功能磁共振分析rTMS对卒中后认知功能障碍的治疗效果

Therapeutic effect of rTMS on post-stroke cognitive dysfunction:an analysis using functional MRI

目的:基于功能磁共振分析重复经颅磁刺激(rTMS)对卒中后认知功能障碍的治疗效果。方法:选取86例卒中后认知障碍患者纳入研究,对患者进行rTMS连续治疗,分别于治疗前及治疗4周后对患者进行功能磁共振检查,比较患者治疗前后在不同部位的局部一致性(ReHo)值变化,并对患者治疗前后的低频振荡振幅(ALFF)进行比较;采用蒙特利尔认知评估量表(MOCA)对患者的认知能力进行评价,并以Barthel指数评估日常生活能力。结果:治疗后与治疗前比较,患者左侧额上回、右侧脑叶、右侧缘上回、左侧额中回、右侧额下回等区域ReHo值显著降低,患者左侧颞中回、右侧颞下回、左侧颞上回、右侧小脑半球等区域的ReHo值显著升高。患者右中央前回脑区在经典频段下和Slow-4频段下与治疗前比较,ALFF减弱;患者右小脑Crus2区在Slow-4频段下与治疗前比较,ALFF增强;左顶下叶角回脑区在Slow-5频段下与治疗前比较,ALFF增强。经过治疗,患者的认知能力及日常生活能力得到改善,MOCA评分及Barthel指数均升高(P<0.05)。结论:对卒中后认知功能障碍患者采用rTMS治疗可以通过调控脑区自发神经元活动,改善患者的认知能力及日常生活能力,具有临床应用潜力。

Objective To analyze the therapeutic effects of repeated transcranial magnetic stimulation(rTMS)on post-stroke cognitive dysfunction using functional magnetic resonance imaging(fMRI).Methods The 86 enrolled patients with post-stroke cognitive dysfunction underwent rTMS and fMRI examination before and 4 weeks after treatment.The regional homogeneity(ReHo)and amplitude of low frequency fluctuation(ALFF)were compared before and after treatment;Montreal cognitive assessment scale(MOCA)was used to evaluate the cognitive ability,and Barthel index to assess the activity of daily living.Results The treatment significantly reduced ReHo values in left superior frontal gyrus,right lobe,right supramarginal gyrus,left middle frontal gyrus,and right inferior frontal gyrus,but increased ReHo values in left middle temporal gyrus,right inferior temporal gyrus,left superior temporal gyrus,and right cerebellar hemisphere.Compared with that before treatment,ALFF was reduced at the right precentral gyrus in the classical and Slow-4 bands,but enhanced at the right cerebellar Crus 2 in the Slow-4 band and at left parietal-inferior margin gyrus in the Slow-5 band.After treatment,the patient's cognition and activity of daily living improved,and MOCA score and Barthel index increased(P<0.05).Conclusion rTMS for patients with post-stroke cognitive dysfunction can improve their cognitive ability and activity of daily living by regulating the spontaneous neuronal activity in the brain areas,with the potential for clinical application.