Transcranial magnetic stimulation of the precuneus enhances memory and neural activity in prodromal Alzheimer's disease
Transcranial magnetic stimulation of the precuneus enhances memory and neural activity in prodromal Alzheimer's disease
复制标题
经颅磁刺激楔前叶增强记忆和神经活动的前驱阿尔茨海默病
DOI：
10.1016/j.neuroimage.2017.12.048
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发表时间：
2018-04-01
期刊：
影响因子：
5.7
通讯作者：
Bozzali, Marco
中科院分区：
文献类型：
--
作者：
Koch, Giacomo;Bonni, Sonia;Bozzali, Marco
记忆丧失是典型的阿尔茨海默病（AD）的最初症状之一，对此没有有效的治疗方法。楔前叶（PC）最近被强调为早期AD中观察到的记忆障碍的关键区域，这可能是由于大规模网络（如默认模式网络（DMN））内的断开机制。使用多模式的方法，我们在一个为期两周的，随机，假对照，双盲试验的影响，高频重复经颅磁刺激（rTMS）的PC认知，测量阿尔茨海默病合作研究临床前阿尔茨海默氏症认知综合征在14例早期AD患者（7名女性）。TMS结合脑电图（TMS-EEG）用于检测大脑连接的变化。我们发现，PC的rTMS诱导情景记忆的选择性改善，但在其他认知领域没有。TMS-EEG信号的分析显示，患者PC的神经活动增加，β带的脑振荡增强，以及PC与DMN内内侧额叶区之间的功能连接的修改。我们的研究结果表明，PC的高频rTMS是一种有前途的，非侵入性的治疗AD早期患者记忆功能障碍的方法。这种临床改善伴随着脑连接的调节，与AD中脑断开的病理生理学模型一致。
Memory loss is one of the first symptoms of typical Alzheimer's disease (AD), for which there are no effective therapies available. The precuneus (PC) has been recently emphasized as a key area for the memory impairment observed in early AD, likely due to disconnection mechanisms within large-scale networks such as the default mode network (DMN). Using a multimodal approach we investigated in a two-week, randomized, sham-controlled, double-blinded trial the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) of the PC on cognition, as measured by the Alzheimer Disease Cooperative Study Preclinical Alzheimer Cognitive Composite in 14 patients with early AD (7 females). TMS combined with electroencephalography (TMS-EEG) was used to detect changes in brain connectivity. We found that rTMS of the PC induced a selective improvement in episodic memory, but not in other cognitive domains. Analysis of TMS-EEG signal revealed an increase of neural activity in patients' PC, an enhancement of brain oscillations in the beta band and a modification of functional connections between the PC and medial frontal areas within the DMN.Our findings show that high-frequency rTMS of the PC is a promising, non-invasive treatment for memory dysfunction in patients at early stages of AD. This clinical improvement is accompanied by modulation of brain connectivity, consistently with the pathophysiological model of brain disconnection in AD.