| Objective :The changes of low-frequency fluctuation(ALFF)and fractional amplitude of low-frequency fluctuation(fALFF)in different frequency bands of patients with vascular mild cognitive impairment(VaMCI)before and after acupuncture were investigated by using the resting-state functional magnetic resonance imaging(RS-fMRI)technology.The effects of acupuncture treatment on cognitive function and functional activities in different brain regions of patients with VaMCI were analyzed.The neural network regulation mechanism of acupuncture to improve the cognitive function of VaMCI was explored,and the brain function network characteristics of acupuncture effect were preliminarily revealed,which provided imaging basis for promoting acupuncture treatment of VaMCI.Methods :In this study,14 VaMCI patients were recruited from the acupuncture department of The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June 2021 to February 2022 by using the random grouping method of sealed envelopes.According to the inclusion and exclusion criteria,VaMCI patients were randomly divided into the acupuncture treatment group and the non-acupoint shallow needling group according to the ratio of 1 : 1.Both groups were given conventional symptomatic basic treatment and received acupuncture intervention for 3 months(acupuncture treatment group was given conventional acupuncture,and non-acupoint group was given non-meridian and non-acupoint shallow acupuncture).Patients in both groups received Montreal Cognitive Assessment(MoCA),Mini-Mental State Examination(MMSE),Hopkins Verbal Learning Test,Boston Naming Test,Clock Drawing Test,Trail Making Test,Instrumental Activities of Daily Living and RS-fMRI examination.MoCA and MMSE were evaluated at 1 month,2 months and 3 months after treatment.RS-fMRI examination was evaluated again after 3 months of treatment.SPSS21.0 software was used for statistical analysis of all data.The measurement data were tested for normality and homogeneity of variance,and two-sample t-test,non-parametric test and repeated measurement variance analysis were used for analysis according to the situation.Count data were analyzed by chi-square test.P<0.05 was considered statistically significant.The RS-fMRI data were preprocessed by RESTplus v1.25 analysis software under Matlab R2017 b platform.Then,the preprocessed data were paired t-tested for the index values of the two groups before and after the intervention fromALFF and fALFF analysis methods.Finally,the results were subjected to multiple regression correction,and the differences in the activation of brain regions between the two groups in the traditional frequency band,slow4 frequency band and slow5 frequency band were observed,and the results were comprehensively compared and analyzed combined with the evaluation results of the cognitive function scale.Results :1.Acupuncture can effectively improve the cognitive function of VaMCI patients.After treatment,the cognitive related scale score of acupuncture treatment group was significantly higher than that of non-acupoint shallow needling group,and the therapeutic effect of acupuncture can exclude the effect of placebo.Acupuncture points have specific effects.2.Evaluation of cognitive scale:(1)Comparison of MoCA score: There was no significant difference in MoCA score between the two groups at 1 month and 2 months of treatment(P>0.05);after 3 months of treatment,the MoCA scores between the two groups were statistically different(P>0.05).Acupuncture treatment group 3 months before treatment(P=0.000),1 month after treatment(P=0.023)compared with the score increased,the difference was statistically significant.There was no significant difference in the comparison among groups(P>0.05).(2)Comparison of MMSE scores: In the comparison between groups,there was no statistically significant difference in MMSE scores between the two groups before treatment(P>0.05),and there was statistically significant difference in MMSE scores after 1 month,2 months and 3 months of treatment(P<0.05).There was no significant difference in MMSE score between the groups before and after treatment(P>0.05).3.Functional magnetic resonance data analysis:(1)Brain regions with mALFF differences before and after treatment in acupuncture group: the mALFF of the left lingual gyrus in the traditional frequency band was significantly decreased;the mALFF of the left lingual gyrus,the anterior part of the left cingulate gyrus,and the left dorsolateral frontal gyrus in the slow4 band was significantly decreased;the mALFF of the left fusiform gyrus,the right middle frontal gyrus,and the right precuneus in the slow5 band was significantly increased;and the mALFF of the left middle occipital gyrus was significantly decreased.(2)Brain regions with mfALFF differences before and after treatment in acupuncture group:mfALFF in the left lingual gyrus of the traditional frequency band was significantly decreased,and mfALFF in the left lentiform putamen,left precentral gyrus and left superior occipital gyrus was significantly increased.The mfALFF of the right dorsolateral superior frontal gyrus decreased significantly in slow4 band,and the mfALFF of the left cerebellum,left inferior temporal gyrus,right inferior frontal gyrus,left precuneus and right cingulate gyrus increased significantly in slow5 band.(3)Brain regions with mALFF differences before and after treatment in non-acupoint group: the mALFF of the left talar fissure in the traditional frequency band was significantly reduced,and the mALFF of the left thalamus was significantly increased.The mALFF of bilateral talus at slow4 band and left paracentral lobule decreased significantly,while the mALFF of right talus at slow5 band increased significantly.(4)Brain regions with mfALFF differences before and after treatment in non-acupoint group: mfALFF in the right lingual gyrus,right cuneus and left paracentral lobule in the traditional frequency band decreased significantly,and mfALFF in the left middle frontal gyrus increased significantly.In the slow4 band,the mfALFF of the right calcarine fissure and the left paracentral lobule decreased significantly,and the mfALFF of the right medial and paracingulate gyrus increased significantly.mfALFF of right precuneus and right caudate nucleus in slow5 band increased significantly.(5)The brain regions with mALFF difference between the two groups after treatment: compared with the non-acupoint shallow needling group,the mALFF of the right middle frontal gyrus in the traditional frequency band was significantly decreased,the mALFF of the right angular gyrus and the right superior occipital gyrus in the slow4 band was significantly decreased,and the mALFF of the anterior part of the left cingulate gyrus was significantly increased.mALFF of right superior frontal gyrus and left inferior parietal lobule in slow5 band was significantly decreased.(6)The brain regions with mfALFF difference between the two groups after treatment: compared with the non-acupoint shallow needling group,the acupuncture treatment group had no difference between the two groups in the traditional frequency band and slow5 band.In the slow4 band,the mfALFF of the right hippocampus,the left parahippocampal gyrus,the anterior part of the left cingulate gyrus and the left superior occipital gyrus increased significantly,while the mfALFF of the right precuneus and the left middle frontal gyrus decreased significantly.4.Correlation analysis:(1)The correlation between the ratio of mALFF and MoCA score in the acupuncture treatment group : the ratio of mALFF in the left lingual gyrus of the traditional frequency band was negatively correlated with the MoCA score at 3 months after treatment(P=0.014),the ratio of mALFF in the left lingual gyrus of the slow4 band was negatively correlated with the MoCA score at 3 months after treatment(P=0.027),and the ratio of mALFF in the right middle frontal gyrus of the slow5 band was negatively correlated with the MoCA score at 3 months after treatment(P=0.017).(2)Correlation between mALFF ratio and MMSE score in the differential brain regions of the acupuncture treatment group:mALFF ratio in the left lingual gyrus of slow4 band was negatively correlated with MMSE score 3 months after treatment(P=0.046),and mALFF ratio in the left fusiform gyrus of slow5 band was positively correlated with MMSE score 3 months after treatment(P=0.043).Conclusion :1.Acupuncture can effectively improve the cognitive function of VaMCI patients.After treatment,the scores of cognitive related scales in the acupuncture treatment group were significantly higher than those in the non-acupoint shallow needling group.The therapeutic effect of acupuncture can exclude the effect of placebo,and acupuncture points have specific effects.2.Acupuncture can change the values ofALFF and fALFF in the traditional,slow4 and slow5 frequency bands of the brain,and the different brain regions are mainly concentrated in DMN and visual network.There is a correlation between ALFF ratio and MoCA or MMSE scores before and after treatment in lingual gyrus,fusiform gyrus and middle frontal gyrus.The specific changes of DMN and visual network before and after acupuncture may reflect the brain function network characteristics of acupuncture effect,and may be one of the neural network regulation mechanisms for acupuncture to improve VaMCI cognitive symptoms.3.Traditional frequency band,slow4 frequency band and slow5 frequency band can reflect the specificity between brain regions to varying degrees,and the frequency effect should be considered in RS-fMRI research. |
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