Effect Of Acupuncture Combined With Rehacom Training Programs For Stroke Patients With Cognitive Dysfunction:A Resting-state FMRI Study

ObjectiveThe first objective is to investigate the clinical effect of acupuncture combined with Rehacom training programs for patients with cognitive impairment after stroke.The second objective is to explore the effect of acupuncture combined with Rehacom training programs on the default mode network (DMN) of patients with cognitive impairmen after stroke using the resting-state functional MRI(fMRI). Then to further explore the possible mechanism of the improving cognitive function and to provide a objective clinical theory for promoting the stroke cognitive rehabilitation program.MethodsA total of 118 patients with cognitive impairmen after stroke who meet the eligibility criteria will be recruited and allocated into the control group(n=30), the acupuncture treatment group(n=28), the Rehacom training group(n=31) and the acupuncture combined with Rehacom group(n=29). The participants in the control group only accept the the basis treatment for primary disease including medical treatment and health education; The participants in the acupuncture treatment group will receive the basis treatment and acupuncture treatment(Acupuncture Shenting and Baihui).The participants in the Rehacom training group will receive the basis treatment and Rehacom cognitive training.The participants in the acupuncture combined with Rehacom group will receive the basis treatment,acupuncture treatment and Rehacom cognitive training.The acupuncture therapy and Rehacom training are will last 12 weeks (45min every time,1 times a day,5 days per week). All subjects underwent rs-fMRI scaning and cognitive function assessment (MoCA) before and after treatment.Results(1) Before treatment,the MoCA scores of the four patient groups were not significantly different (P>0.05).(2) After the intervention, the MoCA scores of the acupuncture treatment group, Rehacom training group and the acupuncture combined with Rehacom group patients after treatment have varying degrees of increase,the differences were statistically significant (P<0.05).(3) After the intervention, the degree of the MoCA scores improvement of the acupuncture combined with Rehacom group is better than the acupuncture treatment group and Rehacom training group, the differences were statistically significant (P<0.05).(4) After the acupuncture combined with Rehacom training, the enhanced functional connectivity brain areas of the default mode network system in stroke patients with cognitive dysfunction are mainly located in (superior, middle and inferior) frontal gyrus, right·thalamus, right insula, left middle occipital gyrus, left middle temporal gyrus, the bilateral hippocampus and the bilateral superior temporal gyrus.(5) Correlation analyses showed significant correlations in Ischemic stroke patients of the acupuncture combined with Rehacom group,as following:(a) the improvement of visuospatial/executive and RS FC of the left middle occipital gyrus (r=0.40, P=0.033); (b) the improvement of △MoCA and RS FC of the right thalamus (r=0.49, P=0.010);(c) the improvement of attention and RS FC of right inferior frontal gyrus (r=0.52,P=0.0046);(d) the improvement of delayed recall and RS FC of the left middle temporal gyrus (r=0.44, P =0.018); and the improvement of delayed recall and RS FC of the left hippocampus (r= 0.65,P=0.001).Conclusion1 Both acupuncture and Rehacom training can improve the cognitive function of Stroke patients with cognitive impairment, and acupunture therapy combined Rehacom training showed synergistic therapeutic effect, that can further improve the cognitive function and help the rehabilitation of stroke patients with cognitive dysfunction.2 One of the central mechanism of acupuncture combined with Rehacom training program improve cognitive function in stroke patients with cognitive impairment may be based on enhancing the functional connectivity within the key brain regions of the default network system (such as the frontal lobe, temporal lobe, hippocampus and other).