重复经颅磁刺激改善血管性痴呆认知功能磁共振成像效果分析

Functional MRI Analysis of Repetitive Transcranial Magnetic Stimulation′s Efficacy in Improving Cognitive Function in Vascular Dementia Patients

目的通过对比治疗前后血氧水平依赖功能磁共振成像(blood oxygen level dependent-functional magnetic resonance imaging,Bold-fMRI)各脑区激活体积的变化特点,探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对血管性痴呆(vascular dementia,VD)患者认知功能的疗效;探究脑区激活体积的增加与认知功能改善的相关性;初步猜想并分析rTMS可能的作用机制。方法纳入锦州医科大学附属第一医院2023年1月至2023年10月期间门诊和住院部收治的VD患者38例,随机数表法(random number table method,PNTM)分为观察组(接受rTMS治疗组)和对照组(常规治疗组)各19例,比较两组患者治疗前和治疗2个月后的蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)的评分,根据两组Bold-fMRI各脑区激活体积的变化,分析VD患者认知功能改变与的脑区激活体积增加的相关性。结果经过2个月的rTMS治疗后,观察组的MoCA评分明显优于对照组,差异有统计学意义(P<0.05)。观察组经过rTMS治疗后,双侧前额叶背外侧(dorsolateral prefrontal cortex,DLPFC)和双侧前额叶腹外侧(ventrolateral prefrontal cortex,VLPFC)激活体积明显增加,差异具有统计学意义(P<0.05)。观察组经过rTMS治疗后双侧DLPFC和双侧VLPFC的激活体积值与MoCA评分均成明显正相关(P<0.01)。结论rTMS可有效改善VD患者的认知功能,增加VD患者各脑区的激活体积,脑区激活体积的增加与认知功能改善具有相关性,这可能与rTMS可以增加刺激区域及其相互作用脑区的血流量有关。

Objective To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)on cognitive function in patients with vascular dementia(VD)by comparing the changes of brain activation volume in blood oxygen level dependent-functional magnetic resonance imaging(Bold-fMRI)before and after treatment;to explore the correlation between the increase of brain activation volume and the improvement of cognitive function;to premilinary predicate and analyze the possible mechanism of rTMS.Methods 38 VD patients admitted to the Outpatient and Inpatient Department of the First Affiliated Hospital of Jinzhou Medical University from January 2023 to October 2023 were divided into observation group(rTMS treatment group)and control group(routine treatment group)with 19 cases in each group.The scores of montreal cognitive assessment(MoCA)before and after treatment were compared between the two groups.According to the changes of brain activation volume in Bold-fMRI of the two groups,the correlation between cognitive function changes and brain activation volume increase was analyzed.Results After 2 months of rTMS treatment,the MoCA score of the observation group was significantly better than that of the control group(P<0.05).After rTMS treatment,the activation volume of bilateral dorsolateral prefrontal cortex(DLPFC)and bilateral ventrolateral prefrontal cortex(VLPFC)increased significantly in the observation group(P<0.05).After rTMS treatment,the activation volume of bilateral DLPFC and bilateral VLPFC in the observation group was positively correlated with MoCA score(P<0.01).Conclusion RTMS can effectively improve the cognitive function of VD patients and increase the activation volume of various brain regions in VD patients.The increase of activation volume of brain regions is related to the improvement of cognitive function,which may be related to the increase of blood flow in stimulating regions and their interacting brain regions.