| Objective: In this study,on the basis of rehabilitation training and antidepressant drugs,intermittent theta burst stimulation was innovatively applied to the left dorsolateral prefrontal cortex of patients with post-stroke depression and cognitive impairment,to explore the effect of this treatment on the depression and cognitive function of patients.Methods: According to certain inclusion and exclusion criteria,40 patients with post-stroke depression and cognitive impairment were randomly divided into experimental group and control group by random number table method,with 20 patients in each group.Patients in both groups were treated with not only conventional drug therapy,either orally or intravenously(such as stabilizing blood pressure and blood sugar,regulating lipid metabolism,nourishing nerve and improving microcirculation,etc.)and routine rehabilitation training(occupational therapy,physical therapy,etc.),traditional cognitive training(orientation,memory,computation,attention,and such training),but also antidepressant drug(escitalopram oxalate tablets).On this basis,the experimental group was supplemented with intermittent theta burst stimulation,and the treatment site was the left dorsolateral prefrontal cortex,while the control group received a false stimulus by stimulating the same site with transcranial magnetic.Before and 4weeks after treatment,Hamilton rating scale for depression(HAMD-17)was used to evaluate the depression status,mini-mental state examination(MMSE),montreal cognitive assessment(MoCA)and event-related potential(P300)were used to assess the cognitive function of the patients,modified Barthel index(MBI)was used to assess the patients' ADL ability.Results: There was no significant difference in age,sex,stroke duration,stroke site,stroke type and other general conditions between the two groups before treatment(P >0.05),which was comparable.The national institutes of healthstroke scale(NIHSS),HAMD-17,the latency and amplitude of P300,MMSE,MoCA and MBI scores were also similar before treatment between the two groups,with no significant difference(P >0.05).After treatment in the two groups,HAMD-17 score was decreased,MMSE,MoCAand MBI scores were increased to varying degrees,the latency period of P300 was shortened and amplitude was increased.In the experimental group,HAMD-17 score was(12.30 ± 3.53)after treatment,which was(8.20 ± 3.07)points lower than that before treatment.MMSE,MoCA and MBI scores were respectively(20.45±3.14),(18.50±3.80)and(67.00±8.65),which were severally improved(3.50±2.12),(5.30±1.59)and(17.20±7.78).The latency period of P300 was(348.45±26.36)ms,which was(28.31±22.27)ms shorter than that before treatment.The amplitude of P300 was(4.77±0.91)?V,and increased by(1.04 ± 0.83)?V after treatment.While in the control group,HAMD-17,MMSE,MoCA,MBI,the latency and amplitude of P300 of patients after treatment were(14.50±2.71),(17.20±4.02),(15.75±4.01),(62.00±6.37),(364.45±10.24)ms,(3.82±0.62)?V,respectively,and the differences between post-treatment and pre-treatment were(-4.5±2.50),(2.30±1.26),(2.80±1.28),(13.00±3.40),(-14.88± 9.19)ms,and(0.56 ± 0.50)points,respectively.In comparison,depression and cognitive impairment were significantly improved in both groups before and after treatment,and the differences were statistically significant(P < 0.05).Compared with the control group,patients in the experimental group had lower depression scores and better cognitive status after 4 weeks of treatment,and the difference was statistically significant(P < 0.05).By comparing the difference between before and after treatment in the two groups,the improvement of each indicator in the experimental group was more obvious,and the difference was significant(P < 0.05).Conclusion: Compared with the combination of rehabilitation training and antidepressant medication alone,the addition of intermittent theta burst stimulation is expected to further improve the depressive mood and promote the recovery of cognitive impairment of post-stroke patients with depression and cognitive impairment. |
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