Theta burst stimulation can relieve dysphagia and cognitive impairment / 中华物理医学与康复杂志

ABSTRACT

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the prefrontal lobe on dysphagia and impaired cognition, and to explore the neural mechanisms involved.Methods:Twenty-eight patients with dysphagia and mild cognitive impairment were randomly divided into an iTBS group of 16 and a control group of 11. The iTBS group received 20 minutes of iTBS (2 seconds on and 8 seconds off) of the right dorsal lateral prefrontal cortex (DLPFC) once daily for 2 weeks, with the intensity at 80% of the resting movement threshold of the right abductor pollicis brevis, while the control group was given sham iTBS. Before and after the treatment, both groups′ cognitive functioning was evaluated using the Montreal Cognitive Assessment Scale (MoCA), a trial marking test, a digit span test and a Stroop color word test. Video-fluoroscopy was used to record oral transmission times (OTTs), hyoid bone anterior displacement and hyoid bone upward displacement during swallowing. Resting-state functional magnetic resonance imaging measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity in the patients′ brains.Results:Before the treatment there was no significant difference in the average indices of cognition or swallowing function between the 2 groups. Afterward the average MoCA score had increased significantly in both groups, with the improvement in the iTBS group significantly greater than that of the controls. Average OTT had shortened significantly in both groups, with significantly greater improvement in the iTBS group. The magnetic resonance imaging showed that after iTBS treatment, local excitation indicators and functional connections in several brain regions had changed. ALFF and ReHo in the right anterior cuneus had increased, ReHo in the left middle temporal gyrus, the orbital region of the left inferior frontal gyrus and the left middle cingulate gyrus had decreased, and functional connectivity in the right DLPFC, the bilateral cuneus and the right middle cingulate gyrus had increased.Conclusions:Two weeks of intermittent TBS of the right DLPFC can improve the swallowing and cognition of persons with dysphagia. Functional reorganization of brain networks may be one of the neural mechanisms involved.