Therapy Of Repetitive Transcranial Magnetic Stimulation For Subcortical Ischemic Vascular Disease Patients With Mild Cognitive Impairment

Objective:Mild cognitive impairment is the most common clinical feature of subcortical ischemic vascular disease,characterized by executive dysfunction and delayed memory recall, which is usually ignored by patients’ care-givers, deeming it as normal aging manifestation,MCI is the early stage for patients with SIVD and have a higher incidence of progressing into vascular dementia which actually is reversible, so it is essential to offer early diagnosis and treatment for patients with SIVD complicated with MCI. Present treatment for cognitive impairment complicated with SIVD included cholinesterase inhibitors (par donepezil example)、nimodipine、oxiracetam et.al, some chinese herbs including Ginkgo Leaf and Jiannao yizhi granules may have some efficacy which require large clinical trials to prove.Resent studies discovered that rTMS have powerful treatment effect for vascular cognitive impairment、depression、 movement disorders、neurodynia、migraine et.al, which shed light for the treatment for patients with early stage SIVD. Therefore our study focus on the treatment effect of rTMS for cognitive impairment complicated with SIVD patients.Methods:Cognitive impairment patients with SIVD were enrolled, all patients went through neuro-psychological tests, criteria as Moca≤26,were followed, as a result, a total of 61 patients were selected.Patients were randomized into 2 groups:the study group (using rTMS treatment) as well as the control group (not using rTMS treatment), all patients went through normal therapy (including anti-platelet、activating blood circulation to dissipate blood stasis、antilipemic agents et.al), all drugs influence cognition and all cognitive improvement rehabilitation methods were excluded from the treatment methods.TMT-A、TMT-B、VFT、AVLT score and P300 latency and amplitude changes were compared between the two groups before and after treatment.Results:Before treatment,TMT-A,TMT-B,VFT and AVLT showed no difference in the two groups(P=0.29;P=0.92,P=0.74,P=0.64); After treatment, in the study group TMT-A,TMT-B decreased significantly (P=0.040,P=0.041) while VFT,AVLT increased significantly (P=0.034,P=0.01); the results were also significantly different in the two groups after treatment with TMT-A,TMT-B decrease(P=0.019,P=0.009) and VFT,AVLT increase(P=0.044,P=0.045). In the study group P300 latency after treatment was significantly shortened than that before treatment(P=0.045), which was also significantly different from that in the control group(P=0.025),P300 latency showed no difference in the control group before and after treatment(P=0.51), P300 amplitude showed no difference before and after greatment in both groups(P=-0.075,P=0.34).Conclusion:Our study revealed that TMS therapy can improve cognitive function in SIVD with mild cognitive impairment.