Cognition-enhancing effect of vagus nerve stimulation in patients with Alzheimer's disease:: A pilot study
Cognition-enhancing effect of vagus nerve stimulation in patients with Alzheimer's disease:: A pilot study
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DOI：
10.4088/jcp.v63n1103
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发表时间：
2002-11-01
影响因子：
5.3
通讯作者：
Ben-Menachem, E
中科院分区：
文献类型：
--
作者：
Sjögren, MJC;Hellström, PTO;Ben-Menachem, E
工作背景：迷走神经刺激（VNS）是一种治疗难治性癫痫的既定治疗方法，在欧洲也用于难治性抑郁症。临床和实验研究也表明VNS对癫痫和抑郁症的认知有积极影响。本试点研究的目的是调查VNS对认知的影响，在阿尔茨海默病diseases.Method：所有纳入的患者（N = 10）符合美国国立神经和交流障碍和中风研究所和阿尔茨海默病及相关疾病协会的阿尔茨海默病的诊断标准。在植入迷走神经刺激器（神经控制假体）之前，患者接受神经心理学测试（例如，阿尔茨海默病评估量表-认知子量表[ADAS-cog]和简易精神状态检查[MMSE]）、脑计算机断层扫描、医学/神经学和心理学检查（状态评估）和腰椎穿刺检查脑脊液。使用Montgomery-Asberg抑郁评定量表对抑郁症状的存在进行评定。术后2周开始迷走神经刺激，随访6个月以上。结果：治疗3个月后，10例患者中有7例根据ADAS-cog（中位改善3.0分）为应答者，9例根据MMSE（中位改善1.5分）为应答者。治疗6个月后，7例患者在ADAS-cog上有应答（中位改善2.5分），7例患者在MMSE上有应答（中位改善2.5分）。迷走神经刺激耐受性良好，其副作用是轻微的，短暂的。结论：这个开放标签的试点研究的结果表明，迷走神经刺激对阿尔茨海默病患者的认知有积极的影响。需要进一步研究。
Background: Vagus nerve stimulation (VNS) is an established treatment method for therapy-refractory epilepsy and, in Europe, for treatment-resistant depression also. Clinical and experimental investigations have also shown positive effects of VNS on cognition in epilepsy and depression. The purpose of the present pilot study was to investigate the effect of VNS on cognition in patients with Alzheimer's disease.Method: All the included patients (N = 10) met the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria for the diagnosis of Alzheimer's disease. Before the implantation of the vagus stimulator (NeuroCybernetic Prosthesis), the patients underwent neuropsychological tests (e.g., Alzheimer's Disease Assessment Scale-cognitive subscale [ADAS-cog] and Mini-Mental State Examination [MMSE]), computerized tomography of the brain, medical/neurologic and psychological examinations (status evaluation), and lumbar puncture with investigation of the cerebrospinal fluid. The presence of depressive symptoms was rated using the Montgomery-Asberg Depression Rating Scale. The VNS was initiated 2 weeks after the implantation, and the patients were followed up with regular investigations and tests over 6 months. Response was defined as improvement or absence of impairment in ADAS-cog and MMSE scores after 3 and 6 months.Results: After 3 months of treatment, 7 of 10 patients were responders according to the ADAS-cog (median improvement of 3.0 points), and 9 of 10 patients were responders according to the MMSE (median improvement of 1.5 points). After 6 months of treatment, 7 patients were responders on the ADAS-cog (median improvement of 2.5 points), and 7 patients were responders on the MMSE (median improvement of 2.5 points). VNS was well tolerated, and its side effects were mild and transient.Conclusion: The results of this open-label pilot study suggest a positive effect of VNS on cognition in patients with Alzheimer's disease. Further studies are warranted.