| Objective: To evaluate the therapeutic effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with memory cognitive training on post-stroke cognitive impairment (PSCI), and investigate cerebral perfusion changes using CT perfusion imaging (CTP) and the correlation between CT perfusion parameters and MoCA score and MMSE score. Methods: In this randomized controlled trial, 170 PSCI patients were allocated to either an active intervention group (real HF-rTMS + cognitive training, n=85) or a control group (sham HF-rTMS + cognitive training, n=85). Outcome measures included CTP parameters (cerebral blood flow ［CBF］, blood volume ［CBV］, mean transit time ［MTT］, peak time ［TTP］), ERP-P300 components, and standardized neuropsychological assessments (Stroop test, RBMT-II, MoCA, MMSE) at baseline and 6-week follow-up. Correlation analyses assessed relationships between hemodynamic parameters and cognitive outcomes. Results: After treatment, CBF and CBV in the two groups were increased when compared with those before treatment, and MTT and TTP were shortened when compared with those before treatment (P<0.05，0.01), and the above parameters in the observation group were improved more significantly than those in the control group (P<0.05). After treatme-nt, the latency of ERP-P300 in the two groups was decreased when compared with that before treatment, and the amplitude was increased (P<0.05，0.01). The latency of ERP-P300 in the observation group was lower than that in the control group, and the amplitude was higher than that in the control group (P<0.05，0.01). After treatment, the Stroop task test accuracy and RBMT-II score of the two groups were improved, and the Stroop task test time was shortened (P<0.01). After treatment, the Stroop task test accuracy was higher, the time was shorter, and the RBMT-II score was greater in the observation group than those in the control group (P<0.01). After treatment, the MoCA score and MMSE score in the two groups were increased when compared with those before treatment (P<0.01), and the MoCA score and MMSE score in the observation group were higher than those in the control group (P<0.01). CBF and CBV in CTP parameters were positively correlated with MoCA score and MMSE score (r=0.176, 0.170, 0.470, 0.395, P<0.05), and MTT was negatively correlated with MoCA score and MMSE score (r=-0.192, -0.235, P<0.05). There was no significant correlation between TTP in CTP parameters and MoCA score and MMSE score. Conclusion: The HF-rTMS combined with cognitive training protocol significantly enhances cognitive recovery in PSCI patients, potentially mediated through optimized cerebral perfusion. CTP parameters demonstrate predictive value for cognitive outcomes, with CBF/CBV and MTT serving as potential neuroimaging biomarkers. |
