| Reserch background and purpose:Stroke is characterized by high incidence rate,high mortality rate and high disability rate.It often causes various functional impairments such as physical impairment,speech dysfunction,cognitive impairment,and in all of them,cognitive impairment is one of the main dysfunction afterstroke,its incidence is as high as 80%,mainly manifested in learning,attention,memory and otherfunctional decline,which is closely related to poorfunctional prognosis of patients.If not found in time and effective intervention,it will eventually progress to dementia,which seriously affects the quality of life of stroke patients.The mechanism of post stroke cognitive impairment(PSCI)is complex and has many factors affecting prognosis.On the one hand,the neuroanatomical damage related to cognitive function caused by stroke will directly lead to cognitive impairment.On the otherhand,as a stress event,stroke often leads to the dysfunction of hypothalamic pituitary thyroid axis function,and causes abnormal thyroid hormone level,which will furtheraggravate the cognitive impairments.Now,most observational studies have proved that the prognosis of stroke patients with cognitive impairment is worse with low thyroid hormone level,but no effective intervention has been given.There is no unified guidance forthe treatment of thyroid hormone in patients who are not in accordance with the diagnostic criteria of hypothyroidism orhyperthyroidism.There is no definite conclusion on whetherto use the drugs.In view of the adverse effect of long-term low thyroid hormone level on cognitive impairment patients afterstroke,it is necessary to explore a safe and effective way to treat the patients with cognitive impairment as soon as possible,in orderto reduce the adverse effects of long-term hypothyroidism.Repeat transcranial magnetic stimulation can effectively improve the cognitive function of patients with PSCI patients,but it is not known whetherit can also improve the cognitive function of patients with low thyroid hormone level.This paperaims to observe the effect of rTMS on the cognitive function and thyroid hormone level of patients with low thyroid hormone level,and to explore the correlation between thyroid hormone level and cognitive function,and to provide a safe and effective rehabilitation way forPSCI patients with low thyroid hormone level.Research methods:Forty stroke patients(14 days ? disease duration ? 6 months)who met the inclusion criteria were randomly assigned to the magnetic stimulation group(rTMS group)of 20 patients and the sham stimulation group(Sham group)of 20 patients.Finally,31 patients completed the study(16 patients in the rTMS group and 15 in the Sham group).All patients were first given baseline neuropsychological test(pretest)to assess theircognitive function,activity of daily living and blood hormone series index(TSH,T3,T4,FT3,FT4).The motorthresholds of all patients were measured before intervention,and all parameters of the magnetic stimulation program were the same(1 Hz,90% MT,20 minutes/time,1 time/d,5 times/w,a total of 4 weeks),but the placement methods of the two groups were different,the rTMS group placed the coil tangent to the scalp target area,while the Sham group placed the coil perpendicularto the scalp.Both groups were treated with routine medication,rehabilitation nursing,daily life activity training and cognitive function training.After4 weeks of intervention and 4 weeks follow-up,the above evaluation indexes were repeated.Research results:1.Change of serum T3 level: the T3 level was significantly higherin the two groups after4 weeks of intervention and at the follow-up period(P<0.05),and the T3 level of rTMS group was significantly higherthan Sham group(P<0.05).At the follow-up,the rTMS group was significantly higherthan that in the intervention group(P<0.05).2.The change of serum T4 level: after4 weeks of intervention and follow-up,there was no significant difference in T4 level between the rTMS groups and Sham group(P>0.05),and the T4 level of the two groups were all not changed(P>0.05)during the follow-up,and there was no significant difference between the rTMS groups and Sham group(P>0.05).3.The change of serum FT3 level: after4 weeks of intervention,the FT3 level of patients in rTMS group was significantly higherthan that before intervention(P<0.05),and there was no significant difference between the two groups(P>0.05);during the follow-up,there was no significant difference in FT3 level between the two groups compared with that after4 weeks of intervention(P>0.05).4.The change of serum FT4 level: after4 weeks of intervention and follow-up,there was no significant difference in FT4 level between the rTMS groups and Sham group(P>0.05);During the follow-up,there was still no significant difference between the two groups(P>0.05),and the FT4 level was no significant difference between the rTMS groups and Sham group after4 weeks of intervention(P>0.05).5.The changes of serum TSH level : after4 weeks of intervention,TSH level of the two groups was significantly higherthan that before intervention(P<0.05),and there was no significant difference between the rTMS groups and Sham group(P > 0.05);at the follow-up,the patients in the rTMS group were significantly higherthan those after4 weeks of intervention(P<0.05).6.The changes of Mo CA score: after4 weeks of intervention and follow-up,Mo CA score of the two groups was significantly higherthan that before intervention(P <0.05),and that in the rTMS group was significantly higherthan that in sham group(P< 0.05);at the follow-up,the rTMS group was significantly higherthan that after4weeks of intervention(P < 0.05).7.The changes of VFT score: after4 weeks of intervention and follow-up,VFT scores of the two groups were significantly higherthan before intervention(P < 0.05),and there was no significant difference between the rTMS groups and Sham group(P >0.05);during the follow-up,the VFT scores has no significant difference between the two groups compared with those in the 4 weeks(P > 0.05).8.The changes of DSF score: after4 weeks of intervention,the DSF score of the two groups was significantly higherthan that before intervention(P < 0.05),and the rTMS group was significantly higherthan that of the sham group(P < 0.05);at the follow-up,the rTMS group was significantly higherthan that before intervention(P <0.05),and the rTMS group was significantly higherthan that of the sham group(P <0.05);during the follow-up,the DSF scores has no significant difference between the two groups compared with those in the 4 weeks(P > 0.05).9.The changes of DSB score: after4 weeks of intervention,the DSB score of the two groups was significantly higherthan that before intervention(P < 0.05),and the rTMS group was significantly higherthan that of the sham group(P < 0.05);at the follow-up,the rTMS group was significantly higherthan that before intervention(P <0.05),and the rTMS group was significantly higherthan that of the sham group(P <0.05);during the follow-up,the DSB scores has no significant difference between the two groups compared with those in the 4 weeks(P > 0.05).10.The changes of MBI score: after4 weeks of intervention,the MBI score of the two groups was significantly higherthan that before intervention(P < 0.05),and there was no significant difference between the rTMS groups and Sham group(P > 0.05);during the follow-up,the MBI score of the two groups was significantly higherthan that before intervention(P < 0.05);during the follow-up,there was no significant difference between the rTMS groups and Sham group compared with the fourweeks afterintervention(P > 0.05).11.Comparison of cognitive function difference changes between two groups:(1)the difference of cognitive function after4 weeks of intervention(after4 weeks intervention-before intervention): after4 weeks of intervention,the difference between Mo CA score,VFT score,DSF score,DSB score and MBI score in rTMS group was significantly higherthan that in sham group(P < 0.05);(2)follow-up time difference(follow-up-before intervention): Mo CA score and DSF score of patients in rTMS group were significantly higherthan that of sham group(P < 0.05);(2)follow up time difference(follow-up time before intervention): Mo CA score and DSF score of patients in rTMS group were significantly higherthan The difference of time difference between the two groups was significantly higherthan that of sham group(P < 0.05),and the VFT score and MBI score all had no significant difference compared with that of sham group(P > 0.05).12.Correlation analysis of the difference between the levels of thyroid hormone(T3,T4,FT3,FT4,TSH)and cognitive function(Mo CA,VFT,DSB,DSF,MBI)and cognitive function in the rTMS group(4 weeks afterintervention-before intervention): the difference of T3 level was positively correlated with Mo CA score(r=0.638,P<0.05).13.Correlation analysis of the difference between the levels of thyroid hormone(T3,T4,FT3,FT4,TSH)and cognitive domain scores in Mo CA scale in the rTMS group(4 weeks afterintervention-before intervention): the difference of T3 level was positively correlated with delayed recall,attention and naming scores(r=0.562,P<0.05;r=0.562,P<0.05;r=0.531,P<0.05),the difference of FT3 level was positively correlated with visual space and executive function(r=0.514,P<0.05).Research conclusion:Repetitive transcranial magnetic stimulation can improve the cognitive function and thyroid hormone T3 level of PSCI patients with low thyroid hormone level,and the treatment effect has a sustained effect;the change of T3 level in rTMS group is positively correlated with the change of Mo CA total score,delayed recall,attention and naming,and the difference of FT3 level was positively correlated with visual space and executive function. |
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