Effect and Neuroimaging Mechanism of Scalp Acupuncture Combined with rTMS on Post-Stroke Cognitive Impairment based on the Resting-state Fraction Amplitude of Low Frequency Fluctuation
Objective To explore the effect of scalp acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)on global cognitive function in patients with post-stroke cognitive impairment(PSCI).To explore the resting-state neuroimaging mechanism of scalp acupuncture combined with rTMS in improving cognitive function in patients with PSCI using fraction amplitude of low frequency fluctuation(fALFF).Methods PSCI patients were randomly assigned to scalp acupuncture group and scalp acupuncture combined with rTMS group(the combined group).Both groups were given conventional rehabilitative training.The scalp acupuncture group selected the affected-side anterior oblique parietotemporal line(MS6).Low frequency(1Hz)rTMS over primary motor cortex(M1)of the unaffected-side in the combined group.The duration was once a day for 20 min,6 sessions one week,in total of 12 sessions for consecutive two weeks.Comparing the total and subtests of the Montreal Cognitive Assessment Scale(MoCA)before and after treatment.At the same time,the statistical method of Difference-in-Difference(DID)was used to analyze the trend of each observational index.The fALFF was used to detect the changes of spontaneous neurological activity in local brain areas and partial correlation analysis was performed with statistical differences cognitive behavioral indicators and significant fALFF values.Results A total of 47 subjects entered the final statistical analyses,including 25 subjects in the scalp acupuncture group and 22 subjects in the combined group.Compared with scalp acupuncture group,there were no significant differences in the global cognitive function in the combined group(P=0.914＞0.05).However,the MoCA subscore-delayed memory task score was significantly improved in the combined group(P=0.035＜0.05).At the same time,the trend analysis also showed that the improvement effect in the combined group was significantly better than those in the scalp acupuncture group(DID=0.80,t=2.20,P=0.033＜0.05).After two weeks of intervention,compared with the baseline fALFF value,the increase of left precuneus,right cerebelum,left fusiform gyrus,left superior parietal gyrus in the combined group were significantly decreased than those of scalp acupuncture group.(GRF corrected,voxel P＜0.01,cluster P＜0.05).The results of partial correlation analysis showed that the fALFF difference of left fusiform gyrus was positively correlated with the difference of subscore-delayed memory in combined group(r=0.719,P＜0.05).Other correlation analyses were not statistically significant(P＞0.05).Conclusion Scalp acupuncture combined with rTMS intervention have definite efficacy in delayed memory.The underpinning neuroimaging mechanism may be related to local neurological spontaneous activity in brain regions involving in cognitive processing such as left fusiform gyrus.
StrokeCognitive impairmentScalp acupunctureRepetitive transcranial magnetic stimulationFraction amplitude of low frequency fluctuation
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