Intervention Study Of RTMS Based On Rs-fMRI In Patients With Low Thyroid Hormone Level PSCI

Objective To evaluate brain plasticity by resting state functional magnetic resonance imaging(fMRI)and explore the potential neuroendocrine mechanism of rTMS in improving cognitive function in PSCI patients.Methods 30 patients who were admitted to Shijiazhuang People’s Hospital for inpatient rehabilitation from August 2020 to December 2021 and met the inclusion and exclusion criteria were randomly selected.Patients were randomly divided into rTMS group and Sham group,with 15 patients in each group.In the rTMS group,on the basis of conventional cognitive training combined with rTMS stimulation,the stimulation site was the healthy dorsolateral prefrontal lobe(DLPFC),for 4 weeks stimulate.The Sham group received Sham stimulation.General data were collected,the cognitive function and daily living ability of the patients were evaluated by the scale.Fasting blood was taken for thyroid hormone measurement at the same time the next morning after admission and the day before discharge.Subsequently,Achieva3.0T whole-body magnetic resonance imaging system was used to conduct TL-weighted imaging(Tl Wl),T2-weighted imaging(T2Wl)and resting state fMRI(RS-FMRI)before and after treatment for all patients.SPSS25.0 was used for general data analysis,and Matlap software package was used for preprocessing and analysis of resting fMRI images and data.Firstly,f ALFF and Re Ho were used to analyze the consistency between the whole brain voxels,and then the correlation analysis between f ALFF value and MoCA score was conducted to obtain the obvious differences in brain regions.Then the left hypothalamus(ROI1)and right hypothalamus(ROI)were used as seed points to analyze the brain regions associated with THs.Results 1.Comparison of MMSE,MoCA and MBI scores between 2 groups before intervention showed no statistical significance(P>0.05).After 4 weeks of intervention,MMSE,MoCA and MBI scores in 2 groups were significantly improved,with statistical significance(P<0.05).Compared with the Sham group,the score of rTMS group increased more significantly,and the difference was statistically significant(P<0.05).2.Comparison of scores of MoCA subitems between 2 groups before and after intervention:before intervention,there was no statistical significance in MoCA scores(P>0.05).After 4weeks of intervention,the scores of MoCA in rTMS group were significantly increased with statistical significance(P<0.05).In the Sham group,scores of all subitems of MoCA were improved,and scores of patients’ orientation were significantly improved,with statistically significant differences(P<0.05),but there were no statistically significant differences in other items(P>0.05).After intervention,there were statistically significant differences in naming,attention,language,delayed recall and orientation between the two groups(P<0.05).3.Comparison of THs between the two groups before and after intervention: there was no statistically significant difference in THs between the two groups before intervention(P>0.05).After 4 weeks of intervention,T3 and FT3 in rTMS group were significantly increased,with statistical significance(P<0.05).T3 level in Sham group was significantly increased,and the difference was statistically significant(P<0.05).After 4 weeks of intervention,there were statistically significant differences in T3,T4 and TSH between groups(P<0.05).4.Correlation analysis of cognitive ability and THs level in rTMS group 4 weeks after intervention: MoCA was positively correlated with T3,MoCA was positively correlated with TSH.MMSE was positively correlated with T3,MMSE was positively correlated with TSH.MBI score was positively correlated with TSH.5.Correlation analysis of MoCA subitems and THs levels in rTMS group after 4 weeks of intervention: FT3 was positively correlated with orientation.TSH was positively correlated with naming ability,abstraction ability and delayed recall ability.6.Resting state functional MRI results: After 4 weeks of intervention,the occipital lobe was the main brain region with increased functional connectivity according to Re Ho value analysis.f ALFF value analysis showed that the brain regions with increased functional connectivity were mainly posterior cerebellar lobe,middle frontal gyrus and superior frontal gyrus,while the decreased brain regions were superior temporal gyrus and middle temporal gyrus.In the rTMS group,the active brain regions with significant correlation between f ALFF value and MoCA scale after intervention were mainly left medial frontal lobe,anterior cerebellar lobe,cingulate gyrus,parahippocampal gyrus,left middle frontal gyrus,hypothalamus and anterior central gyrus.The brain regions associated with enhanced ROI1(left hypothalamus)function and T3 were right posterior cerebellar lobe,left upper frontal lobe,limbic lobe,parahippocampal gyrus,et al.The brain regions with enhanced functional connection with ROI1(left hypothalamus)and associated with TSH were right posterior cerebellar lobe,right superior prefrontal gyrus,left medial prefrontal gyrus,et al.The brain regions with enhanced functional connection with ROI2(right hypothalamus)and associated with T3 were right cerebellum,left temporal lobe,parahippocampal gyrus,right middle occipital gyrus,et al.The brain regions with enhanced functional connectivity with ROI2(right hypothalamus)and associated with TSH were the right posterior cerebellar lobe,right middle occipital gyrus,left limbic lobe,et al.Conclusion 1.rTMS combined with routine cognitive training has better therapeutic effect on patients with low thyroid hormone PSCI;2.rTMS intervention can regulate the synchronized and spontaneous activity of neurons in the brain and enhance the functional connections of cognition-related brain regions;3.rTMS can indirectly affect the function of hypothalamus through cerebral cortex,improve the level of PSCI thyroid hormone,and improve cognitive function,proving that there is a new neuroendocrine mechanism for the recovery of cognitive ability in PSCI patients.Figure 9;Table 10;Reference 104.