Study On The Neuromechanism Of Acupuncture Shenting And Baihui On Cognitive Function Of Cerebral Small Vessel Disease Cognitive Impairment Based On Resting State Amplitude Of Low-frequency Fluctuation

Objective:1.The rest-state functional magnetic resonance imaging(rs-fMRI)technique was used to analyze the difference between patients with cerebral small vessel disease cognitive impairment(CSVDCI)and healthy controls.The difference in amplitude of low frequency fluctuation(ALFF)between patients with CSVDCI and healthy controls was analyzed to investigate the neuroimaging changes of cognitive impairment in cerebral small vessel disease.2.A randomized controlled trial was conducted to observe the efficacy of acupuncture Shen Ting and Baihui of patients with CSVDCI and to analyze the dimensions of their effects on cognitive function,and the post-intervention effects of acupuncture Shen Ting and Baihui on patients with CSVDCI were observed by follow-up.Also,based on rs-fMRI analysis of the changes of ALFF values in patients with CSVDCI,the effects of acupuncture Shen Ting and Baihui on local spontaneous brain activity in patients with CSVDCI were further investigated and correlated with neuropsychological scales to find possible brain function mechanisms for the treatment of cognitive dysfunction and efficacy of acupuncture Shen Ting and Baihui in CSVDCI.Methods:This study is divided into two parts,the first part is a study of resting-state low-frequency amplitude in cognitive dysfunction in CSVD,and the second part is a study of the efficacy and mechanism of acupuncture in treating cognitive dysfunction in CSVD.Study1.A total of 124 subjects who met the diagnostic criteria for cognitive dysfunction in CSVD were included,a total of 46 patients completed functional MRI scans,and 32 healthy control subjects with normal cognitive function were recruited for functional MRI scans.The group differences in whole-brain ALFF values between the baseline period of CSVDCI and healthy subjects were analyzed and correlated with neuropsychological scales.Study2.This study was a randomized controlled clinical trial that included 124 eligible subjects,randomly divided into two groups: 62 cases in the control group,who were given conventional treatment;and 62 cases in the treatment group,who were given acupuncture to Shenting and Baihui based on conventional treatment.Acupuncture treatment was performed once a day,5days a week,for 12 weeks,with a 12-week follow-up after the intervention.The MoCA was used to assess the overall cognitive function before and after the intervention and after the follow-up;the SDMT,the VFT,and the DST were used to assess the attention cognitive function;the TMT assesses executive functioning;the BNT assesses naming ability;the ADL assesses daily living skills.Functional MRI images were also collected before and after the intervention and after 12 weeks for statistical analysis,including 19 cases in the control group and 25 cases in the acupuncture group.The functional MRI images were statistically analyzed again at 12 weeks of follow-up,including 17 cases in the control group and 20 cases in the acupuncture group.The changes in whole brain ALFF values before and after treatment and at12 weeks of follow-up were analyzed in both groups and correlated with MoCA scores.Results:1.Comparison of whole-brain ALFF values showed that compared with the controls,the ALFF values in the right superior parietal gyrus,left inferior occipital gyrus,left fusiform gyrus,right lingual gyrus,left calcarine and the left middle temporal gyrus were reduced in patients with CSVDCI;the ALFF values in the left superior occipital gyrus,syrinx gyrus,middle temporal gyrus,and right superior parietal gyrus in patients with CSVDCI were correlated with MoCA scores were positively correlated and statistically significant(P<0.05).2.Behavioral: Before the intervention,there were no statistically significant differences between the treatment and control groups in terms of gender,age,education,right and left handedness,smoking,alcohol consumption,duration of illness,and past medical history(P>0.05).There were no statistically significant differences in the pre-intervention outcome indicators MoCA total score,SDMT score,VFT score,DST score,TMT-A elapsed time,TMTB elapsed time,BNT score,and ADL score between the two groups of subjects(P>0.05).Compared with pre-intervention,the treatment group improved better than the control group in MoCA scores,SDMT scores,VFT scores,DST scores,TMT elapsed time,BNT scores,and ADL scores after intervention(P<0.01 or P<0.05);Compared with pre-intervention,the treatment group improved better than the control group in MoCA,SDMT score,VFT score,DST score,TMT elapsed time,BNT score,and ADL score after follow-up(P<0.01 or P<0.05);There was no statistically significant difference between the two groups in the comparison of differences in MoCA scores,SDMT scores,VFT scores,DST scores,TMT elapsed time,BNT scores and ADL scores after follow-up compared with after intervention(P>0.05).Resting-state functional MRI: Comparing the ALFF differences before and after the intervention in the two groups,the brain regions with significantly higher ALFF values in the treatment group than in the control group were the right inferior temporal gyrus,the left middle occipital gyrus,the left superior occipital gyrus,the left insula,the bilateral postcentral gyrus,the right superior parietal gyrus,the right cerebellum,the right precuneus,and the right precentral gyrus.In the correlation analysis with the difference of MoCA,the difference of ALFF in the right inferior temporal gyrus,left middle occipital gyrus,left superior occipital gyrus,and right superior parietal gyrus in the acupuncture group was positively correlated with the difference of MoCA,which was statistically significant(P<0.05).Conclusion:The spontaneous brain activity in the left superior occipital gyrus,fusiform gyrus,middle temporal gyrus,and right superior parietal gyrus was reduced in patients with CSVDCI compared with normal subjects.These brain regions are important components of the human brain and are closely related to cognitive function,and the occurrence of cognitive dysfunction in patients with CSVDCI may be related to the reduced functional activity of these brain regions.Acupuncture of Shenting and Baihui for 12 consecutive weeks can effectively improve the overall cognitive function,attention,executive function and naming ability of patients with CSVDCI,and improve the patients’ daily living ability to some extent,which may be related to the fact that acupuncture of Shenting and Baihui for 12 consecutive weeks can increase the spontaneous activity of specific brain regions,in which the right inferior temporal gyrus,left middle occipital gyrus,left superior occipital gyrus and right superior parietal gyrus.The effect of acupuncture on the improvement of cognitive function was found to have a posterior effect by 12 weeks of follow-up.