Cortical excitability in very mild Alzheimer's disease: a long-term follow-up study
Cortical excitability in very mild Alzheimer's disease: a long-term follow-up study
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DOI：
10.1007/s00415-010-5663-8
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发表时间：
2010-12-01
影响因子：
6
通讯作者：
Esteban, A.
中科院分区：
文献类型：
--
作者：
Olazaran, J.;Prieto, J.;Esteban, A.
使用成对脉冲经颅磁刺激（pTMS）测量运动皮层兴奋性已被提出用于阿尔茨海默病（AD）的早期诊断，也可用于监测治疗反应和疾病进展。然而，在AD痴呆前期进行的研究很少，可用的长期数据很少，皮质兴奋性和认知表现之间的相关性尚未得到解决。11例轻度认知功能障碍（MCI）转化为AD相关痴呆的患者和12例老年对照组被选入本研究。两组在基线时进行认知评估和pTMS，AD组在多奈哌齐治疗4个月和21个月后也进行了认知评估和pTMS。非参数统计用于比较两个研究组在基线时的皮质兴奋性，并分析AD组的病程。相关分析进行调查皮质兴奋性和认知性能之间的关联。AD患者的短潜伏期皮质内抑制（SICI）和皮质内易化减少。然而，有很高的个体间变异性，只有在2毫秒的刺激间隔（ISI）达到统计学意义。多奈哌齐治疗后观察到2 ms SICI恢复的趋势。在AD患者中，300 ms时的基线皮质兴奋性与更好的认知表现相关。虽然目前的研究结果不支持pTMS在晚发性AD的早期诊断中的作用，但在预测治疗反应和理解疾病机制方面的潜在作用出现了。
Measurement of motor cortex excitability using paired-pulse transcranial magnetic stimulation (pTMS) has been proposed for the early diagnosis of Alzheimer's disease (AD) and could also be useful for monitoring treatment response and disease progression. However, studies conducted at the pre-dementia stage of AD are scarce, very few long-term data are available, and correlations between cortical excitability and cognitive performance have not been addressed. Eleven patients with mild cognitive impairment (MCI) that converted to AD-related dementia and 12 elderly control subjects were selected for this study. Cognitive assessments and pTMS were conducted at baseline in the two groups and also after 4 and 21 months of treatment with donepezil in the AD group. Non-parametric statistics were used to compare cortical excitability between the two study groups at baseline and to analyse disease course in the AD group. Correlation analysis was performed to investigate associations between cortical excitability and cognitive performance. Short-latency intracortical inhibition (SICI) and intracortical facilitation were reduced in AD patients. However, there was high inter-individual variability, and statistical significance was only attained at a 2-ms interstimulus interval (ISI). A trend towards recovery of 2-ms SICI was observed after treatment with donepezil. Baseline cortical excitability at 300 ms was associated with better cognitive performance in AD patients. Although the present results do not support a role for pTMS in the early diagnosis of late-onset AD, a potential role in prediction of treatment response and understanding of disease mechanisms emerged.