Combined mnemonic strategy training and high-definition transcranial direct current stimulation for memory deficits in mild cognitive impairment.
Combined mnemonic strategy training and high-definition transcranial direct current stimulation for memory deficits in mild cognitive impairment.
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DOI：
10.1016/j.trci.2017.04.008
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发表时间：
2017-09
期刊：
影响因子：
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通讯作者：
Stringer AY
中科院分区：
文献类型：
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作者：
Hampstead BM;Sathian K;Bikson M;Stringer AY
记忆缺陷是阿尔茨海默氏痴呆症的特征，其临床前体阶段被称为轻度认知障碍。非药物干预有望增强这些患者的功能，可能延迟表明向痴呆转变的功能障碍。先前的研究结果表明，记忆策略训练（MST）增强了长期保留的训练刺激，并伴随着增加的血氧水平依赖的信号在侧额叶和顶叶皮质以及在海马。本研究旨在通过同时进行经颅直流电刺激（tDCS）来提高MST的推广和受益患者的范围。该方案描述了一项前瞻性、随机对照、四臂、双盲研究，目标是轻度认知障碍患者的记忆缺陷。一旦随机化，参与者完成连续五天的日常会话，其中他们在左侧前额叶皮层上接受活动或假高清晰度tDCS，该区域已知对成功的记忆编码很重要，并且已被MST参与。高清晰度tDCS（主动或假）将与MST或自传体记忆回忆（与回忆疗法相当）联合使用。参与者在这些治疗前后以及3个月的随访期间接受使用生态相关措施和功能磁共振成像的记忆测试。主要结果测量包括面孔-名称和物体-位置关联任务。次要结果指标包括记忆能力的自我报告以及空间导航任务（近距离转移）和散文记忆（药物说明;远距离转移）。功能性磁共振成像的变化将在任务表现和静息状态下使用激活和连接分析进行评价。这些结果将提供有关认知和神经调节技术的功效以及这些有前途的方法之间的协同作用的重要信息。探索性结果将检查影响治疗效果的患者特征，从而确定最适合干预的特征。
Memory deficits characterize Alzheimer's dementia and the clinical precursor stage known as mild cognitive impairment. Nonpharmacologic interventions hold promise for enhancing functioning in these patients, potentially delaying functional impairment that denotes transition to dementia. Previous findings revealed that mnemonic strategy training (MST) enhances long-term retention of trained stimuli and is accompanied by increased blood oxygen level–dependent signal in the lateral frontal and parietal cortices as well as in the hippocampus. The present study was designed to enhance MST generalization, and the range of patients who benefit, via concurrent delivery of transcranial direct current stimulation (tDCS). This protocol describes a prospective, randomized controlled, four-arm, double-blind study targeting memory deficits in those with mild cognitive impairment. Once randomized, participants complete five consecutive daily sessions in which they receive either active or sham high definition tDCS over the left lateral prefrontal cortex, a region known to be important for successful memory encoding and that has been engaged by MST. High definition tDCS (active or sham) will be combined with either MST or autobiographical memory recall (comparable to reminiscence therapy). Participants undergo memory testing using ecologically relevant measures and functional magnetic resonance imaging before and after these treatment sessions as well as at a 3-month follow-up. Primary outcome measures include face-name and object-location association tasks. Secondary outcome measures include self-report of memory abilities as well as a spatial navigation task (near transfer) and prose memory (medication instructions; far transfer). Changes in functional magnetic resonance imaging will be evaluated during both task performance and the resting-state using activation and connectivity analyses. The results will provide important information about the efficacy of cognitive and neuromodulatory techniques as well as the synergistic interaction between these promising approaches. Exploratory results will examine patient characteristics that affect treatment efficacy, thereby identifying those most appropriate for intervention.