ABSTRACT NUMBER: ESOC2026A553 INTEGRATIVE STRUCTURAL BRAIN CHANGES AND COGNITIVE IMPROVEMENTS FOLLOWING NEURO-NAVIGATED RTMS IN MILD COGNITIVE IMPAIRMENT CAUSED BY CEREBRAL SMALL VESSEL DISEASE

Abstract Background and aims: Methods A total of 54 MCI patients caused by cerebral small vessel disease (CSVD) were included in this study. All patients received neuro-navigation rTMS targeting left angular gyrus for 4 weeks (rTMS group: n=28; sham group: n=26;) and received multimodal MRI and cognitive assessments before and after rTMS. White matter network was constructed and local diffusion homogeneity (LDH) was calculated to analyze white matter differences. Surface-based morphometry was used to detect cortical changes. In addition, the correlation between these structural alterations and improved cognitive function were analyzed. Results After rTMS, general cognitive function and episodic memory of CSVD-MCI patients significantly improved. Assortativity improved (P=0.039) while hierarchy decreased (P=0.036). In addition, lower LDH were detected in right hippocampus cingulum fasciculus, left inferior longitudinal fasciculus, right inferior/superior cerebellar peduncle and right cingulum gyrus. Sulcus depth of left medial orbitofrontal cortex, superior frontal/parietal cortex, middle/inferior temporal cortex and right lateral occipital cortex was decreased. Improved general cognition was negatively correlated with decreased sulcus depth in left inferior temporal cortex (R=-0.585, P=0.001) and left superior parietal cortex (R=-0.447, P=0.017). Improved memory was negatively correlated with altered LDH in right inferior cerebellar peduncle (R=-0.427, P=0.037). Conclusions Our study shows that neuro-navigated rTMS targeting left angular gyrus can enhance cognitive function in CSVD-MCI patients by impacting brain structures, offering new biological evidence for its potential as an early CSVD intervention. Conflict of interest Name of author: nothing to disclose