Effects Of Scalp Acupuncture Combined With RTMS On Cognitive Function In Stroke Patients Based On Resting State Ratio Low-frequency Amplitud

Objective:To observe the effect of scalp acupuncture combined with repetitive transcranial magnetic stimulation(r TMS)on global cognitive function,neurological function and attention in patients with post-stroke cognitive impairment(PSCI).To explore the resting-state neuroimaging mechanism of scalp acupuncture combined with r TMS in improving cognitive function in patients with PSCI using fraction amplitude of low frequency fluctuation(f ALFF)algorithm.Our research will provide reference for the optimization of rehabilitation prescription for PSCI patients.Methods:PSCI patients were randomly assigned to scalp acupuncture group and scalp acupuncture combined with r TMS group(the combined group).Both groups were given conventional rehabilitative training.The scalp acupuncture group selected the subjects’ affected-side anterior oblique parietotemporal line(MS6).Low frequency(1Hz)r TMS over primary motor cortex(M1)of the unaffected side in the combined group.The duration was once a day for 20 minutes,6 sessions one week,in total of 12 sessions for consecutive two weeks.The Montreal Cognitive Assessment Scale(Mo CA),the National Institutes of Health Stroke Scale(NIHSS)and digit span test(DST)were conducted for assessing subjects’ cognitive function,neurological function and attention,respectively.The f ALFF was used to detect the changes of spontaneous neurological activity in local brain areas.All subjects received observational evaluation and resting-state functional magnetic resonance imaging(f MRI)scans at baseline and after the completion of all interventions.Paired sample t test or wilcoxon rank sum test was used for within-group comparison for observational indicators,and independent sample t test or Mann-Whitney U test was used for within-group comparison for observational indicators.At the same time,the statistical method of Difference-in-Difference(DID)was used to analyze the trend of each observational index.A data-driven approach was further used for between-group comparison for observational indicators as well.In the meantime,the statistical method of Difference-in-Difference(DID)was used to analyze the trend change of each observational index.A data-driven approach was further conducted to compare the differences of f ALFF within-group and between-group.FALFF values of different brain regions of between-group comparison were extracted.Hemiplegic side was used as control variables,and partial correlation analysis was performed with statistical differences cognitive observational indicators.Results:1.Clinical efficacy study(1)Results of observational indexes within-group comparison: Compared with before intervention,global cognitive function,neurological function scores were significantly improved within-group after two weeks of intervention and the difference was statistically significant(P<0.05).There was no statistical difference between the two groups of attention(P>0.05).(2)Results of observational indexes between-group comparison: Compared with scalp acupuncture group,there were no significant differences in the global cognitive function,neurological function and attention scores of subjects in the combined group(P>0.05).However,the Mo CA subscore-delayed memory task score of the combined group was significantly improved and the difference was statistically significant(P<0.05).At the same time,the trend analysis of observational indicators also showed that the improvement trend of the combined group was significantly better than those of the scalp acupuncture group,and the difference was also statistically significant(DID=0.80,P<0.05).2.Resting-state neuroimaging mechanism study(1)Within-group comparison of resting state f ALFF values: After two weeks of intervention,f ALFF values of left cerebelum,right lingual gyrus in the scalp acupuncture group were increased and left parietal inferior angular gyrus was decreased compared with baseline level.FALFF value of left cerebelum,right middle frontal gyrus were increased and left triangular part inferior frontal gyrus was decreased in combination group(GRF corrected,voxel P<0.01,cluster P<0.05).(2)Between-group comparison of resting state f ALFF values: After two weeks of intervention,the f ALFF value of the left precuneus,right cerebelum,left fusiform gyrus,left superior parietal gyrus were decreased compared with those of the scalp acupuncture group(GRF corrected,voxel P<0.01,cluster P<0.05).(3)Partial correlation analysis between resting f ALFF and cognitive function: The f ALFF difference of left fusiform gyrus was positively correlated with the difference of subscore-delayed memory in combined group(r=0.719,P<0.05).Other correlation analyses were not statistically significant(P>0.05).Conclusion:1.On the basis of conventional rehabilitation,two weeks of scalp acupuncture and scalp acupuncture combined with r TMS intervention can improve the global cognitive function,neurological function and attention of patients with PSCI.Among them,scalp acupuncture combined with r TMS intervention has better effect on the improvement of delayed memory.2.Compared with scalp acupuncture intervention,the local nerve spontaneous activity of left precuneus,right cerebelum,left fusiform gyrus,left superior parietal gyrus in PSCI patients were significantly changed after the treatment of scalp acupuncture combined with r TMS.The changes of spontaneous activity of the left fusiform gyrus was closely related to the changes of the subscore-delayed memory.The neuroimaging mechanism of the combination of acupuncture plus transcranial magnetic stimulation for improving cognitive function in PSCI patients may be related to the changes of local neurological spontaneous activity in brain regions involving in cognitive processing such as left fusiform gyrus.