Analysis Of Central Mechanism Of Cognitive Impairment After Stroke And The Central Mechanism Of Acupuncturing Baihui On Cognitive Impairment After Stroke:Resting-state Functional Magnetic Resonance Imaging Study

Part I Analysis of functional connectivity(FC) on cognitive impairment after stroke and normal Subjects:Resting-state functional magnetic resonance imaging studyObjective:Cognitive impairment affect the rehabilitation of limb function and activity of daily life.The study found there are different levels of abnormal brain activity on cognitive impairment after stroke.This study use the resting-state functional magnetic resonance imaging to investigate the differences of functional connectivity for cognitive impairment after stroke and normal subjects.Explore the central mechanism about the post-stroke cognitive impairment occurred from the aspects of brain function.Materials and methods:34cognitive impairment after stroke and26normal subjects were recruited in this study.All subjects were placed in the MRI scanner,Preprocessing of fMRI data was performed using Statistical Parametric Mapping, version5.Intragroup comparisons of FC data were made using SPM5.Statistical parameter mapping Was overlapped onto MNI standard triaxiality template.Results:34cognitive impairment after stroke and26normal subjects were recruited in each group according to the affected factors(head motion,behavioral performance and machine noise)were ruled out.Compared with normal control group,in qroup of cognitive impairment after stroke,the significantly decreased FC in the left hippocampus-right superior temporal gyrus, left hippocampus-left middle frontal gyrus, left hippocampus-right superior frontal gyrus,left hippocampus-right inferior frontal gyrus,left hippocampus-left middle temporal gyrus.The significantly increased FC in the left hippocampus-right inferior parietal lobe.the significantly decreased FC in the right hippocampus-left inferior frontal gyrus, right hippocampus-right middle frontal gyrus, right hippocampus-left middle frontal gyrus, right hippocampus-left anterior cingulate.The significantly increased FC in the right hippocampus-bilateral thalamus, in the right hippocampus-left superior temporal gyrus,in the right hippocampus-left middle temporal gyrus.Conclusion:The significantly decreased FC of hippocampus-cortex (frontal lobe、 temporal lobe),It illustrate the central mechanism of cognitive dysfunction after stroke may be the inadequate brain network connection.The study also found that the increased FC of he hippocampus and its adjacent area,this may be a compensatory mechanism. Part II Analysis of central mechanism of acupuncturing Baihui on cognitive impairment after stroke:Resting-state functional magnetic resonance imaging studyObjective:A large number of clinical and basic researchs found that acupuncture can improve cognitive function in patients with strokeThe highest occurrence acupuncture points which can improve cognitive function is Baihui acupoint (GV20),but now the central mechanism of the effect of acupuncturing Baihui is not clear.Firstly, this study proved acupuncturing Baihui(GV20) can improve cognitive function on cognitive impairment after stroke.On this basis,we use the resting-state functional magnetic resonance imaging to investigate the differences of functional connectivity at baseline and8weeks and analysis of central mechanism of acupuncturing Baihui on cognitive impairment after strokeMaterials and methods:1.Patients with cognitive impairment after stroke were ra ndomized to receive Acupuncture combined with cognitive training and only cognitive training.All participants received neuropsychological assessment,motor function evaluatio nand activity of daily life evaluation at baseline and8weeks.2.Choose the32patients with cognitive impairment after stroke who completed the experiment in chapter two and they were randomized to receive acupuncturing Baihui(GV20) and acupuncturing yanglingquan(GB34)at baseline and8weeks.All participants received neuropsychologica1assessment and RS fMRI at baseline and8weeks.Neuropsychological scale scores a nd functional connectivity were analyzed by correlation, P<0.05meant statisticalsignifi cation.Analysis of central mechanism of acupuncturing Baihui on cognitive impairment after stroke.Results:1.Clinical research:Compared with per-treatment,The scale scores of the group of acupuncture combined with cognitive training and the group of only cognitiv e training were increased, the differences are obvious statistical significance.Compared withthe group of only cognitive training, the group of acupuncture combined with cog nitive training show the better effect. It is indicated that acupuncturing Baihui(GV20) can improve cognitive function in patients with strok.Acupuncture combined with cogn itive training is the ideal solution for the treatment of cognitive impairment after strok e.2.In Functional magnetic resonance imaging:The group of acupuncturing Baihui(GV20):Compared with per-treatment,thesignificantly increased FC in the left hippocampus- right inferiorfrontal gyrus,the left hippocampus-right middle frontal gyrus, the right hip pocampus-left inferior frontal gyrus,the right hippocampus-left middle frontal gyrus,the right hippocampus—ft superior frontal gyrus,the right hippocampus-left parietal lobe. Neuropsychological scale scores showed Memory scores and memory quotient scores improved significantly after treatment.The group of acupuncturing yanglingquan(GB34): The significantly decreased FC in the left hippocampus-right middle occipital gyrus, the right hippocampus-right superior temporal gyrus, the right hippocampus-right poste rior lobe of cerebellum. Significant correlations were found between improved neurops ychological scores and increased FC of the hippocampus with the frontal lobe and left parietal lobe in the treatmentgroup only.Conclusion:1.Acupuncturing Baihui(GV20) can improve cognitive function in patients with stroke.Acupuncture combined with cognitive training is the ideal solution for the treatment ofcognitive impairment after stroke.2.Increased RS FC of the hippocampus with the frontal and parietal lobes may be an important mechanism of cognitive recovery after stroke.In the control group,we can’t find the therapeutic effect of acupoint.We also can’t find the significant correlations between neuropsychological scores and FC of the hippocampus.It reveals the theory of acupointspecificity to some extent.