Effect Of Hyperbaric Oxygen Combined With Repetitive Transcranial Magnetic Stimulation On Cognitive Impairment And Depressive Symptoms Of Cerebral Small Vessel Disease

Background:Cerebral small vessel diseases（CSVD）refers to a group of syndromes of clinical,cognitive,imaging,and pathological manifestations of small vessel disease in the brain.The main blood vessels involved are small arteries and arterioles in the brain.Capillaries and venules are the primary causes of cognitive impairment and loss of function in the elderly^[1].Different degrees of cognitive dysfunction,from mild to dementia and other nerve damage,have become an important disease affecting the physical and mental health and quality of life of the elderly^[2].Different types of stroke patients with CSVD are prone to post-stroke depression（PSD）symptoms such as emotion,behavior,and personality disorder^[3].PSD significantly increases mortality,disability,and cognitive dysfunction in stroke patients.rate.Pathological changes such as cerebral microbleed（CMB）,white matter lesions（WML）,and enlarged perivascular space（EPVS）in brain tissue of patients with CSVD are mainly based on nerves.Imaging,but there is no consensus on the normal reference range of imaging markers in the use of CSBD.The experimental diagnostic indicators for CSBD are also lacking in specificity.The neuropsychological assessment of vascular cognitive impairment associated with CSBD is used.There is no uniform regulation on the prediction scale.At present,the diagnostic criteria for CSBD are not unified in the world,so it is easy to be missed or misdiagnosed,and there is no specific treatment for this disease,which delays treatment or causes serious complications and results in poor prognosis..However,it is undeniable that with the progress of people’s associations and the increasing proportion and number of elderly people,more and more patients with cerebral small vessel disease and cognitive dysfunction,depression,etc.,bring to society,families and patients.A heavy burden has become a major social issue affecting the health and quality of life of our population.Therefore,it is especially important and necessary to explore a safe and effective treatment.Objective:To explore the application value of hyperbaric oxygen combined with repetitive transcranial magnetic stimulation（rTMS）therapy for cognitive impairment and depressive symptoms in cerebral small vessel disease.Methods:A total of 76 patients with cerebral small vessel disease admitted to our hospital were enrolled in the study.They were divided into conventional control groups by digital lottery.The routine treatment was combined with hyperbaric oxygen and rTMS adjuvant therapy.The overall cognitive function was assessed using the Montreal Cognitive Assessment Scale（MoCA）,the Hamilton Depression Rating Scale（HAMD）was used to assess overall depressive symptoms,and the line making test A（TMT-A）and the connection test B（trail）were used.Making test B,TMT-B),language fluency function（VFT）,and auditory word learning function（AVLT）respectively evaluate its executive function,language fluency,and auditory word learning function.The improvement of cognitive impairment and depressive symptoms and the adverse effects were compared between the two groups.Results:There were no differences in the pre-treatment MoCA scale,the HAMD scale score,and the TMT-A,TMT-B,VFT,and AVLT indicators.The test group MoCA（t=-7.6129;P<0.05）,HAMD（t=-7.2894;P<0.05）,control group（t=-0.1741;P>0.05）,（t=-0.1658;P>0.05）,TMT-A,TMT-B,VFT,and AVLT cognitive scale scores were significantly improved（t=4.9;5.2;5.0;-4.9,P<0.05）,and were different from the control group（t=-1.4;-3.9;5.1;3.5,P<0.05）.Conclusions:Hyperbaric oxygen combined with rTMS for the treatment of cognitive impairment and depressive symptoms of cerebral small vessel disease can effectively improve and promote the recovery of symptoms,especially the improvement of executive function,language fluency,and auditory vocabulary learning,and no obvious adverse reactions.