The Observation And Mechanism Of Repeated Transcranial Magnetic Stimulation For Cognitive Dysfunction In Patients With Hemorrhagic Stroke

Purpose:This paper makes a multi-mode analysis of early hemorrhagic stroke patients suffering from cognitive disorder through resting-state functional magnetic resonance imaging(rs-fMRI)based on regional homogeneity(Reho),fractional amplitude of low-frequency fluctuation(fALFF)and functional connectivity(FC),and observes the changed condition of cognitive disorder and synchronous change in the region of interest(ROI)and the left and right hippocampal regions against high-frequency transcranial magnetic stimulation of dorsolateral left frontal lobe,so as to explore the corresponding recovery mechanism for the above-mentioned patients.Method: Thirty(30)cases of patients suffering from cognitive disorder due to hemorrhagic stroke affecting basal nuclei and/or corona radiate were divided into two groups,i.e.experiment group(15 cases)and control group(15cases),the former subjected to conventional speech rehabilitation training and repeated transcranial magnetic stimulation of dorsolateral left frontal lobe while the latter only subjected to conventional speech rehabilitation training for a therapy peROId of 3 weeks.All patients were scanned before and after therapy with Siemens Tim TROI3.0T whole-body magnetic resonance imaging system(Siemens medical system,Erlangen,Germany)through conventional T1 weighted imaging(T1W1),T2 weighted imaging(T2W1),FLAIR,3D anatomy imaging and resting-state function-magnetic resonance imaging(rs-fMRI).With dorsolateral left frontal lobe and left and right hippocampal regions defined as the region of interest(ROI),Reho and fALFF values of dorsolateral left frontal lobe(ROI1)were measured first;then the functional connectivity between ROI1 and ROI2(left hippocampal region)and ROI3(right hippocampal region)and that between ROI1 and the whole brain were analyzed.All rs-fMRI data were processed and analyzed with SPM8 software.All patients were subjected to cognitive function assessment with Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)both before and after therapy and spss21 software was used for statistical analysis of assessment data.Results:The cognitive function of patients in experiment group has improved much higher than that of patients in control group.As for patients in experiment group compared with those in the control group,the brain regions where the functional connectivity between brain and ROI1 has improved mainly include precuneus,infeROIr tempotal gyrus,middle frontal gyrus,infeROIr frontal gyrus and marginal gyrus and those where the functional connectivity has markedly decreased mainly include middle temporal gyrus and thalamus;those where fractional amplitude of low-frequency fluctuate(fALFF)has improved mainly include supeROIr temporal gyrus,infeROIr frontal gyrus and parahippocampal gyrus;those where regional homogeneity(ReHo)has improved mainly include supramarginal gyrus,precuneus and cingulate gyrus;those where the functional connectivity with ROI2 has improved mainly include middle frontal gyrus,posteROIr cerebellar gyrus and infeROIr temporal gyrus and those where the functional connectivity has weakened mainly include frontal pole,middle temporal gyrus and supramarginal gyrus;those where the functional connectivity with ROI3 has improved mainly include right precuneus,posteROIr cerebellar gyrus,infeROIr frontal gyrus and medial frontal gyrus and those where the functional connectivity has weakened mainly include parietal lobe,right parahippocampal gyrus and visual association cortex.Conclusion:5.Repeated transcranial magnetic stimulation has remarkably improved the cognitive function of patients suffering from cognitive disorder due to hemorrhagic stroke(cerebral hemorrhage);6.The therapy provided for hemorrhagic stroke patients in experiment group but not for those in control group after which fALFF and Reho values increase in the brain regions thereof may be considered as one of the mechanisms for helping patients recover from cognitive disorder;7.The fALFF and Reho values are positively correlated with MoCA score and the brain regions where the functional connectivity with ROI(dorsolateral left frontal lobe)is enhanced,except infeROIr temporal gyrus,are all positively correlated with MoCA score,which may reflect the improvement in cognitive function.8.Enhancement of the functional connectivity between left and right hippocampal regions and dorsolateral left frontal lobe has improved the recovery loop for patients suffering from cognitive disorder due to hemorrhagic stroke.