| Objective:1 To investigate the effects of electroacupuncture on the cognitive function of patients with vascular cognitive impairment no dementia(VCIND)in community.2 To explore the possible neuroregulatory mechanism of the influence of electroacupuncture on the cognitive function of VCIND patients by observing the changes of the functional connection and structure of the brain default mode network in VCIND patients before and after intervention.Methods:Research 1: This study is a parallel randomized controlled clinical trial.140 eligible VCIND subjects were randomly divided into control group and electroacupuncture group,70 cases in each group.The control group was given conventional basic drug treatment and health education,once a week,30 min / time,lasting for 8 weeks;the electroacupuncture group was given the intervention of "shenting" and "Baihui" on the basis of the control group,once a day,30 min / time,5 times / week,lasting for 8 weeks.Within one week before and after the intervention,Montreal Cognitive Assessment(Mo CA),Auditory Verbal Learning Test(avlt)and Stroop Color Word Test(Stroop)were used to evaluate the overall cognitive function,memory function and executive function of VCIND subjects.The inter group validity of outcome indicators was analyzed by intention to treat(ITT)analysis after multiple regression interpolation.The stability of the efficacy indicators after intervention was estimated by ITT analysis and per protocol(PP)analysis after the missing values were filled by single regression filling method,conditional mean filling method and last visit carry forward method.Research 2: On the basis of the experimental design of study 1,subjects who met the requirements of nuclear magnetic resonance imaging were scanned before and after the intervention,and the resting state functional image and structure image T1 data of the subjects before and after the intervention were collected.The area of interest(ROI)was the posterior cingulate cortex(PCC).The functional connectivity strength between PCC and other voxels in the whole brain was calculated.The functional connectivity changes of DMN before and after intervention were compared between the two groups.Based on the results of cognitive function test,correlation analysis was made between the changes of DMN functional connectivity and cognitive function scores in the two groups.ROI was extracted from the brain regions with significant difference in DMN functional connectivity,and voxel morphometry analysis method based on ROI was used to observe the changes of gray matter volume in the regions of interest before and after intervention in two groups of VCIND patients.According to the ROI of different brain regions,the specific GMV of VCIND patients was extracted.Combined with the results of cognitive function test,the correlation between the changes of brain Gmv and the score of cognitive function in the two groups of patients with VCIND was analyzed.Results:1 Baseline results: There was no significant difference in age,gender,education years,history of hypertension,diabetes,hyperlipidemia,coronary heart disease,smoking,drinking and Beck Depression Scale score between the two groups(P > 0.05).There was no significant difference between the two groups in the total score of baseline Mo CA,AVLT,and Stroop color word test(P > 0.05).2 The results of effectiveness analysis before and after the intervention showed that:Compared with the control group,the total score of MOCA in the EA group was significantly increased after intervention,and the difference between the two groups was statistically significant(P=0.011);Compared with the control group,the changes of Stroop neutral response time and Stroop consistent response time in the EA group were significantly reduced after intervention,and the difference between the two groups was statistically significant(P=0.038,0.038).There was no significant difference between the EA group and the control group in the number of AVLT first recall,second recall,third recall,sum of three recall,15 min delayed recall and delayed recognition array(P =0.062,0.652,0.143,0.139,0.525,0.193);there was no significant difference in Stroop reverse reaction time and Stroop average reaction time between groups(P =0.111,0.061).3 The results of sensitivity analysis before and after intervention showed that: the difference of Mo CA total score,Stroop neutral response time and Stroop consistent response time between groups had relatively stable efficacy consistency.4 The results of DMN functional connection showed that: compared with the control group,the functional connectivity of DMN in the posterior cingulate gyrus,left middle frontal gyrus,left anterior cingulate gyrus,left and right superior temporal gyrus,right insula,left anterior central gyrus and other brain regions in the electroacupuncture group were enhanced,and the difference was statistically significant.5 Correlation analysis of cognitive function and the peak intensity of different brain regions:There was a low positive correlation between the difference of MOCA total score and the functional connection between posterior cingulate gyrus and left middle frontal gyrus(r =0.336,P = 0.034);the difference of Mo CA scores had a low positive correlation with the functional connection between the posterior cingulate gyrus and the right superior temporal gyrus(r = 0.345,P = 0.029).6 Results of functional connectivity analysis based on ROI: The GMV difference of left middle frontal gyrus between the two groups showed that there was a significant difference between the EA group and the control group(P = 0.042);the GMV difference of the right superior temporal gyrus of the two groups showed that there was a statistical difference between the EA group and the control group(P = 0.031).7 Correlation analysis between cognitive function and GMV in left middle frontal gyrus and right superior temporal gyrus: there was no significant correlation between Mo CA score difference and GMV difference of left middle frontal gyrus and right superior temporal gyrus after intervention in two groups of VCIND patients(r=0.238,0.318,P=0.139,0.055).Conclusion:1 Electroacupuncture of "shenting" and "Baihui" can significantly improve the cognitive function and executive function of VCIND patients in the community.2 Electroacupuncture of "shenting" and "Baihui" can significantly enhance the functional connection of DMN in patients with VCIND.The functional connections between theposterior cingulate gyrus and the left middle frontal gyrus,and the posterior cingulate gyrus to the right superior temporal gyrus were positively correlated with cognitive function.Electroacupuncture of "shenting" and "Baihui" can improve the gray matter volume of left middle frontal gyrus and right superior temporal gyrus in patients with VCIND,but this change is not significantly related to the change of cognitive function.3 The mechanism of electroacupuncture "shenting" and "Baihui" in improving the cognitive function of patients with VCIND may be achieved by enhancing the functional connectivity of DMN in patients with VCIND. |
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