中国康复2025，Vol.40Issue(6)：338-343,6.DOI:10.3870/zgkf.2025.06.003
基于CT灌注成像探讨高频重复经颅刺激联合记忆认知训练对脑卒中后认知功能障碍的影响
Effect of high frequency repetitive transcranial stimulation combined with memory cognitive training on cognitive dys-function after stroke based on CT perfusion imaging
摘要
Abstract
Objective:To evaluate the therapeutic effects of high-frequency repetitive transcranial magnetic stimula-tion(HF-rTMS)combined with memory cognitive training on post-stroke cognitive impairment(PSCI),and inves-tigate cerebral perfusion changes using CT perfusion imaging(CTP)and the correlation between CT perfusion pa-rameters and MoCA score and MMSE score.Methods:In this randomized controlled trial,170 PSCI patients were allocated to either an active intervention group(real HF-rTMS+cognitive training,n=85)or a control group(sham HF-rTMS+cognitive training,n=85).Outcome measures included CTP parameters(cerebral blood flow[CBF],blood volume[CBV],mean transit time[MTT],peak time[TTP]),ERP-P300 components,and stand-ardized neuropsychological assessments(Stroop test,RBMT-Ⅱ,MoCA,MMSE)at baseline and 6-week follow-up.Correlation analyses assessed relationships between hemodynamic parameters and cognitive outcomes.Results:After treatment,CBF and CBV in the two groups were increased when compared with those before treatment,and MTT and TTP were shortened when compared with those before treatment(P＜0.05,0.01),and the above parameters in the observation group were improved more significantly than those in the control group(P＜0.05).After treatme-nt,the latency of ERP-P300 in the two groups was de-creased when compared with that before treatment,and the amplitude was increased(P＜0.05,0.01).The la-tency of ERP-P300 in the observation group was lower than that in the control group,and the amplitude was higher than that in the control group(P＜0.05,0.01).After treatment,the Stroop task test accuracy and RBMT-Ⅱ score of the two groups were improved,and the Stroop task test time was shortened(P＜0.01).After treat-ment,the Stroop task test accuracy was higher,the time was shorter,and the RBMT-Ⅱ score was greater in the ob-servation group than those in the control group(P＜0.01).After treatment,the MoCA score and MMSE score in the two groups were increased when compared with those before treatment(P＜0.01),and the MoCA score and MMSE score in the observation group were higher than those in the control group(P＜0.01).CBF and CBV in CTP parameters were positively correlated with MoCA score and MMSE score(r=0.176,0.170,0.470,0.395,P＜0.05),and MTT was negatively correlated with MoCA score and MMSE score(r=-0.192,-0.235,P＜0.05).There was no significant correlation between TTP in CTP parameters and MoCA score and MMSE score.Conclusion:The HF-rTMS combined with cognitive training protocol significantly enhances cognitive recovery in PSCI patients,potentially mediated through optimized cerebral perfusion.CTP parameters demonstrate predictive value for cognitive outcomes,with CBF/CBV and MTT serving as potential neuroimaging biomarkers.关键词
脑卒中后认知功能障碍/高频重复经颅刺激/记忆认知康复训练/CT灌注成像/记忆/认知功能Key words
cognitive dysfunction after stroke/high frequency repetitive transcranial stimulation/memory cogni-tive rehabilitation training/CT perfusion imaging/memory/cognitive function分类
临床医学引用本文复制引用
杨保元,常士峰,王建晖..基于CT灌注成像探讨高频重复经颅刺激联合记忆认知训练对脑卒中后认知功能障碍的影响[J].中国康复,2025,40(6):338-343,6.基金项目
2022年南阳南石医院科研立项项目(KJGG116) （KJGG116）
