Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive Function and Intestinal Flora in Patients on Maintenance Hemodialysis

Background: To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive function and intestinal microflora in maintenance hemodialysis (MHD) patients with subjective cognitive decline (SCD). Methods: One-way blind design was used, thirty-three MHD patients with MMSE score ≥24, SCD-Q9 score ≥5 and SCD were enrolled in this study, the intervention group (rTMS Group) and the Sham group (Sham group) were randomly assigned 1:1 according to the random number method. The cognitive function was measured at baseline and at the end of the experiment, before and after intervention, the changes of each index were compared between the two groups. Results: MMSE score in rTMS group was significantly higher than that in Sham group after intervention (27.94 ± 1.25 VS 26.94 ± 1.39, P = 0.037). In the 5 parts of MMSE score, there was only a significant difference in the memory ability (P = 0.039). After intervention, the SCD-Q9 score in rTMS group were significantly lower than those in Sham group (6.09 ± 1.06 vs 7.09 ± 1.25, P = 0.018), only the ability of daily activity memory was significantly different between the two groups (P = 0.037). After intervention, there was no significant difference in α-diversity (Fig.1) and β-diversity (Fig.2) between the two groups. The results showed that the composition of intestinal flora was similar between the two groups at family level and genus level after intervention (Fig.3). Lefse analysis was used to screen the flora with statistical difference between the two groups after intervention (Fig.4, Table.1), there were 5 distinct microbial communities at the family level, Marinifilaceae, Flavobacteriaceae, RF39, Carnobacteriacea were the most abundant in rTMS group, while Wohlfahrtiimonadaceae was the most abundant in Sham group. At the level of 17 genera, the abundance of Faecalibacterium, Alistipes and Odoribacter in rTMS group was higher than that of Erysipelatoclostridium in Sham group (Fig.5). Conclusion: rTMS therapy may alter the cognitive function of MHD patients with SCD, improve their memory, and affect the abundance of some intestinal flora, which may modulate the differential flora associated with SCD, it is suggested that the therapy may affect cognitive function during SCD by regulating the flora.