Cognitive interventions in Alzheimer's and Parkinson's diseases: emerging mechanisms and role of imaging.
Cognitive interventions in Alzheimer's and Parkinson's diseases: emerging mechanisms and role of imaging.
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DOI：
10.1097/wco.0000000000000346
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发表时间：
2016-08
影响因子：
4.8
通讯作者：
Klöppel S
中科院分区：
文献类型：
--
作者：
Vemuri P;Fields J;Peter J;Klöppel S
最近有一场关于认知干预的有效性缺乏令人信服的科学证据的争论。本研究的目的是回顾阿尔茨海默病和帕金森病的认知干预的现状，提出新的机制，并讨论成像在设计有效的干预策略中的作用。认知干预似乎是有希望的阿尔茨海默病和帕金森病。尽管在轻度认知障碍、早期阿尔茨海默病和轻度至中度帕金森病中已显示出可行性，但仍需要研究这些干预措施的长期疗效和机制。有必要进行科学严谨的研究，以验证认知干预试验的有效性。未来的研究将大大受益于在其研究设计中包括纵向成像。成像可用于通过测量干预期间的大脑变化来证明疗效和机制。成像也可用于确定可能影响治疗反应的生物学和疾病相关因素，即效应调节剂。考虑效应调节剂将使我们能够以更高的灵敏度测量生物标志物和认知的治疗反应，并有助于设计将导致更好的患者结局的试验。
There has been recent debate about the lack of compelling scientific evidence on the efficacy of cognitive interventions. The goal of this study is to review the current state of cognitive interventions in Alzheimer's disease and Parkinson's disease, present emerging mechanisms, and discuss the role of imaging in designing effective intervention strategies. Cognitive interventions appear to be promising in Alzheimer's disease and Parkinson's disease. Although feasibility has been shown in mild cognitive impairment, early Alzheimer's disease, and mild to moderate Parkinson's disease, studies to investigate long-term efficacy and mechanisms underlying these interventions are still needed. There is a need to conduct scientifically rigorous studies to validate the efficacy of cognitive intervention trials. Future studies will greatly benefit from including longitudinal imaging in their study design. Imaging can be used to demonstrate the efficacy and mechanisms by measuring brain changes over the intervention period. Imaging can also be used to determine biological and disease-related factors that may influence the treatment response, that is, the effect modifiers. Consideration of effect modifiers will allow us to measure the treatment response in biomarkers and cognition with greater sensitivity and also aid in designing trials that will lead to better patient outcomes.