高频重复经颅磁刺激对脑卒中后认知障碍合并抑郁患者的影响OA北大核心CSTPCD

Objective To observe the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on patients with post-stroke comorbid cognitive impairment and depression(PSCCID).Methods A total of 30 patients with PSCCID were treated in the department of rehabilitation medicine of Sichuan Academy of Medical Science and Sichuan Provincial People's Hospi-tal from January 2018 to December 2020 were randomly divided into control group and observation group,with 15 cases in each group.The control group received routine medication treatment and routine rehabilitation,including exercise therapy(40 minutes a time,once a day,five days a week),occupational therapy(30 minutes a time,once a day,five days a week),and cognitive training(30 minutes a time,once a day,five days a week),for four weeks.The observation group received high-frequency rTMS treatment(stimulation of the left dorsolateral prefrontal cortex,10 Hz,100%resting motion threshold,20 minutes a time,once a day,five days a week)for four weeks,in addition to the treatment received by the control group.Before and after treatment,the Montreal cognitive assessment(MoCA)and the mini-mental state examination(MMSE)scores were used to assess cognitive function.The 17-item Hamilton depression rating scale(HAMD-17)was used to assess depression.The 3.0T magnetic resonance imaging system was used to scan the patient's brain,and voxel-based morphological analysis was used to analyze the changes of gray matter density in local brain areas.Results Compared with those before treatment,the MMSE and MoCA scores were higher and the HAMD-17 score was lower in both groups after treatment,and the differences were statistically significant(P<0.05).Compared with the control group,the MMSE and MoCA scores were higher in the observation group after treatment,and the HAMD-17 score were lower,and the differences were statistically significant(P<0.05).Compared with the control group,gray matter density in the left head and face regions of precentral gyrus,and the left caudal area of middle temporal gyrus of the observation group were higher,while gray mat-ter density in the left medioventral occipital cortex and right middle frontal gyrus were lower,and the difference was statistically sig-nificant(P<0.05).Conclusion High-frequency rTMS can improve cognitive function and depression of patients with PSCCID,and the mechanism may be related to the increase of the gray matter density in local brain regions.