| Background:Post-stroke cognitive impairment(PSCI)is a clinical syndrome characterized by cognitive impairment that persists for at least 6 months after a stroke.Epidemiological studies have shown that about 1/4 to 1/2 of stroke patients will develop PSCI.Previous studies have identified risk factors for PSCI,such as age,education level,hypertension,diabetes,and atrial fibrillation.However,effective treatments for preventing and treating PSCI are still lacking.Repetitive transcranial magnetic stimulation(rTMS)is a non-invasive neuromodulatory therapy that can enhance recovery of brain function after stroke by increasing excitability of the affected hemisphere or reducing inhibition from the unaffected hemisphere.Objective:To compare the therapeutic effects of rTMS treatment and conventional treatment on improvement of cognitive function and daily living ability in patients with post-stroke cognitive impairment(PSCI)using a retrospective cohort study and propensity score matching.The aim is to provide evidence-based medicine for rTMS treatment of PSCI and to explore the factors influencing clinical outcomes within six months after discharge from the hospital among PSCI patients through multivariate logistic regression analysis,in order to provide theoretical basis for predicting the prognosis of PSCI.Methods:1.A retrospective cohort study was conducted to collect clinical data of PSCI patients hospitalized in the Department of Neurology,Department of Geriatric Neurology and Department of Rehabilitation of Qilu Hospital,Shandong University from June 2017 to June 2022.Propensity score matching with a 1:1 ratio performed using SPSS 26.0 software to reduce selection bias between the rTMS treatment group and the control group receiving conventional treatment.GraphPad Prism 9.4.0 software was used to compare and analyze changes in cognitive function scores,daily living ability scores,and adverse reactions between the two groups after treatment.2.Patients with PSCI who attended the Department of Neurology,Department of Geriatric Neurology and Department of Rehabilitation of Qilu Hospital,Shandong University from June 2017 to June 2022 were selected to collect their baseline data of stroke type,stroke site and cognitive function score,and to follow up their status of clinical outcome and medication regimen after six months.SPSS 25.0 and R 4.2.2 statistical software were used to organize and analyze the data,and univariate analysis of possible influencing factors on clinical outcome of PSCI patients was performed.Indicators with statistically significant differences in the univariate analysis were included in a multifactorial logistic regression analysis to analyze independent influences on clinical outcome of cognitive impairment after stroke,and the dominance ratio(OR)and 95%confidence interval(95%CI)of each variable were calculated.Dose-response relationships between independent influences and clinical outcome of PSCI were explored using restricted cubic spline models.Results:1.After propensity score matching,86 patients were included:43 in the observation group and 43 in the control group.There was no statistical difference in the comparison of baseline characteristics between the two groups of patients.After treatment,patients in both groups recovered their cognitive function and daily living ability,and the degree of recovery of cognitive function was higher in the observation group compared with the control group,and no adverse effects were observed in both groups.2.After screening by inclusion and exclusion criteria,131 patients were included,of whom 55 patients experienced clinical outcome and 76 patients did not experience clinical outcome.The results of univariate analysis showed that age,hypertensive disease,type 2 diabetes,atrial fibrillation,application of donepezil,history of smoking,history of alcohol consumption,time to initiation of treatment,admission MMSE score,and admission MBI score were associated with the clinical outcome of patients.The results of multifactorial logistic regression analysis showed that time to stroke event,application of donepezil,MMSE score,and admission MBI score may be independent influences on the clinical outcome of PSCI occurrence.Restricted cubic spline model analysis showed a linear dose-response relationship between admission MMSE score and the likelihood of clinical outcome within six months of discharge for patients with PSCI.Conclusions:1.The application of rTMS can effectively enhance the cognitive function of PSCI patients,especially in terms of orientation.2.Application of rTMS does not increase the risk of adverse effects during hospitalization in patients with PSCI.3.For patients with PSCI,the independent influencing factors for clinical outcome occurring within six months of discharge were time to initiation of PSCI treatment distance to stroke event,application of donepezil,admission MMSE score and admission MBI score.4.There was a linear dose-response relationship between the admission MMSE score and the likelihood of clinical outcome within six months of discharge in patients with PSCI. |
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