高频重复经颅磁刺激治疗遗忘型轻度认知障碍的局部一致性研究

High-frequency repetitive transcranial magnetic stimulation can relieve mild amnestic cognitive impairment

目的通过局部一致性(ReHo)分析方法探究高频重复经颅磁刺激(rTMS)治疗遗忘型轻度认知障碍(aMCI)的脑功能影像机制。方法采用随机对照的研究方法,将25例aMCI患者分为观察组(13例)和对照组(12例),观察组行经颅磁刺激治疗,刺激部位为左侧前额叶背外侧区(DLPFC),频率10 Hz,80%RMT,每次400个脉冲,5次/周,共治疗4周;对照组仅将磁刺激线圈垂直置于颅骨表面行假经颅磁刺激治疗,其余仪器设备、刺激位点、强度及频率等与观察组相同。分别于治疗前和治疗4周后(治疗后),采用中文版蒙特利尔认知评估量表(MoCA)对2组患者进行认知功能评估,并行静息态功能性磁共振成像(fMRI)数据采集,比较治疗前后aMCI患者大脑ReHo值的变化。结果观察组患者经4周rTMS治疗后的MoCA评分较组内治疗前和对照组治疗后明显提高(P<0.05)。fMRI检测结果显示,与组内治疗前相比,观察组治疗后右侧额中回脑区的ReHo值显著增加(P<0.05),而对照组治疗后右侧额中回和左侧楔前叶脑区的ReHo值显著降低(P<0.05)。结论高频rTMS可以提高aMCI患者的认知功能,使认知相关脑区神经元间的自发活动更趋于同步化。

Objective To investigate the therapeutic mechanism of high-frequency repetitive transcranial magnetic stimulation(rTMS)in treating mild amnestic cognitive impairment(aMCI).Methods Twenty-five patients with aMCI were randomly divided into an observation group of 13 and a control group of 12.The observation group was given 10-Hz rTMS over the left dorsolateral prefrontal cortex at 80%of the motor threshold-400 pulses a day,5 times a week for 4 consecutive weeks.The control group received sham stimulation on the same schedule.Before and after the experiment,both groups were evaluated using the Montreal cognitive assessment(MoCA)and received fMRI scans.Results After the intervention,the average MoCA score of the observation group had improved significantly more compared with that of the control group and compared with before the intervention.According to the fMRI results,regional homogeneity in the right middle frontal gyrus of the observation group had increased significantly,while that of the control group both there and in the left precuneus had decreased significantly.Conclusions High-frequency rTMS can effectively improve the cognitive function of patients with aMCI and synchronize neuron activity in cognition-related brain regions.