High-frequency repetitive transcranial magnetic stimulation combined with cognitive training improves cognitive function and cortical metabolic ratios in Alzheimer's disease
High-frequency repetitive transcranial magnetic stimulation combined with cognitive training improves cognitive function and cortical metabolic ratios in Alzheimer's disease
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高频重复经颅磁刺激结合认知训练改善阿尔茨海默病的认知功能和皮质代谢比
DOI：
10.1007/s00702-019-02022-y
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发表时间：
2019
影响因子：
3.3
通讯作者：
Zhang Min
中科院分区：
文献类型：
--
作者：
Zhang Fengxia;Qin Yuanyuan;Xie Lingfeng;Zheng Caixia;Huang Xiaolin;Zhang Min
各种研究报告了关于重复经颅磁刺激（rTMS）结合认知训练（CT）治疗阿尔茨海默病（AD）的疗效、参数和潜在机制的不一致结果。本研究的目的是评估rTMS-CT对AD患者认知、日常生活活动、神经精神行为症状和大脑刺激区域下代谢物水平的影响，并研究代谢变化（用质子磁共振波谱[1H-MRS]测量）与治疗后临床结局的相关性。连续招募了30名轻度或中度AD患者，并随机分为两个干预组之一：（1）带CT的真实的rTMS（即，真实的组）和（2）具有CT的假rTMS（即，假手术组）。采用10 Hz rTMS刺激左侧背外侧前额叶皮层（DLPFC），然后刺激左侧颞叶外侧（LTL），每天20 min，共4周。每例患者在基线（T0）、治疗后即刻（T1）和治疗后4周（T2）接受神经心理学评估。在T0和T1时用1H-MRS测量刺激皮层中N-乙酰天冬氨酸/肌酸（NAA/Cr）、肌醇/肌酸（mI/Cr）和胆碱/肌酸（Cho/Cr）的比值。28例患者接受了4周的rTMS-CT治疗。假手术组中有2例患者在多次治疗后退出。与假手术组相比，真实的rTMS组在T1和T2时的认知功能和行为均显著改善。在真实的组中，与假手术组相比，左侧DLPFC的NAA/Cr比值显著升高（p= 0.045）;然而，在左侧LTL中，它仅显示出增加的趋势（p= 0.162）。左侧DLPFC中NAA/Cr比值的变化与阿尔茨海默病评估量表（ADAS-cog）中认知量表的变化呈负相关。这项研究表明，可能适度的影响，rTMS-CT预防临床和神经元功能恶化，在左侧DLPFC的AD患者。左侧DLPFC是比左侧LTL更好的候选区域。
Various studies report discordant results regarding the efficacy, parameters, and underlying mechanisms of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training (CT) on Alzheimer’s disease (AD). The objective of the study was to assess the effect of rTMS-CT on cognition, the activities of daily life, neuropsychiatric behavioral symptoms, and metabolite levels beneath the stimulated areas of the brain in patients with AD and to investigate the correlation of metabolic changes (measured with proton magnetic resonance spectroscopy [1H-MRS]) with clinical outcomes after treatment. Thirty consecutive patients with mild or moderate AD were enrolled and randomly divided into one of the two intervention groups: (1) real rTMS with CT (i.e., real group) and (2) sham rTMS with CT (i.e., sham group). 10 Hz rTMS was used to stimulate the left dorsolateral prefrontal cortex (DLPFC) and then to stimulate the left lateral temporal lobe (LTL) for 20 min each day for 4 weeks. Each patient underwent neuropsychological assessment at baseline (T0), immediately after treatment (T1), and 4 weeks after treatment (T2). The ratios ofN-acetylaspartate/creatine (NAA/Cr), myoinositol/creatine (mI/Cr), and choline/creatine (Cho/Cr) in the stimulated cortex were measured using1H-MRS at T0 and T1. Twenty-eight patients were treated with rTMS-CT for 4 weeks. Two patients in the sham group withdrew after being treated several times. Compared with the sham group, the cognitive function and behavior in the real rTMS group improved significantly at T1 and T2. In the real group, compared with the sham group, the NAA/Cr ratio in the left DLPFC was significantly elevated (p= 0.045); however, in the left LTL, it only showed a tendency toward increase (p= 0.162). The change in the NAA/Cr ratio in the left DLPFC was negatively correlated with the change in the cognitive scales of the Alzheimer’s Disease Assessment Scale (ADAS-cog). This study indicated a possible modest effect of rTMS-CT on preventing clinical and neuronal functional deterioration in the left DLPFC of patients with AD. The left DLPFC is a better candidate area than the left LTL.