Using Dual-Target rTMS, Single-Target rTMS, or Sham rTMS on Post-Stroke Cognitive Impairment.

The clinical application of 10 Hz repetitive transcranil magnetic stimulation (rTMS) remains limited despite its demonstrated effectiveness in enhancing cortical excitability and improving cognitive function. The present study used a novel stimulus target [left dorsolateral prefrontal cortex + primary motor cortex] to facilitate the enhancement of cognitive function through the bidirectional promotion of cognitive and motor functions; Methods: Post-stroke cognitive impairment patients (n = 48) were randomly assigned to receive either dual-target, single-target, or sham rTMS for 4 weeks. Before and after 4 weeks of treatment, participants were asked to complete the Montreal Cognitive Assessment (MoCA) test, the Modified Barthel Index (MBI), the Trail-making Test (TMT), and the Digital Span Test (DST). In addition, the levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in serum were also measured. After adjusting for pre-intervention (baseline) MoCA scores, the post-intervention MoCA scores varied significantly. After post-hoc analysis, differences existed between the post-treatment scores of the dual-target rTMS group and the sham rTMS group (the experimental group scores were significantly higher), and between those of the dual-target rTMS group and the single-target rTMS group (the dual-target rTMS scores were significantly higher). The serum VEGF levels of the dual-target rTMS group were significantly higher those that of the sham rTMS group. The present study presented data showing that a dual-target rTMS therapy is effective for Post-stroke cognitive impairment (PSCI). 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. No: ChiCTR220066184. Registered 26 November, 2022, https://www.chictr.org.cn.

Xu B ，Lin C ，Wang Y ，Wang H ，Liu Y ，Wang X ... -  《Journal of Integrative Neuroscience》

Repetitive Transcranial Magnetic Stimulation and Tai Chi Chuan for Older Adults With Sleep Disorders and Mild Cognitive Impairment: A Randomized Clinical Trial.

Liu Z ，Zhang L ，Bai L ，Guo Z ，Gao J ，Lin Y ，Zhou Y ，Lai J ，Tao J ，Chen L ... -  《JAMA Network Open》

Perturbational complexity index in assessing responsiveness to rTMS treatment in patients with disorders of consciousness: a cross-over randomized controlled trial study.

Xu C ，Yuan Z ，Chen Z ，Liao Z ，Li S ，Feng Y ，Tang Z ，Nian J ，Huang X ，Zhong H ，Xie Q ... -  《Journal of NeuroEngineering and Rehabilitation》

Effect of tDCS combined with virtual reality for post-stroke cognitive impairment: a randomized controlled trial study protocol.

Post-stroke cognitive impairment (PSCI) not only increases patient mortality and disability, but also adversely affects motor function and the ability to perform routine daily activities. Current therapeutic approaches for, PSCI lack specificity, primarily relying on and medication and traditional cognitive therapy supplemented by a limited array of tools. Both transcranial direct current stimulation (tDCS) and virtual reality (VR) training have demonstrated efficacy in improving cognitive performance among PSCI patients. Previous findings across various conditions suggest that implementing a therapeutic protocol combining tDCS and VR (tDCS - VR) may yield superior in isolation. Despite this, to our knowledge, no clinical investigation combining tDCS and VR for PSCI rehabilitation has been conducted. Thus, the purpose of this study is to explore the effects of tDCS - VR on PSCI rehabilitation. This 4-week, single-center randomized clinical trial protocol will recruit 200 patients who were randomly assigned to one of four groups: Group A (tDCS + VR), Group B (tDCS + sham VR), Group C (sham tDCS + VR), Group D (sham tDCS + sham VR). All four groups will receive conventional cognitive rehabilitation training. The primary outcome measurement utilizes the Mini-Mental State Examination (MMSE). Secondary outcome measures include the Montreal Cognitive Assessment, Frontal Assessment Battery, Clock Drawing Test, Digital Span Test, Logic Memory Test, and Modified Barthel Index. Additionally, S-YYZ-01 apparatus for diagnosis and treating language disorders assesses subjects' speech function. Pre- and post-four-week intervention assessments are conducted for all outcome measures. Functional near-infrared spectroscopy (fNIRS) is employed to observe changes in oxygenated hemoglobin (HbO), deoxy-hemoglobin (HbR), and total hemoglobin (HbT) in the cerebral cortex. Our hypothesis posits that the tDCS - VR therapy, in opposed to individual tDCS or VR interventions, could enhance cognitive function, speech ability and daily living skills in PSCI patients while concurrently augmenting frontal cortical activity. This randomized study aims to provide a robust theoretical foundation supported by scientific evidence for the practical implementation of the tDCS - VR combination as a secure and efficient PSCI rehabilitation approach. Chictr.org.cn Identifier: ChiCTR2300070580. Registered on 17th April 2023.

Cheng XP ，Wang ZD ，Zhou YZ ，Zhan LQ ，Wu D ，Xie LL ，Luo KL ，He JP ，Lin W ，Ni J ，Lv L ，Chen XY ... -  《BMC Complementary Medicine and Therapies》

Effects of intermittent theta burst stimulation on cognitive and swallowing function in patients with MCI and dysphagia risk: a randomized controlled trial.

Mild cognitive impairment (MCI) is a high-risk factor for dementia and dysphagia; therefore, early intervention is vital. The effectiveness of intermittent theta burst stimulation (iTBS) targeting the right dorsal lateral prefrontal cortex (rDLPFC) remains unclear. Thirty-six participants with MCI were randomly allocated to receive real (n = 18) or sham (n = 18) iTBS. Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and executive function was evaluated with the Trail Making Test (TMT), Digital span test (DST) and Stroop color word test (SCWT). Quantitative swallowing measurements were obtained using temporal and kinetic parameters based on the videofluoroscopic swallowing study (VFSS). Resting-state functional magnetic imaging (fMRI) was performed to observe brain plasticity, functional connectivity (FC) values were calculated. All assessments were completed at baseline and two weeks after treatment. Participants received 10 sessions of daily robotic navigated iTBS. The MoCA score and the SCWT duration of the real group improved significantly compared with that of the sham group. Temporal parameters of VFSS included 5-ml oral transit time (OTT), 5-ml soft palate elevation time (SET) and 10-ml OTT showed a decreasing trend. However, there was significant improvement in 10-ml OTT when choosing patients with OTT exceeding 1000 ms. FC value between the left middle frontal gyrus and the rDLPFC increased significantly in real stimulation group (p < 0.05 with false discovery rate corrected). We found that baseline FC scores were negatively correlated with the SCWT task duration (r = -0.554, p = 0.017) and with the 10-ml OTT (rho = -0.442, p = 0.027) across all participants. Among those in the iTBS group with a pre-10-ml OTT greater than 1000 ms, we observed a positive correlation between changes in MoCA scores and changes in FC values (r = 0.789, p = 0.035). Furthermore, changes in MoCA scores were positively correlated with changes in 10-ml OTT (r = 0.648, p = 0.031), as determined by Pearson analysis. Navigated iTBS over the rDLPFC has the potential to improve global cognition, response inhibition ability, and certain aspects of swallowing function for patients with MCI at high risk for dysphagia. Changes in FC between right and left DLPFC may underlie the neural mechanisms responsible for the effectiveness of iTBS targeting the right DLPFC.

Wang J ，Zhang M ，Wei X ，Yang C ，Dai M ，Dou Z ，Wang Y ... -  《BMC Geriatrics》