The Clinical Characteristics And RTMS Therapy For Vascular Parkinsonism:A Preliminary Study

Chapter One:Analysis of clinical features of vascular parkinsonismObjectives:To characterize the clinical manifestations of vascular parkinsonism,explore the impact of clinical characteristics on the quality of life,and establish a theoretical foundation for its diagnosis and subtyping.Methods:From June 2021 to July 2023,a total of 93 patients with vascular parkinsonism(VP)were admitted to the Neurology Department of Guangdong Provincial People’s Hospital and compared with 92 idiopathic Parkinson’s Disease(PD)patients in terms of demographics,clinical characteristics,and medical history.The VP patients were further classified into three subgroups based on An Updated Diagnostic Approach To Subtype Definition Of Vascular Parkinsonism-Recommended From An Expert Working Group.Results:Compared to PD patients,a higher proportion of VP patients exhibit comorbidities such as hyperlipidemia and coronary heart disease.Additionally,VP patients are more susceptible to experiencing falling,pseudobulbar palsy,pyramidal sign,cognitive impairment,urinary incontinence and depression than PD patients.The MDS-UPDRS-Ⅲ,H&Y,HAMD scores in VP patients were higher than those in PD.In VP patients,the PDQ-39 score was significantly associated with falling,pseudobulbar palsy,pyramidal sign,MMSE,MDS-UPDRS-Ⅲ,H-Y,HAMD and HAMA scores.Multiple linear regression analysis revealed that the influencing factors for PDQ-39 were H-Y stage score as well as HAMD scores and MMSE scores.Conclusion:Compared to patients with PD,VP patients exhibit a higher prevalence of vascular risk factors,more severe motor and non-motor symptoms,as well as poorer quality of life.Depression,cognitive impairment,and severe motor symptoms can all contribute to reduced quality of life in individuals with vascular parkinsonism.Chapter two:Brain function investigation of vascular parkinsonism with comorbid depression using resting state functional magnetic resonance imagingObjective:To explore the performance of rs-fMRI and elucidate the underlying neural mechanisms of vascular parkinsonism accompanied by depression.Methods:A total of 91 VP patients were enrolled and categorized into threegroups based on their depression severity:non-depression group(n=25),mild depression group(n=34),and moderate to severe depression group(n=32).The amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(ReHo)in various brain regions were compared,as well as their correlations with Hamilton Depression Rating Scale scores.Result:In the groups for mild depression and moderate to severe depression,the ALFF and ReHo values of the right fusiform gyrus and left inferior occipital gyrus increased,while the ALFF values of the left precuneus declined.The ALFF and ReHo values of the left inferior occipital gyrus and the right fusiform gyrus were strongly correlated with the HAMD score.However,the left precuneus’s ALFF score and HAMD score had a negative correlation.Conclusion:Aberrant neural activity in the right fusiform gyrus,left inferior occipital gyrus,left precuneus may be implicated in emotional processing and contribute to depression in patients with VP.Chapter three:Preliminary study of neuro-navigated rTMS Therapy of vascular parkinsonism with depressionObjective:To investigate the efficacy and the potential neural mechanism of neuro-navigated Repetitive Transcranial Magnetic Stimulation(rTMS)therapy in vascular parkinsonism patient with depression.Methods:42 VP patients with depression were included in the trial.They were randomly assigned into two groups—21 received active stimulation,and 21 received sham stimulation.Neuro-navigated technology was utilized to administer highfrequency rTMS stimulation to the left DPLFC.The demographics,clinical characteristics,and medical history were compared between two groups.Evaluations were conducted at baseline(T0 phase),post-treatment(T1 phase),as well as during a 2-week(T2 phase)and 4-week(T3 phase)follow-up period.Result:In the active-stimulation group,there was a significant reduction in HAMD scores during the T1,T2,and T3 phases.Furthermore,HAMA scores decreased significantly during the T1 and T2 phases.Notably,delayed recall memory scores were higher in the stimulation group during the T3 phase compared to those recorded at baseline(T0).The active-stimulation group showed a decrease in the ALFF value of the right cerebellum after rTMS therapy.Conclusion:Neuro-navigated high-frequency rTMS stimulation of the left dorsolateral prefrontal cortex in patients with depression can effectively improve depressive and anxiety symptoms,as well as delayed memory function.This improvement may be attributed to a reduction in amplitude of low-frequency fluctuations(ALFF)in the right cerebellum.