Effect of repetitive transcranial magnetic stimulation combined with virtual reality technology on post-stroke cognitive impairment

doi:10.3877/cma.j.issn.2095-123X.2023.06.005

Abstract

Abstract:

Objective

To observe the effect of repetitive transcranial magnetic stimulation (rTMS) combined with virtual reality (VR) technology on cognitive impairment after stroke.

Methods

One hundred and fifty-three PSCI patients admitted to the Rehabilitation Medicine Department of China MCC5 Group Corp. Ltd. Hospital from April 2021 to August 2022 were selected as the research subjects. They were divided into a combination group, rTMS group, and control group using a random number table method. According to the inclusion and exclusion criteria, 49 cases were obtained in the combination group, 48 cases in the rTMS group, and 48 cases in the control group. The control group received routine cognitive rehabilitation training and false magnetic stimulation, the rTMS group switched to real rTMS stimulation on top of the control group, while the combination group added VR technology on top of the rTMS group. All three groups were intervened for 8 weeks. Before and after 8 weeks of treatment, the Montreal cognitive assessment scale (MoCA), Stroop color word test (SCWT), and National Institutes of Health stroke scale (NIHSS) were observed in three groups of patients, and the levels of hypersensitive C-reactive protein (hs-CRP), brain derived neurotrophic factor (BDNF), serum neuron specific enolase (NSE), homocysteine (HCY), and superoxide dismutase (SOD) were measured.

Results

The MoCA score and SCWT results of the combination group were higher than those of the rTMS group and the control group, while the NIHSS score was lower than that of the control group, and the difference was statistically significant (P<0.05). The BDNF level in the combination group was higher than that in the rTMS group and control group, while the NSE and HCY levels were lower than those in the rTMS group and control group, the hs-CRP level was lower than that in the control group, and the SOD level was higher than that in the control group, with statistical significance (P<0.05).

Conclusion

rTMS combined with VR technology can improve cognitive impairment, promote neural function recovery, and improve related biochemical indicators in PSCI patients.

Key words: Post-stroke cognitive impairment, Repetitive transcranial magnetic stimulation, Virtual reality technology

Liangfei Ma, Ling Yin, Ting Fang, Xixi Zeng, Jiaxuan Tong, Xiankun Ma. Effect of repetitive transcranial magnetic stimulation combined with virtual reality technology on post-stroke cognitive impairment[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(06): 346-351.

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References 21

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组别	例数	年龄（岁，Mean±SD）	性别（男/女）	病程（d，Mean±SD）	卒中性质（出血/缺血）	卒中位置（左/右）	教育年限（年，Mean±SD）
联用组	49	75.14±3.36	28/21	70.83±6.06	12/37	25/24	6.76±0.74
rTMS组	48	74.47±4.04	28/20	68.98±6.17	11/37	23/25	6.76±0.81
对照组	48	73.93±4.38	27/21	70.06±5.57	10/38	24/24	6.83±0.62
F/χ²值		0.815	0.043	1.091	0.185	0.086	0.650
P值		0.255	0.979	0.103	0.911	0.951	0.394

组别	例数	年龄（岁，Mean±SD）	性别（男/女）	病程（d，Mean±SD）	卒中性质（出血/缺血）	卒中位置（左/右）	教育年限（年，Mean±SD）
联用组	49	75.14±3.36	28/21	70.83±6.06	12/37	25/24	6.76±0.74
rTMS组	48	74.47±4.04	28/20	68.98±6.17	11/37	23/25	6.76±0.81
对照组	48	73.93±4.38	27/21	70.06±5.57	10/38	24/24	6.83±0.62
F/χ²值		0.815	0.043	1.091	0.185	0.086	0.650
P值		0.255	0.979	0.103	0.911	0.951	0.394

组别	例数	时间	MoCA（分）	SCWT（个）	NIHSS（分）
对照组	48	治疗前	19.75±2.14	49.62±3.02	18.07±1.66
		治疗8周后	20.05±2.09	53.21±3.18	15.36±1.36
		t值	1.195	4.066	5.169
		P值	0.093	0.021	0.002
rTMS组	48	治疗前	19.88±1.39	50.07±3.09	17.62±1.21
		治疗8周后	21.87±1.93^a	56.35±3.83^a	11.20±1.35^a
		t值	3.681	5.718	6.850
		P值	0.028	0.001	0.001
联用组	49	治疗前	19.92±1.50	48.93±3.17	18.53±1.28
		治疗8周后	23.95±1.63^ab	59.22±2.33^ab	10.93±1.29^a
		t值	5.691	6.922	7.207
		P值	0.001	0.001	0.001

组别	例数	时间	MoCA（分）	SCWT（个）	NIHSS（分）
对照组	48	治疗前	19.75±2.14	49.62±3.02	18.07±1.66
		治疗8周后	20.05±2.09	53.21±3.18	15.36±1.36
		t值	1.195	4.066	5.169
		P值	0.093	0.021	0.002
rTMS组	48	治疗前	19.88±1.39	50.07±3.09	17.62±1.21
		治疗8周后	21.87±1.93^a	56.35±3.83^a	11.20±1.35^a
		t值	3.681	5.718	6.850
		P值	0.028	0.001	0.001
联用组	49	治疗前	19.92±1.50	48.93±3.17	18.53±1.28
		治疗8周后	23.95±1.63^ab	59.22±2.33^ab	10.93±1.29^a
		t值	5.691	6.922	7.207
		P值	0.001	0.001	0.001

组别	例数	时间	hs-CRP（mg/L）	BDNF（ng/mL）	NSE（μg/L）	HCY（μmol/L）	SOD（U/mL）
对照组	48	治疗前	8.59±0.92	6.70±0.68	21.81±1.96	17.15±2.14	84.89±5.36
		治疗后	6.50±0.81	7.51±0.66	18.05±1.81	13.36±1.89	92.95±6.89
		t值	4.537	3.811	3.084	4.692	6.328
		P值	0.015	0.023	0.035	0.013	0.001
rTMS组	48	治疗前	8.76±1.01	6.73±0.72	21.48±1.98	16.73±1.99	85.15±6.50
		治疗8周后	5.19±0.38^a	8.46±0.62^a	15.42±1.70^a	10.92±1.31^a	94.81±6.09^a
		t值	5.174	4.405	5.670	6.287	6.551
		P值	0.002	0.016	0.001	0.001	0.001
联用组	49	治疗前	8.72±0.70	6.68±0.71	21.40±2.38	16.49±2.60	84.60±6.72
		治疗8周后	5.14±0.36^a	10.61±0.73^ab	13.39±2.14^ab	8.42±1.05^ab	96.36±6.13^a
		t值	5.180	5.971	7.591	8.640	7.541
		P值	0.002	0.001	0.001	0.001	0.001

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