in basic ADLs, and prefrontal functional connectivity. Trial registration The study has been listed in the Chinese Clinical Trial Registry (ChiCTR2400080685).