| Background and purposeStroke is currently considered as a common and frequently-occurring clinical disease,of which post-stroke cognitive impairment(PSCI)is one of the common complications after stroke.About 67% of the patients with cerebral apoplexy in within 3 months after stroke can produce different degree of cognitive impairment,if it can not be timely detection and treatment,can be further evolved into vascular cognitive impairment,which increased the difficulty of the rehabilitation training,to a large extent influence the patient's identity and daily needs,and to the families and nursing workers has brought many inconvenience on the communication and understanding.Therefore,effective assessment of cognitive function with early detection and treatment is crucial.Repetitive transcranial magnetic stimulation(rTMS)is a new and non-invasive neuroelectrophysiological technique,which improves the function of cortical regions by stimulating local and remote cortical regions and affecting neurotransmitters and synaptic transmission.At present,many scholars at home and abroad have studied the changes of cognitive function in patients with cognitive impairment after stroke by rTMS,but few reports have been reported on the severity of cognitive impairment and the discussion of moderate cognitive impairment after stroke.Therefore,this study used Mini-Mental Status Examination(MMSE)to screen patients with moderate cognitive impairment,and carried out rTMS treatment with different parameter modes to observe the curative effect of different treatment modes,and followed up the therapeutic effect for 8 weeks,to explore the short-term and long-term cognitive function and life ability of the subjects.Materials and Methods1.Case selection: from August 2017 to September 2018,72 patients with post-stroke cognitive impairment who failed to meet the diagnostic criteria for dementia admitted to our hospital were selected,and 12 of them withdrew.Patients were divided into high frequency group,low frequency group,combined group and control group by random number table method in order of treatment,with 15 cases in each group.2.Treatment:(1)drug treatment: drug treatment for the patient's basic disease,such as blood pressure control,improve circulation and other drugs;(2)routine rehabilitation training: the use of neurodevelopmental therapy,sports re-learning technology,daily life activities training,physical therapy,occupational therapy;(3)cognitive function training: once a day,30 min each time,6 days a week,a total of 2 weeks of treatment;(4)transcranial magnetic stimulation therapy: on the basis of the above treatment,the patients in the four groups were supplemented with high frequency 5Hz for 20 min,low frequency 1Hz for 20 min,and combined group 5Hz for 10 min before 1Hz for 15 min,and sham stimulation for 20 min.3.Efficacy evaluation:,treatment 2 weeks prior to the treatment and 8 weeks after treatment respectively in patients with four groups of simple Mental state assessment scale(Mini-getting the Status Examination,MMSE),the Chinese version of the Montreal cognitive assessment(Montreal cognitive assessment,MoCA)score,auditory event related potential P300 detection,modified Barthel index(modified Barthel index,MBI)to evaluate the cognitive function in patients with and life skills,All of them were completed by the relevant senior therapists,who were not involved in the treatment.Result1.The MMSE scale score was improved only in the high frequency group and the combined group at 2 weeks after treatment compared with that before treatment;Treatment for 8 weeks,the high frequency group and combined group orientation force score and MMSE score relatively rise before this treatment,with statistical significance(P < 0.05),a joint group of attention and computing power is before this treatment improved obviously,MMSE score than the control group improved significantly(P < 0.05),low frequency group was improved,the total score but still has no statistical significance(P > 0.05).2.At 2 weeks of treatment,memory,attention and orientation of patients in the combined group were significantly improved(P < 0.05),while memory and orientation of patients in the high frequency group and the low frequency group were significantly improved(P < 0.05).At 8 weeks of treatment,the visual space and executive ability of the high-frequency group and the combined group were improved.In addition to the above indicators,the visual space and executive ability of the combined group and the total score of MoCA were improved compared with the control group.Memory,orientation and MoCA scores of the high frequency group and the low frequency group were improved compared with those before treatment(P< 0.05).3.At 2 weeks of treatment,the incubation period and amplitude of P300 in the high frequency group and the combination group were significantly improved compared with that before treatment in this group and the control group,and the low-frequency group was significantly improved compared with that before treatment in this group(P < 0.05).During the 8-week follow-up,the P300 latency and amplitude of the combined group were significantly improved in the low-frequency group and the control group(P < 0.05),and the P300 index of the high-frequency group and the low-frequency group was statistically significant(P < 0.05)compared with that before treatment and in the control group.4.BMI index of high frequency group,low frequency group and combination group improved after 2 weeks of treatment,but there was no significant difference in BMI index of group,group and control group(P > 0.05);at 8 weeks follow-up,the scores of high frequency group,low frequency group and combination group improved significantly compared with those of the control group before treatment,and the improvement of the combination group was more obvious than that of the control group at the same time,with statistical significance(P < 0.05).Conclusion:1.For people with moderate cognitive impairment after stroke,the use of rTMS at different frequencies has a certain effect on improving cognitive function,mainly in memory,orientation and so on.2.Compared with traditional rehabilitation cognitive training and single-frequency rTMS therapy,the combined frequency stimulation model has obvious improvement in visual space and executive ability,attention and P300 index,and has better improvement in daily living ability.3.The improvement of cognitive function appeared earlier in the combined model group,and there were many sub-cognitive items.The improvement of daily living ability in the follow-up group was more obvious than that in the other groups. |
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