Dai Pei, Wang Zhao-Xia, Yu Hui-Xian, Liu Chang-Bin, Liu Si-Hao, Zhang Hao
School of Rehabilitation, Capital Medical University, China Rehabilitation Research Center, Beijing 100068, China.
Department of Rehabilitation Medicine, Beijing Tian tan Hospital, Capital Medical University, Beijing 100070, China.
Brain Sci. 2023 Sep 11;13(9):1309. doi: 10.3390/brainsci13091309.
Cognitive impairment in cerebral small vessel disease (CSVD) is a common cause of vascular dementia and is often accompanied by mental disorders. The purpose of this study was to investigate the effect of continuous theta burst stimulation (cTBS) over the right dorsolateral prefrontal cortex (DLPFC) on the cognitive function and Hamilton depression (HAMD) scores in patients with CSVD.
A total of 30 CSVD patients who met the inclusion criteria were randomly assigned to either the sham or cTBS group. The patients in both groups received routine cognitive function training. All the patients were under treatment for 14 sessions, with one session per day (each cTBS conditioning session consisted of three-pulse bursts at 50 Hz repeated at 5 Hz, 80% MT, and 600 pulses). Before and after the treatment, the patients in both groups were evaluated using the Montreal Cognitive Assessment (MoCA), Stroop Color-Word Test (SCWT), Trail Marking Test (TMT), Digital Span Test (DST), and HAMD test. The time to complete the SCWT and TMT were recorded. The scores of the MoCA, DST and HAMD test were recorded.
The HAMD scores in the cTBS group decreased significantly compared to the control ( < 0.05). There were no significant differences in the MoCA (including the MoCA subitems) or DST scores or in the SCWT or TMT completion times between the two groups ( > 0.05). For the HAMD scores and the MoCA subitem visuospatial/executive scores, the SCWT-B and SCWT-C completion times in the two groups both improved significantly before and after treatment ( < 0.05). For the MoCA scores, the DST-backward scores and the TMT-B completion times in the cTBS group improved significantly before and after treatment ( < 0.05). There was no significant difference in the SCWT-A, TMT-A completion times and MoCA subitems naming, attention, language, abstraction, delayed recall, and orientation scores either before or after treatment in the two groups or between the two groups ( > 0.05).
In this study, cTBS over the right DLPFC decreased the HAMD scores significantly in patients with CSVD but had no significant improvement or impairment effects on cognitive function. cTBS over the right DLPFC could be used to treat CSVD patients with depression symptoms.
脑小血管病（CSVD）中的认知障碍是血管性痴呆的常见原因，且常伴有精神障碍。本研究旨在探讨右侧背外侧前额叶皮质（DLPFC）连续theta爆发刺激（cTBS）对CSVD患者认知功能及汉密尔顿抑郁量表（HAMD）评分的影响。
共30例符合纳入标准的CSVD患者被随机分为假刺激组或cTBS组。两组患者均接受常规认知功能训练。所有患者接受14次治疗，每日1次（每次cTBS条件刺激由50Hz的三脉冲串以5Hz重复、80%运动阈值和600个脉冲组成）。治疗前后，两组患者均采用蒙特利尔认知评估量表（MoCA）、斯特鲁普色词测验（SCWT）、连线测验（TMT）、数字广度测验（DST）及HAMD测验进行评估。记录完成SCWT和TMT的时间。记录MoCA、DST及HAMD测验的得分。
与对照组相比，cTBS组的HAMD评分显著降低（<0.05）。两组之间的MoCA（包括MoCA子项目）或DST评分、SCWT或TMT完成时间无显著差异（>0.05）。对于HAMD评分及MoCA子项目视觉空间/执行功能评分，两组的SCWT-B和SCWT-C完成时间在治疗前后均显著改善（<0.05）。对于MoCA评分、DST倒背评分及cTBS组的TMT-B完成时间在治疗前后显著改善（<0.05）。两组在治疗前后或两组之间的SCWT-A、TMT-A完成时间及MoCA子项目命名、注意力、语言、抽象、延迟回忆和定向评分均无显著差异（>0.05）。
在本研究中，右侧DLPFC的cTBS显著降低了CSVD患者的HAMD评分，但对认知功能无显著改善或损害作用。右侧DLPFC的cTBS可用于治疗有抑郁症状的CSVD患者。
