Objective:To investigate the effect of repetitive transcranial magnetic stimulation combined with cognitive function training on improving cognitive and psychological and behavioral symptoms in patients with vascular dementia.Methods:A total of 80 patients with vascular dementia who received treatment at The Third People's Hospital of Huzhou from October 2020 to October 2022 were included in this study. They were divided into a control group and an observation group ( n = 40 per group) based on different treatment methods. The control group received repetitive transcranial magnetic stimulation, while the observation group received both repetitive transcranial magnetic stimulation and cognitive function training. Both groups were treated continuously for 4 weeks. The scores of The Mini-Mental State Examination (MMSE), the Behavioral Pathology in Alzheimer's Disease Rating Scale (BE-HAVE-AD), Activities of Daily Living (ADL), and Pittsburgh Sleep Quality Index (PSQI) of the two groups were analyzed before and after treatment. Additionally, serum levels of homocysteine and neuron-specific enolase in both groups were compared before and after treatment. The clinical efficacy of the two groups was evaluated, and the total response rate was calculated. Adverse reactions occurring during the treatment period in both groups were also recorded. Results:Before treatment, the Mini-Mental State Examination (MMSE) scores for the control and observation groups were (14.92 ± 2.43) points and (14.83 ± 2.56) points, respectively. After treatment, the scores were (22.81 ± 3.05) points for the control group and (25.62 ± 4.07) points for the observation group. After treatment, the MMSE scores in both groups were significantly higher than the respective levels before treatment in the corresponding group, and the observation group had a significantly higher score than the control group ( t = 2.25, P < 0.05). Before treatment, the BE-HAVE-AD scores for the control and observation groups were (45.28 ± 6.27) points and (44.95 ± 6.38) points, respectively. After treatment, the scores were (27.54 ± 2.22) points for the control group and (23.07 ± 1.79) points for the observation group. After treatment, the BE-HAVE-AD scores were significantly lower than those before treatment in each group, and the observation group had a significantly lower score than the control group ( t = 9.56, P < 0.05). Before treatment, the ADL scores for the control and observation groups were (23.17 ± 1.43) points and (22.83 ± 1.64) points, respectively. After treatment, the scores were (38.27 ± 3.25) points for the control group and (41.52 ± 4.26) points for the observation group. After treatment, the ADL scores in each group were significantly higher than their respective levels before treatment, and the observation group had a significantly higher score than the control group ( t = 3.83, P < 0.05). Before treatment, the PSQI scores for the control and observation groups were (16.423 ± 1.51) points and (15.86 ± 1.49) points, respectively. After treatment, the scores were (9.16 ± 1.12) points for the control group and (7.07 ± 1.07) points for the observation group. After treatment, the PSQI scores were significantly lower than those before treatment in each group, and the observation group had a significantly lower score than the control group ( t = 8.53, P < 0.05). Before treatment, the serum levels of homocysteine in the control and observation groups were (54.27 ± 8.21) ng/L and (55.13 ± 7.64) ng/L, respectively, while the serum levels of neuron-specific enolase in these two groups were (59.66 ± 9.51) μg/L and (60.97 ± 10.29) μg/L, respectively. After treatment, the serum levels of homocysteine in the control and observation groups were (30.63 ± 1.95) ng/L and (25.57 ± 2.06) ng/L, respectively, and the serum levels of neuron-specific enolase in these two groups were (49.23 ± 6.12) μg/L and (37.21 ± 7.01) μg/L, respectively. After treatment, the serum levels of homocysteine and neuron-specific enolase in each group were significantly lower than the respective levels before treatment in the corresponding group; the observation group exhibited significantly lower serum levels of homocysteine and neuron-specific enolase than the control group ( t = 11.28, 8.16, both P < 0.05). The total response rate in the observation group was 95.00% (38/40), which was significantly higher than that in the control group [72.50% (29/40), P < 0.05]. The incidence of adverse reactions in the observation group was 5.00% (2/40), which was significantly lower than that in the control group [20.00% (8/40), χ2 = 7.44, P < 0.05]. Conclusion:Repetitive transcranial magnetic stimulation combined with cognitive function training can more effectively improve cognitive and psychological and behavioral symptoms in patients with vascular dementia, has better efficacy, and is safer compared with repetitive transcranial magnetic stimulation alone.

Objective To explore the correlation between the change of the serum levels of thyroid hormone and the severity of anxiety symptoms in patients with generalized anxiety disorder after treatment with paroxetine hydrochloride.Methods 76 patients with generalized anxiety disorder treated in the Third People's Hospital of Huzhou from January to August 2023 were collected as study group,and they were divided into mild group(n=23),moderate group(n=30),and severe group(n=23),according to degree of anxiety by Hamilton anxiety scale(HAMA),69 healthy examination subjects in the same period were selected as control group.Patients in study group were treated with paroxetine hydrochloride tablets for 8 weeks,patients were evaluated anxiety symptoms,the serum levels of thyroid hormone were measured at baseline and 8 weekend,including triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),antithyroglobulin antibody(TG),anti-thyroid peroxidase antibody(TPO).Results After 8 weeks of paroxetine hydrochloride treatment,the significant efficacy rates of mild group,moderate group,and severe group were 73.9％,76.7％,and 73.9％,with no statistically significant difference in efficacy among three groups(x2=0.073,P＞0.05).In the baseline period,FT4 levels of patients in moderate group and severe group were significantly higher than those in mild group and control group,and the difference was statistically significant(P＜0.05).The severity of anxiety symptoms in the baseline period of patients in moderate group and severe group showed a low positive correlation and a significant positive correlation with FT4 levels(r=0.382、0.610,P＜0.05).After 8 weeks treatment,the FT4 levels of patients in moderate group and severe group decreased significantly compared to the baseline period,and the difference was statistically significant(t=2.847,3.042,P＜0.05).The reduction rate of HAMA score in severe group was positively correlated with the change in FT4 level during the baseline period and at the end of 8 weeks of treatment(r=0.517,P＜0.05).By a binary Logistic regression analysis showed that the higher levels of FT4 in the baseline period with the worse efficacy in moderate group and severe group.Conclusion The improvement of anxiety symptoms could be affected by high baseline levels of FT4 in generalized anxiety disorder patients with moderate to severe anxiety.

Objective To investigate the effects of disease course on cognitive function and related risk factors in elderly patients with type 2 diabetes. Methods A total of 193 patients with type 2 diabetes were selected and divided into 4 groups according to the course of disease, the new diagnosis group, the group of the course of disease within 1 year, the group of the course of disease between 1-5 years and the group of the course of disease over 5 years. The general clinical features, biochemical indicators and neuropsychological test scores among the groups were compared.Results Age (P=0.024), treatment methods (P<0.001), and total cholesterol (P=0.037) were significantly different among the groups of different courses of disease. Logistic regression analysis using cognitive dysfunction as a dependent variable revealed that the course of diabetes (OR=1.205, 95％CI=1.128-1.286) and medical treatment (OR=2.931, 95％CI=1.067-8.053) was associated with cognitive dysfunction. Conclusion There is a cognitive dysfunction in the elderly patients with type 2 diabetes, and the course of diabetes is an important risk factor.