This study used a novel stimulus target (left dorsolateral prefrontal cortex + primary motor cortex)to facilitate the enhancement of cognitive and motor function in person with PSCI through the bidirectional promotion.
48 PSCI participants were randomly allocated into one of the three groups: ①The dual-target stimulation group received rTMS stimulation at 10 Hz on the affected lateral motor cortex (M1) and the dorsolateral left prefrontal lobe (DLPFC); ②The single-target stimulation group performed 10Hz sham stimulation in the affected M1 and 10 Hz true stimulation in the DLPFC; ③ The sham stimulation group underwent 10 Hz sham stimulation on the affected M1 and DLPFC. All participants received conventional rehabilitation and 20 sessions of rTMS. Before and after 4 weeks of treatment, the participants were asked to complete the Montreal Cognitive Assessment (MoCA) test, Fugl-Meyer Motor Function Assessment (FMA), the Modified Barthel Index (MBI), Berg Balance function Assessment (BBS), and Cortical Excitability. In addition, the levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in serum were also measured.
Cognitive function: MoCA score improved significantly in all three groups compared to before treatment (P 0.001); MoCA score was different among the three groups after treatment (F=4.645, P 0.05), and the dual-target treatment group was significantly higher than The other two groups. Motor function: FMA, MBI, and BBS improved significantly after treatment in all three groups. FMA score to differ between the three groups (F=3.635, P=0.034), The dual-target stimulation group and the sham stimulation group were significantly different (P=0.010); The three groups differ significantly after FMA-LL score treatment (F=9.353, P=0.000), And the dual-target stimulation group was significantly higher than the single-target stimulation group (P=0.034); The three groups differ significantly after BBS score treatment (F=9.059, P=0.000), And the dual-target stimulation group was significantly higher than the single-target stimulation group (P=0.041), There was no significant difference between the three groups after MBI and FMA-UE scores (P>0.05).Cortical Excitability: RMT, MEP latency and amplitude improved significantly after the three groups; RMT, MEP latency and amplitude were significantly different after treatment (P 0.05). The dual-target stimulation group was better than the single-target group (P 0.05).Levels of BDNF and VEGF: After treatment, BDNF and VEGF levels improved significantly in the dual-target group, and BDNF levels in the single-target group; VEGF levels were significantly different between the dual-target group and the sham group(P 0.05).
Dual-target rTMS improvement in cognitive and motor function in PSCI participants is more significant than single-target stimulation, especially in lower limb motor function.
The stimulation exhibited remarkable efficacy, suggesting that dual-target stimulation (left dorsolateral prefrontal cortex+motor cortex (L-DLPFC+M1) holds promise as a potential target for TMS therapy in individuals with cognitive impairment after stroke.
rTMS
Motor function
