Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Department of Rehabilitation Medicine, the People's Hospital of Zhongjiang, Deyang, China.
J Alzheimers Dis. 2024;101(1):337-352. doi: 10.3233/JAD-240505.
There are currently no uniform treatments for post-stroke comorbid cognitive impairment and depression (PSCCID).
To verify whether repetitive transcranial magnetic stimulation (rTMS) can improve PSCCID symptoms and explore the underlying roles of resting-state functional magnetic resonance imaging (rs-fMRI).
Thirty PSCCID patients were randomized in a 1 : 1 ratio to receive 4 weeks of rTMS (intervention group) or sham rTMS (control group) over the left dorsolateral prefrontal cortex (DLPFC). rs-fMRI was acquired to analyze the functional plasticity of brain regions at baseline and immediately after the last intervention.
Cognition, depression status, and neural electrophysiology were improved in both intervention and control groups after treatment (p = 0.015-0.042), and the intervention group had more significant improvement than the control group. Analysis of functional connectivities (FCs) within the default mood network (DMN) showed that the connection strength of the left temporal pole/left parahippocampal cortex and right lateral temporal cortex/right retrosplenial cortex in the intervention group were enhanced compared with its pre-intervention and that in the control group after treatment (p < 0.05), and the both FC values were positively correlated with MMSE scores (p < 0.001). The intervention group had stronger FCs within the DMN compared with the control group after treatment, and some of the enhanced FCs were correlated with the P300 latency and amplitude.
rTMS over the left DLPFC is an effective treatment for improving both cognitive impairment and depression among patients with PSCCID. The enhanced FCs within the DMN may serve as a compensatory functional recombination to promote clinical recovery.
目前，针对卒中后认知障碍合并抑郁（PSCCID），还没有统一的治疗方法。
验证重复经颅磁刺激（rTMS）是否可以改善 PSCCID 症状，并探索静息态功能磁共振成像（rs-fMRI）的潜在作用。
将 30 例 PSCCID 患者按 1∶1 比例随机分为 rTMS 治疗组（干预组）和假刺激 rTMS 治疗组（对照组），分别接受左侧背外侧前额叶皮层（DLPFC）的 4 周 rTMS 治疗或假刺激治疗。在基线和最后一次干预后立即采集 rs-fMRI，以分析脑区的功能可塑性。
治疗后，两组的认知、抑郁状态和神经电生理均得到改善（p=0.015-0.042），且干预组的改善更为显著。默认模式网络（DMN）内的功能连接（FC）分析显示，干预组治疗后的左侧颞极/左侧海马旁回与右侧外侧颞叶/右侧后扣带回的连接强度较治疗前增强，而对照组治疗后的连接强度较治疗前减弱（p<0.05），且两组的 FC 值均与 MMSE 评分呈正相关（p<0.001）。治疗后，干预组的 DMN 内 FC 较对照组增强，且一些增强的 FC 与 P300 潜伏期和振幅呈正相关。
rTMS 刺激左侧 DLPFC 是治疗 PSCCID 患者认知障碍和抑郁的有效方法。DMN 内增强的 FC 可能作为一种代偿性功能重组，促进临床康复。
