The Effect Of Theta Burst Stimulation Combined With Cognitive Training On Patients With Post-stroke Cognitive Impairment

Objective Post-stroke cognitive impairment(PSCI)is one of the common functional impairments of stroke.Severe impairment may bring heavy burden to patients and their families.At present,the treatment of PSCI is mainly cognitive improvement drugs and cognitive rehabilitation training.However,patients and their families often resist the cost and side effects of drug therapy,and there are problems such as poor cooperation in the process of cognitive training.Theta burst stimulation(TBS)is a new mode of repetitive transcranial magnetic stimulation(r TMS),which is applied to the skull by intermittent or continuous pulse string,and has become an important part of clinical therapy with short time and high efficacy.At the same time,combining TBS with cognitive training seemed to produce better results.Therefore,this study aims to observe the efficacy of TBS combined with cognitive training on PSCI patients’ cognition and activities of daily living,to explore a better treatment plan,and to provide help for further clinical application.Methods According to random number table,38 PSCI patients were chosen for our research and divided into 3 groups.In the end,36 patients completed this study.Specifically,there were 12 cases in the bilateral stimulation group,12 cases in the unilateral stimulation group,and 12 cases in the sham stimulation group.All patients in the 3 groups were given routine rehabilitation training,including cognitive training: the ability of orientation,concentration,structure,reasoning,memory,calculation,language ability,etc.,30 minutes per time,5 times per week,a total of 3 weeks.They were also given conventional medication,including a cognitive-improving drug,donepezil hydrochloride,5 mg per time,once a day,orally every night.On the basis of the above treatment,bilateral stimulation group was given the left prefrontal dorsolateral intermittent theta burst stimulation(i TBS)and right prefrontal dorsolateral continuous theta burst stimulation(c TBS).Unilateral stimulation group was given left prefrontal dorsolateral i TBS and right prefrontal dorsolateral sham stimulation.Sham stimulation group was given bilateral prefrontal dorsolateral sham stimulation,five times per week for 3 weeks.Before and after treatment,Mini-mental State Examination(MMSE)and Montreal Cognitive Assessment(Mo CA)were used to show their cognitive function.Modified Barthel Index(MBI)was used to reflect the activities of daily living of the patients.Magnetic Resonance Spectroscopy(MRS)was used to assess the changes in brain metabolism and imaging.Results Before treatment,there were no significant differences in MMSE,Mo CA and MBI scores among 3 groups(P>0.05).After treatment,MMSE,Mo CA and MBI scores in bilateral and unilateral stimulation groups were significantly higher than before and the differences were statistically significant(P < 0.05).The MBI score in the sham stimulation group was higher than that before treatment,and the difference was statistically significant(P<0.05).After treatment,there were significant differences in MOCA scores among the 3 groups,with statistical significance(P<0.05).There were no significant differences in MMSE scores and MBI scores among the 3 groups(P>0.05).there were significant differences between 3 groups in ‘LANGUAGE’ score of MMSE,with statistical significance(P<0.05).Further pair comparison results showed that the MOCA score of the bilateral stimulation group was better than that of the sham stimulation group after treatment,with significant difference and statistical significance(P<0.05).The ‘LANGUAGE’ score of MMSE was better in the bilateral stimulation group than that in the sham stimulation group,and the difference was statistically significant(P<0.05).The intra-group comparison after treatment showed that the MRS metabolic value NAA/Cr in the bilateral hippocampus of the bilateral and unilateral stimulation groups increased after treatment,with significant difference and statistical significance(P<0.05).After treatment,compared with the sham stimulation group,the increase of NAA/Cr in the bilateral stimulation group was more obvious,with statistical significance(P < 0.05).There was a moderately positive correlation between the difference value of NAA/Cr of MRS in the bilateral hippocampus and the difference value of Mo CA score in the 3 groups before and after treatment(r =0.663～0.710,P<0.05).Conclusions The combination of TBS in dorsolateral prefrontal stimulation and cognitive training can improve the cognitive function of PSCI patients,and the treatment of left dorsolateral prefrontal i TBS followed by right dorsolateral prefrontal c TBS may have a better effect.The MRS metabolic value NAA/Cr in the bilateral hippocampus is related to cognitive level,and can be considered as an objective index for the evaluation of cognitive function.