A Clinical Study:Therapeutic Effects of Repetitive Transcranial Magnetic Stimulation and Cognitive Behavioral Therapy on Cognitive Impairment in Alcohol-Dependent Patients

Objective To observe the effects of repetitive transcranial magnetic stimulation(rTMS)and cognitive behavioral therapy(CBT)on cognitive function in alcohol-dependent patients.Methods Data from 285 alcohol-dependent patients were collected from Mudanjiang Medical University and Sun Yat-sen Memorial Hospital at Sun Yat-sen University between 2019 and 2021.The patients were divided into groups depending on alcohol abstinence and non-abstinence.There were 43 patients in the alcohol consumption(AC)group.The patients in the abstinence group were randomly assigned to treatment regimens with different combinations of rTMS and CBT using the Elton system.There were 49 patients in the TB+C0 group,36 in the TB+C1 group,44 in the TL+C0 group,36 in the TL+C1 group,37 in the TR+C0 group,and 40 in the TR+C1 group.Cognitive function was assessed by using the Montreal Cognitive Assessment Scale(MoCA).Results The proportion of patients with cognitive impairment in the AC group at 24 weeks was higher than that at baseline(P<0.05),whereas the proportion of cognitive impairment in the other groups did not differ significantly over time.The percentage of patients with cognitive impairment at 24 weeks was 52.3%in the TL+C0 group and 47.2%in the TL+C1 group,which was significantly lower than that in the AC group(P<0.05).MoCA scores at different time points in the AC group were significantly higher than those in the TB+C0,TL+C0,TL+C1,TR+C0,and TR+C1 groups,respectively.MoCA scores were significantly higher at 12 weeks compared with the baseline in the TB+C0,TL+C0,TL+C1,TR+C0,and TR+C1 groups(P<0.05),and similar changes were observed at 24 weeks.The MoCA scores in the TL+C1 and TL+C0 groups were higher than those in the TR+C0 group at 12 weeks after the intervention(P<0.05).Furthermore,MoCA scores in each of the TB+C1,TL+C1,TL+C0,TR+C1,and TR+C0 groups were higher than those in the AC group at 24 weeks(P<0.05).Conclusion Alcohol consumption impairs cognitive function,as evidenced by a significantly higher proportion of cognitive impairment after 24 weeks of non-abstinence.Most of the tested treatment regimens improved cognitive function.High frequency rTMS of the left dorsolateral prefrontal cortex(DLPFC)was associated with a greater improvement in cognitive function than that of the right DLPFC in alcohol-dependent patients at 12 weeks of abstinence.There does not appear to be a therapeutic advantage of CBT for cognitive impairment in alcohol-dependent patients.Screening for impaired cognitive function should be seriously considered for patients who engage in heavy drinking,and measures should be taken to reduce the risk of dementia induced by alcohol dependence.