Study On The Effectiveness And Safety Of Transcranial Direct Current Stimulation In The Treatment Of Cognitive Decline Caused By Cerebral Small Vessel Disease

Objective:To observe the efficacy and safety of repeated transcranial direct current stimulation(tDCS)in the treatment of cognitive decline caused by cerebral small vessel disease(CSVD).Methods:Cognitive decline patients with CSVD who were hospitalized in the Department of Neurology of the Second Affiliated Hospital of Nanchang University from September 2020 to February 2021 were enrolled.This is a prospective,randomized,double-blind,parallel-controlled,superior-effect clinical research.The patients were assigned to the experimental group or control group for clinical trials according to the provisions of the random envelope.Finally,there were 15 patients in the active-tDCS treatment group and 15 patients in the sham-tDCS treatment group.Both groups of patients were not restricted to conventional treatment and the treatments of comorbid diseases(except memantine and acetylcholinesterase inhibitors).Those medicines were recorded in the case report form(CRF)table.The anode of tDCS stimulation was placed in the left dorsolateral forehead(DLPFC)brain area,and the cathode was placed in the right DLPFC brain area.The tDCS stimulation was given once a day for20 minutes each time,5 times a week,and a total of 4 weeks.The sham stimulation treatment instrument will automatically turn off the current at 30 seconds after the start of the stimulation.Before and after treatment,the Montreal Cognitive Assessment Scale(Mo CA),the Boston Naming Test,Trail Making Test A,and Digit Span were used to evaluate the different cognitive domains of the patients.Rresults:There was no statistically significant difference in gender,age,BMI,hypertension,diabetes,hyperlipidemia,smoking,drinking,and education level of patients in two group patients(P value>0.05).There were no statistically significant differences in baseline Mo CA score and different cognitive domains(P value>0.05).Compared by base-Mo CA score,the difference of Mo CA score in the active-stimulation group was 2.33±2.19 after treatment,and in the sham-stimulation group was-0.53±2.45.The difference was statistically significant between the active and sham groups(P<0.05).The difference in visuospatial and executive function、attention 、 delayed recall between the active and sham groups was statistically significant(P<0.05).Compared by base score,the difference of Boston naming test in the experimental group was 1.73±1.62,the sham-stimulation group was-0.93±2.58.The difference was statistically significant between the active and sham groups(P<0.05).The difference between the two group patients in the Trail Making Test A,and Digit Span score were not statistically significant(P>0.05).During the experiment,1case had minor adverse reaction related to tDCS.The incidence of adverse events was3.3%.Conclusions:tDCS treatment can improve the cognitive functions of patients with CSVD,including visual space and execution,attention,delayed recall and naming functions.The tDCS treatment is safety.