Song Xinxin, Fu Jianming, Yao Yunhai, Shu Yuhong, Wang Zhongli, Chen Xuting, Ma Lianjie, Shen Fang, Sun Xiaolin, Ma Xiaoqing, Zhang Ting, Jin Rujue, Zeng Ming, Gu Xudong
Joint Training Base of Zhejiang Chinese Medical University and Jiaxing University, Hangzhou, China.
Rehabilitation Medicine Center, Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
Front Neurol. 2025 May 14;16:1582437. doi: 10.3389/fneur.2025.1582437. eCollection 2025.
This study employed Transcranial Magnetic Stimulation combined with Electroencephalography (TMS-EEG) to examine the impacts of high-frequency repetitive transcranial magnetic stimulation (rTMS) on brain activity and cognitive function in patients with post-stroke cognitive impairment (PSCI), focusing on changes in connectivity of the left dorsolateral prefrontal cortex (DLPFC) across different frequency bands.
Twenty subacute PSCI patients were recruited for a 20-day rTMS treatment, consisting of 10 days of sham stimulation followed by 10 days of actual stimulation. Clinical function scale data and TMS-EEG data were collected before treatment (Pre), after sham stimulation (Sham), and after rTMS treatment (TMS) to analyze transcranial magnetic stimulation evoked potentials (TEP), time-frequency, and functional connectivity. Additionally, a subgroup analysis was conducted to assess the impact of education level, time since onset, and lesion size on cognitive score improvement.
Compared to the Pre and Sham conditions, cognitive function and daily living ability scores significantly improved post-rTMS. Although the TEP patterns in the Pre and Sham conditions were similar, rTMS enhanced the early TEP amplitude in the left DLPFC, slowed gamma oscillations, increased connectivity in the theta and alpha bands in the bilateral DLPFC, and altered the connectivity patterns between the left DLPFC and other brain regions. Changes in theta-band wPLI were significantly positively correlated with improvements in MMSE scores ( = 0.465, = 0.039) and MoCA scores ( = 0.493, = 0.027). Patients with higher education levels exhibited significant cognitive improvement ( = 0.039), while patients with a time since onset of 60-180 days showed a significant decline in cognitive improvement ( = 0.024).
High-frequency rTMS effectively modulated connectivity patterns between the left DLPFC and other brain regions in PSCI patients, enhancing cognitive functions. Changes in wPLI within the theta frequency band may serve as a potential biomarker for cognitive function improvement in PSCI patients. Education level and time since onset may have a certain impact on cognitive improvement in PSCI patients.
本研究采用经颅磁刺激联合脑电图（TMS-EEG）技术，探讨高频重复经颅磁刺激（rTMS）对脑卒中后认知障碍（PSCI）患者脑活动和认知功能的影响，重点关注左侧背外侧前额叶皮质（DLPFC）在不同频段的连接性变化。
招募20例亚急性PSCI患者进行为期20天的rTMS治疗，包括10天的假刺激，随后是10天的实际刺激。在治疗前（Pre）、假刺激后（Sham）和rTMS治疗后（TMS）收集临床功能量表数据和TMS-EEG数据，以分析经颅磁刺激诱发电位（TEP）、时频和功能连接性。此外，进行亚组分析以评估教育水平、发病时间和病变大小对认知评分改善的影响。
与Pre和Sham条件相比，rTMS治疗后认知功能和日常生活能力评分显著提高。尽管Pre和Sham条件下的TEP模式相似，但rTMS增强了左侧DLPFC的早期TEP振幅，减缓了伽马振荡，增加了双侧DLPFC在θ和α频段的连接性，并改变了左侧DLPFC与其他脑区之间的连接模式。θ频段加权相位滞后指数（wPLI）的变化与简易精神状态检查表（MMSE）评分的改善（r = 0.465，P = 0.039）和蒙特利尔认知评估量表（MoCA）评分的改善（r = 0.493，P = 0.027）显著正相关。教育水平较高的患者表现出显著的认知改善（P = 0.039），而发病时间为60 - 180天的患者认知改善显著下降（P = 0.024）。
高频rTMS有效调节了PSCI患者左侧DLPFC与其他脑区之间的连接模式，增强了认知功能。θ频段内wPLI的变化可能作为PSCI患者认知功能改善的潜在生物标志物。教育水平和发病时间可能对PSCI患者的认知改善有一定影响。
