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Objective To explore the curative effects of repetitive transcranial magnetic stimulation ( rTMS) therapy on subcortical ischemic vascular disease( SIVD) patients with mild cognitive impairment.Methods Sixty-one SIVD patients with mild cognitive impairment but did not meet the diagnostic criteria for vascular dementia were enrolled and randomly divided into the treatment group (n=31) and the control group (n=30) in accordance with international common randomization form,TMT-A、TMT-B、VFT、AVLT score and P300 latency and amplitude changes were compared between the two groups before and after treatment.Results TMT-A、TMT-B、VFT、AVLT showed no difference before treatment between the two groups, but improved significantly after treatment in the treatment group ( P=0.040;P=0.041;P=0.034;P=0.010 ) .the results were also significantly different from the control group after treatment( P=0.019;P=0.009;P=0.044;P=0.045 ) .In the treatment group, P300 latency after treatment was significantly reduced than that before treatment (P=0.045),which was also significantly reduced from the control group ( P=0.025 ) , but P300 amplitude did not reach statistically significant difference before and after treatment in the treatment group.In the control group, P300 latency and amplitude did not reach statistically significant difference before and after treatment.Conclusion TMS therapy can improve cognitive function in SIVD with mild cognitive impairment.
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Objective To explore the pattern of cognitive impairments mainly caused by the white matter lesions(WML) in the frontal lobe in patients with subcortical ischemic vascular disease (SIVD).Methods Fifty SIVD patients were divided into severe WML group (visual score >3, n=27) and mild WML group(visual score ≤3, n=23) according to their severities of the WML in frontal lobe .Seven patients without SIVD were collected as controls .All patients underwent a set of neuropsychological battery ,and the results were analyzed .Results There was no statistical significance among three groups on basic data .Compared with mild WML group and control group , non frontal white matter scores and numbers of lacunes in frontal lobe of severe WML group were significantly higher ( all P=0.000).Compared with mild WML group,the Montreal cognitive assessment scale in severe WML group were significantly lower ( P=0.047 ) , and scores related to the executive function were significantly lower ( P=0.006 ) , even after adjusting the numbers of lacunes in frontal lobe ,there was statistically significant difference (P=0.038). Multiple regression confirmed that the Z scores of executive functions were mainly affected by white matter lesions located in the frontal lobe ( P=0.000 ) .Conclusion WML located in the frontal lobe mainly affect the executive function in patients with SIVD .
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Objective To assess regional cerebrovascular reactivity (CVR) and cognition impairment of subcortical ischemic vascular disease (SIVD). To show whether CVR affects cognitive impairment of SIVD patients. Methods Arterial spin-labeling (ASL) by MR image was applied in measuring regional cerebral blood flow (rCBF) of frontal lobe, temporal lobe, parietal lobe, occipital lobes after 5% CO2 inhalation, and the CVR was demonstrated by increase rate of rCBF in all the subject areas. Results (1)The patients with SIVD had reduced CVR in cortex of frontal lobes, white matter of frontal lobes, temporal lobes and occipital lobes(P < 0.05). (2) CVR in the SIVD patients with cognitive impairment decreased in frontal cortex and white matter when compared with the patients without cognitive impairment(P < 0.01). Conclusion These results showed that CVR decreased significantly in cortical gray matter and white matter in elderly patients with SIVD. Also the reduction of CVR in the frontal cortex and white matter was associated with cognitive impairment.
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Objective To investigate the lesionsin theleft thalamus and to explore their correlation with executive functionin patients with subcortical ischemic vascular disease(SIVD)by using 1H magnetic resonance spectroscopy (1H-MRS) and diffusion tensor imaging (DTI). Methods Fourteen patients with vascular dementia (VaD), 14 patients with vas-cular cognitive impairment without dementia(VCIND)and 14 normal controls (NC) were recruited. The quantitative analy-sis of N-acetylaspartate (NAA), Choline (Cho), myoinositol (MI) and Creatine (Cr) resonance signals in region of interests (ROI) in the left thalamus were measured. Fractional anisotropy (FA) and mean diffusivity (MD) values in the same region were examined by using DTI. The relationship were analyzedamong the MRS, DTI ratios and cognitive impairment reflect-ed in MMSE and trail making test(TMT). Results The NAA/Cr ratio showed a gradual decrease in the left thalamus of VaD andVCIND patients compared with controls(F=3.656, P=0.038). There was no significant difference in NAA/Cr ra- tiobetween VaD and VCIND patients.Compared with controls, patients with VaD and VCIND demonstrated increased MD value in the left thalamus(F=3.882, P=0.030).There was no significant difference in MD value between VaD and VCIND patients (P>0.05). There were no correlations between NAA/Cr, MI/Cr, Cho/Cr value and DTI parameters in the ROI (P>0.05). TMTb time was positively associated with Cho/Cr(r=0.520,P=0.001 ) and with MD value in the left thalamus (r=0.305, P=0.044). Conclusions Combination of 1H-MRS with DTI can provide the valuable informationon the potential lesions in the thalamus in patients with SIVD. The Cho/Cr and MD values in the leftthalamus may be correlated with ex-ecutive function.