谢晓明,韩会建,刘宏亮,等.经颅直流电刺激治疗脑卒中后认知功能障碍的静息态功能性磁共振研究[J].中华物理医学与康复杂志,2020,42(5):392-396
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| 经颅直流电刺激治疗脑卒中后认知功能障碍的静息态功能性磁共振研究 |
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| DOI：10.3760/cma.j.issn.0254-1424.2020.05.002 |
| 中文关键词: 经颅直流电刺激 脑卒中后认知功能障碍 静息态功能磁共振 默认网络 |
| 英文关键词: Transcranial direct current stimulation Stroke Cognitive |
| 基金项目:国家重点研发计划课题（2017YFC1308503） |
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| 中文摘要: |
| 目的 利用静息态功能性磁共振（rs-fMRI）技术，观察脑卒中后认知功能障碍（PSCI）患者在经颅直流电刺激(tDCS)治疗前和治疗4周后脑部默认网络（DMN）的重塑情况，探讨tDCS改善PSCI患者认知功能的中枢机制。 方法 本研究选取PSCI患者18例（PSCI组）和健康受试者20例（健康对照组）。采用tDCS刺激PSCI组患者的背外侧前额叶，刺激强度2.0 mA，每次20 min，每日1此，每周5 d，共4周。治疗前及治疗4周后（治疗后），运用rs-fMRI观察PSCI患者DMN的改变情况，采用蒙特利尔认知评估量表（MoCA）评价患者的认知功能。 结果 PSCI患者DMN明显异常，主要表现为后扣带回/楔前叶功能连接降低，左侧海马和内侧前额叶的功能连接增高。经4周tDCS治疗，患者的MoCA评分［（24.1±2.5）分］显著升高，DMN中后扣带回/楔前叶功能连接明显增加，左侧海马功能连接较治疗前降低。相关性分析显示，PSCI患者后扣带回/楔前叶功能连接程度与MoCA评分呈正相关。 结论 PSCI患者存在大脑DMN异常，tDCS刺激背外侧前额叶能够明显改善PSCI患者的MoCA评分，其机制可能与提高大脑DMN中后扣带回/楔前叶的功能连接程度有关。 |
| 英文摘要: |
| Objective To observe the functional remodeling of the default mode network (DMN) of patients with post-stroke cognitive impairment (PSCI) in response to transcranial direct current stimulation (tDCS) and to explore the mechanisms involved. Methods Eighteen PSCI patients and twenty healthy controls were enrolled. The PSCI patients were given 20 minutes of tDCS at 2.0mA on the dorsolateral prefrontal cortex every weekday for four weeks. The subjects were scanned using resting state functional magnetic resonance imaging before and after the intervention to explore any functional changes in the DMN. Montreal cognitive assessment (MoCA) scoring was performed before and after the treatment. Results Compared to the healthy controls, the cognitively impaired patients showed significant abnormalities in the DMN on admission, including decreased functinal connection (FC) in the posterior cingulate cortex and/or precuneus (PCC/PCu), as well as increased FC in the medial prefrontal cortex (MPFC) and left hippocampus. After the treatment, a significant improvement in the PSCI patients′ average MoCA score was observed. The average FC of the PCC/PCu had also increased significantly, while that of the left hippocampus had decreased significantly, on average. The FC in the PCC/PCu after tDCS was found to be positively related to the MoCA score measured at 4 weeks after admission. Conclusions PSCI patients show functional abnormalities in the DMN. tDCS applied to their dorsolateral prefrontal cortex can significantly improve their average MoCA scores, which may be related to the increasing FC of the PCC/PCu. |
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