Repetitive Transcranial Magnetic Stimulation Improves Executive Function and Music Rhythm.
Repetitive Transcranial Magnetic Stimulation Improves Executive Function and Music Rhythm.
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重复经颅磁刺激可改善执行功能和音乐节奏。
DOI：
10.1176/appi.neuropsych.18100224
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Padala,PrasadR
中科院分区：
文献类型：
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作者：
Padala,KalpanaP;Hunter,CassandraR;Parkes,ChristopherM;Lensing,ShellyY;Padala,PrasadR
音乐的认知基础是复杂的。音乐的重要方面，如音高感知、音高记忆和节奏感知，可能都是由不同但重叠的大脑区域控制的。顶叶、颞叶和额叶区域（左边缘上回）对音高感知和记忆至关重要(7)。运动皮层、辅助运动区和小脑中的时间模式发生器在节奏计时中起着至关重要的作用，比如脚和手指随着音乐轻拍(8)。节奏处理可以选择性地受损，但旋律感知却没有缺陷，这表明存在专门处理节奏的神经系统(9)。左脑半球主要参与节奏处理，但左半球或右半球的功能障碍会影响短音乐片段的节奏模式。一项功能性MRI研究显示，音调以整数比例均匀间隔（如1:2和1:3）会激活左侧运动前区和右侧小脑，音调以复杂比例间隔（如1:2.5）会激活右半球，包括右侧运动前区，并在小脑中激活双侧（10）。前额叶皮层与所有涉及音乐感知、处理和生成的区域有着广泛的联系。此外，前额叶皮层在控制执行功能和动机方面起着至关重要的作用，这两者都是成功参与乐队的关键。执行功能被定义为计划、优先排序和启动行动的能力。它还包括灵活地在任务之间转换的能力，以及为了更努力但更重要和最佳的行动而抑制自动反应的能力，比如放弃即时奖励，以获得在乐队中演奏出色的延迟奖励。要想在乐队中成功演奏，高水平的积极性是很重要的。冷漠是一种兴趣和冷漠的极度缺乏，动机减弱，失去开始，毅力差。众所周知，额叶功能障碍会导致执行功能障碍和冷漠。因此，刺激DLPFC是一个有吸引力的目标，具有改善音乐识别和演奏中关键的多种认知和行为过程的潜力。我们患者的执行功能得到了改善，这可以通过他的处理速度集转移（Trail-Making Test, Part B）和复杂注意力（Conners ' s '）的改善来证明。
DISCUSSIONCognitive underpinnings of music are complex. Important aspects of music such as pitch perception, pitch memory, and rhythm perception may all be controlled by distinct, but overlapping, brain areas. The parietal, temporal, and frontal areas (left supramarginal gyrus) are critical for pitch perception and memory (7). The temporal pattern generators in the motor cortex, the supplementary motor areas, and the cerebellum play a crucial role in rhythmic timing, such as feet and finger tapping to music (8). Rhythm processing could be selectively impaired without deficits in melody perception, suggesting the presence of a neural system specialized for rhythm (9). The left cerebral hemisphere is mainly involved in rhythm processing, but dysfunction in either the left or right hemisphere compromises tapping of rhythmic patterns from short musical pieces. A functional MRI study showed that tones spaced evenly at integer ratios (such as 1: 2 and 1: 3) evoked activation in the left premotor area and the right cerebellum, and tones spaced at complex ratios (such as 1: 2.5) elicited activation in the right hemisphere, including the right premotor area, with bilateral activation in the cerebellum (10). The prefrontal cortex has extensive connections to all areas involved in music perception, processing, and generation. In addition, the prefrontal cortex plays a crucial role in controlling executive function and motivation, both of which are critical for successful participation in a musical band. Executive function is defined as an ability to plan, prioritize, and initiate action. It also involves the ability to flexibly shift between tasks and inhibit automated responses for the sake of more effortful yet more important and optimal actions, such as forgoing immediate rewards for a delayed reward of playing well in a band. High levels of motivation are important in order to successfully play in a band. Apathy is a profound lack of interest and indifference, diminished motivation, loss of initiation, and poor persistence. Frontal lobe dysfunction is known to cause both executive dysfunction and apathy. Thus, stimulation of the DLPFC is an attractive target with a potential to improve multiple cognitive and behavioral processes critical in music recognition and playing. Executive function improved in our patient as demonstrated by improvement in his processing speed-set shifting (Trail-Making Test, Part B) and complex attention (Conners’