{"title":"通过高频神经刺激推进脑卒中后认知康复：皮质兴奋性和生物标志物调节的回顾性评估。","authors":"Ke Wang, Lin Wang","doi":"10.1177/09287329251330722","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Post-stroke cognitive impairment (PSCI) poses significant challenges to patient independence, yet technological interventions like high-frequency repetitive transcranial magnetic stimulation (rTMS) remain underexplored in clinical neurorehabilitation.</p><p><strong>Objective: </strong>This study evaluates the integration of high-frequency rTMS into standard care, focusing on its technological efficacy in modulating neuroplasticity and serum biomarkers to enhance cognitive and functional recovery.</p><p><strong>Methods: </strong>A retrospective analysis of 80 PSCI patients (2021-2023) compared outcomes between a conventional care group (n = 30) and an rTMS group (n = 50) receiving 20 Hz stimulation (YRD-CCY-I device) targeting the dorsolateral prefrontal cortex. Key metrics included Montreal Cognitive Assessment (MoCA), Barthel Index (BI), cortical silent period (CL), central motor conduction time (CMCT), and serum neurotrophic factors (BDNF, VEGF, IGF-1).</p><p><strong>Results: </strong>Post-intervention, the rTMS group demonstrated superior MoCA scores (19.25 vs. 15.24, p = 0.001), BI (76.36 vs. 70.13, p = 0.001), and IADL (20.38 vs. 18.13, p = 0.001) compared to controls. Neurophysiological markers revealed prolonged CL (25.30 vs. 24.02 ms, p = 0.001) and shortened CMCT (12.05 vs. 12.98 ms, p = 0.001), alongside elevated BDNF (9.56 vs. 7.34 ng/mL), VEGF (156.48 vs. 110.54 pg/mL), and IGF-1 (153.74 vs. 112.90 ng/mL, p = 0.001). Overall efficacy was 94% for rTMS versus 73.33% for conventional care (p = 0.047).</p><p><strong>Conclusion: </strong>High-frequency rTMS, as a targeted neurostimulation technology, enhances cognitive recovery and cortical adaptability in PSCI by modulating neuroplasticity and upregulating neurotrophic biomarkers. These findings underscore its potential as a scalable adjunct in technology-driven neurorehabilitation programs.</p>","PeriodicalId":48978,"journal":{"name":"Technology and Health Care","volume":" ","pages":"2211-2219"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Advancing post-stroke cognitive rehabilitation through high-frequency neurostimulation: A retrospective evaluation of cortical excitability and biomarker modulation.\",\"authors\":\"Ke Wang, Lin Wang\",\"doi\":\"10.1177/09287329251330722\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Post-stroke cognitive impairment (PSCI) poses significant challenges to patient independence, yet technological interventions like high-frequency repetitive transcranial magnetic stimulation (rTMS) remain underexplored in clinical neurorehabilitation.</p><p><strong>Objective: </strong>This study evaluates the integration of high-frequency rTMS into standard care, focusing on its technological efficacy in modulating neuroplasticity and serum biomarkers to enhance cognitive and functional recovery.</p><p><strong>Methods: </strong>A retrospective analysis of 80 PSCI patients (2021-2023) compared outcomes between a conventional care group (n = 30) and an rTMS group (n = 50) receiving 20 Hz stimulation (YRD-CCY-I device) targeting the dorsolateral prefrontal cortex. Key metrics included Montreal Cognitive Assessment (MoCA), Barthel Index (BI), cortical silent period (CL), central motor conduction time (CMCT), and serum neurotrophic factors (BDNF, VEGF, IGF-1).</p><p><strong>Results: </strong>Post-intervention, the rTMS group demonstrated superior MoCA scores (19.25 vs. 15.24, p = 0.001), BI (76.36 vs. 70.13, p = 0.001), and IADL (20.38 vs. 18.13, p = 0.001) compared to controls. Neurophysiological markers revealed prolonged CL (25.30 vs. 24.02 ms, p = 0.001) and shortened CMCT (12.05 vs. 12.98 ms, p = 0.001), alongside elevated BDNF (9.56 vs. 7.34 ng/mL), VEGF (156.48 vs. 110.54 pg/mL), and IGF-1 (153.74 vs. 112.90 ng/mL, p = 0.001). Overall efficacy was 94% for rTMS versus 73.33% for conventional care (p = 0.047).</p><p><strong>Conclusion: </strong>High-frequency rTMS, as a targeted neurostimulation technology, enhances cognitive recovery and cortical adaptability in PSCI by modulating neuroplasticity and upregulating neurotrophic biomarkers. 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引用次数: 0
摘要
脑卒中后认知障碍（PSCI）对患者的独立性提出了重大挑战，然而高频重复经颅磁刺激（rTMS）等技术干预在临床神经康复中仍未得到充分探索。目的本研究评估高频rTMS与标准治疗的整合，重点关注其在调节神经可塑性和血清生物标志物以促进认知和功能恢复方面的技术功效。方法回顾性分析80例PSCI患者（2021-2023），比较常规护理组（n = 30）和rTMS组（n = 50）接受针对背外侧前额皮质的20hz刺激（YRD-CCY-I装置）的结果。主要指标包括蒙特利尔认知评估（MoCA）、Barthel指数（BI）、皮质沉默期（CL）、中枢运动传导时间（CMCT）和血清神经营养因子（BDNF、VEGF、IGF-1）。结果干预后，rTMS组MoCA评分（19.25比15.24,p = 0.001）、BI评分（76.36比70.13,p = 0.001）、IADL评分（20.38比18.13,p = 0.001）均优于对照组。神经生理指标显示CL延长（25.30 vs. 24.02 ms, p = 0.001）， CMCT缩短（12.05 vs. 12.98 ms, p = 0.001）， BDNF （9.56 vs. 7.34 ng/mL）、VEGF （156.48 vs. 110.54 pg/mL）和IGF-1 （153.74 vs. 112.90 ng/mL, p = 0.001）升高。rTMS的总有效率为94%，而常规治疗为73.33% （p = 0.047）。结论高频rTMS作为一种靶向神经刺激技术，通过调节神经可塑性和上调神经营养生物标志物，促进PSCI患者的认知恢复和皮层适应性。这些发现强调了它在技术驱动的神经康复项目中作为可扩展辅助手段的潜力。
Advancing post-stroke cognitive rehabilitation through high-frequency neurostimulation: A retrospective evaluation of cortical excitability and biomarker modulation.
Background: Post-stroke cognitive impairment (PSCI) poses significant challenges to patient independence, yet technological interventions like high-frequency repetitive transcranial magnetic stimulation (rTMS) remain underexplored in clinical neurorehabilitation.
Objective: This study evaluates the integration of high-frequency rTMS into standard care, focusing on its technological efficacy in modulating neuroplasticity and serum biomarkers to enhance cognitive and functional recovery.
Methods: A retrospective analysis of 80 PSCI patients (2021-2023) compared outcomes between a conventional care group (n = 30) and an rTMS group (n = 50) receiving 20 Hz stimulation (YRD-CCY-I device) targeting the dorsolateral prefrontal cortex. Key metrics included Montreal Cognitive Assessment (MoCA), Barthel Index (BI), cortical silent period (CL), central motor conduction time (CMCT), and serum neurotrophic factors (BDNF, VEGF, IGF-1).
Results: Post-intervention, the rTMS group demonstrated superior MoCA scores (19.25 vs. 15.24, p = 0.001), BI (76.36 vs. 70.13, p = 0.001), and IADL (20.38 vs. 18.13, p = 0.001) compared to controls. Neurophysiological markers revealed prolonged CL (25.30 vs. 24.02 ms, p = 0.001) and shortened CMCT (12.05 vs. 12.98 ms, p = 0.001), alongside elevated BDNF (9.56 vs. 7.34 ng/mL), VEGF (156.48 vs. 110.54 pg/mL), and IGF-1 (153.74 vs. 112.90 ng/mL, p = 0.001). Overall efficacy was 94% for rTMS versus 73.33% for conventional care (p = 0.047).
Conclusion: High-frequency rTMS, as a targeted neurostimulation technology, enhances cognitive recovery and cortical adaptability in PSCI by modulating neuroplasticity and upregulating neurotrophic biomarkers. These findings underscore its potential as a scalable adjunct in technology-driven neurorehabilitation programs.
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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured. The main focus of THC is related to the overlapping areas of engineering and medicine. The following types of contributions are considered:
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