Precuneus magnetic stimulation for Alzheimer's disease: a randomized, sham-controlled trial.
Precuneus magnetic stimulation for Alzheimer's disease: a randomized, sham-controlled trial.
复制标题
DOI：
10.1093/brain/awac285
复制
发表时间：
2022-11-21
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
重复经颅磁刺激（rTMS）作为一种非侵入性治疗策略，正在与阿尔茨海默病作斗争。阿尔茨海默病患者主要表现出楔前叶是关键节点的默认模式网络的改变。在这里，我们假设颅磁刺激靶向楔前叶是减缓阿尔茨海默病患者认知和功能下降的一种有希望的策略。我们进行了一项随机、双盲、假对照、2期、24周的试验，以确定楔前叶刺激治疗轻至中度阿尔茨海默病患者的安全性和有效性。50例阿尔茨海默病患者按1:1的比例随机分配接受楔前叶或假rTMS（平均年龄73.7岁，52%为女性）。试验包括为期24周的治疗，其中2周的强化疗程，其中rTMS（或假药）每周应用5次，随后是22周的维持阶段，其中每周应用一次刺激。选择临床痴呆评分量表-方框和作为主要结果测量，其中治疗后得分与基线进行比较。次要结果包括阿尔茨海默病评估量表-认知亚量表、简易精神状态检查和阿尔茨海默病合作研究-日常生活活动量表的得分变化。采用单脉冲经颅磁刺激联合脑电图评估楔前叶皮层兴奋性和振荡活动的神经生理变化。我们的研究结果表明，接受楔前叶重复磁刺激的患者在临床痴呆评定量表-盒和评分中表现稳定，而接受假手术治疗的患者则表现出评分的恶化。与假刺激组相比，楔前叶刺激组患者在阿尔茨海默病评估量表-认知亚量表、精神状态迷你检查和阿尔茨海默病合作研究-日常生活活动量表等次要结局指标上的表现也明显更好。神经生理学结果显示，楔前叶刺激组24周后楔前叶皮质兴奋性保持不变，而假手术组明显降低。最后，我们发现楔前叶刺激组局部伽马振荡增强，而假手术组则没有。我们的结论是，24周的楔前叶颅磁刺激可能减缓阿尔茨海默病的认知和功能下降。针对默认模式网络的重复性经颅磁刺激可能是治疗阿尔茨海默病的一种新方法。在一项随机、双盲、II期试验中，Koch等人发现，24周的重复经颅磁刺激楔前叶可以减缓阿尔茨海默病患者的认知和功能下降。默认模式网络的非侵入性刺激可能代表阿尔茨海默病的一种新的治疗方法。查看Moussavi （https://doi.org/10.1093/brain/awac322）对本文的科学评论。
Repetitive transcranial magnetic stimulation (rTMS) is emerging as a non-invasive therapeutic strategy in the battle against Alzheimer’s disease. Alzheimer’s disease patients primarily show alterations of the default mode network for which the precuneus is a key node. Here, we hypothesized that targeting the precuneus with TMS represents a promising strategy to slow down cognitive and functional decline in Alzheimer’s disease patients. We performed a randomized, double-blind, sham-controlled, phase 2, 24-week trial to determine the safety and efficacy of precuneus stimulation in patients with mild-to-moderate Alzheimer’s disease. Fifty Alzheimer’s disease patients were randomly assigned in a 1:1 ratio to either receive precuneus or sham rTMS (mean age 73.7 years; 52% female). The trial included a 24-week treatment, with a 2-week intensive course in which rTMS (or sham) was applied daily five times per week, followed by a 22-week maintenance phase in which stimulation was applied once weekly. The Clinical Dementia Rating Scale–Sum of Boxes was selected as the primary outcome measure, in which post-treatment scores were compared to baseline. Secondary outcomes included score changes in the Alzheimer’s Disease Assessment Scale–Cognitive Subscale, Mini-Mental State Examination and Alzheimer’s Disease Cooperative Study–Activities of Daily Living scale. Moreover, single-pulse TMS in combination with EEG was used to assess neurophysiological changes in precuneus cortical excitability and oscillatory activity. Our findings show that patients that received precuneus repetitive magnetic stimulation presented a stable performance of the Clinical Dementia Rating Scale–Sum of Boxes score, whereas patients treated with sham showed a worsening of their score. Compared with the sham stimulation, patients in the precuneus stimulation group also showed also significantly better performances for the secondary outcome measures, including the Alzheimer’s Disease Assessment Scale–Cognitive Subscale, Mini-Mental State Examination and Alzheimer’s Disease Cooperative Study–Activities of Daily Living scale. Neurophysiological results showed that precuneus cortical excitability remained unchanged after 24 weeks in the precuneus stimulation group, whereas it was significantly reduced in the sham group. Finally, we found an enhancement of local gamma oscillations in the group treated with precuneus stimulation but not in patients treated with sham. We conclude that 24 weeks of precuneus rTMS may slow down cognitive and functional decline in Alzheimer’s disease. Repetitive TMS targeting the default mode network could represent a novel therapeutic approach in Alzheimer’s disease patients. In a randomized, double-blind, phase II trial, Koch et al. find that 24 weeks of repetitive transcranial magnetic stimulation of the precuneus slows down cognitive and functional decline in patients with Alzheimer’s disease. Non-invasive stimulation of the default mode network could represent a novel therapeutic approach in Alzheimer’s disease. See Moussavi (https://doi.org/10.1093/brain/awac322) for a scientific commentary on this article.
登录
查看更多内容
影响因子：
2.4
作者：
Cotelli, M.;Borroni, B.;Cappa, S. F.
通讯作者：
Cappa, S. F.
影响因子：
2.7
作者：
Bonni, Sonia;Veniero, Domenica;Koch, Giacomo
通讯作者：
Koch, Giacomo
影响因子：
5.7
作者：
Koch, Giacomo;Bonni, Sonia;Bozzali, Marco
通讯作者：
Bozzali, Marco
DOI：
10.1002/trc2.12295
发表时间：
2022
影响因子：
4.8
作者：
Cummings, Jeffrey;Lee, Garam;Nahed, Pouyan;Kambar, Mina Esmail Zadeh Nojoo;Zhong, Kate;Fonseca, Jorge;Taghva, Kazem
通讯作者：
Taghva, Kazem
DOI：
10.1002/alz.12286
发表时间：
2021-04
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
--
作者：
Kuller LH;Lopez OL
通讯作者：
Lopez OL