中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (12): 2164-2172.doi: 10.4103/1673-5374.241468

• 原著:退行性病与再生 • 上一篇    下一篇

穹窿脑深部电刺激在早期可改善严重阿尔茨海默病患者的认知功能

  

  • 收稿日期:2018-08-30 出版日期:2018-12-15 发布日期:2018-12-15
  • 基金资助:

    本研究得到了国家自然科学基金（8187052509）和中国国家重点研究发展计划（2017YFC0114005）的资助

Partial improvement in performance of patients with severe Alzheimer’s disease at an early stage of fornix deep brain stimulation

Zhi-Qi Mao1, Xin Wang2, Xin Xu1, Zhi-Qiang Cui1, Long-Sheng Pan1, Xiao-Jing Ning3, Bai-Xuan Xu3, Lin Ma4, Zhi-Pei Ling1, Jian-Jun Jia5, Xin-Guang Yu1, 2   

  1. 1 Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
    2 School of Medicine, Nankai University, Tianjin, China
    3 Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China
    4 Department of Radiology, Chinese PLA General Hospital, Beijing, China
    5 Department of Neurology, Chinese PLA General Hospital, Beijing, China
  • Received:2018-08-30 Online:2018-12-15 Published:2018-12-15
  • Contact: Xin-Guang Yu, MD, xinguang_yu@263.net; Zhi-Pei Ling, MD; and Jianjun Jia, MD.
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. 8187052509 (to XGY) and the National Key Research and Development Plan of China, No. 2017YFC0114005 (to ZPL).

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摘要：

深部脑电刺激（DBS）以往主要用于治疗轻中度阿尔茨海默病病例。作者首次提出穹窿脑深部电刺激可改善早期严重阿尔茨海默病患者临床表现。在DBS之前和DBS后早期应用迷你精神状态检查（MMSE）和临床痴呆评定（CDR）对5例患者精神状态和痴呆程度进行了评估；应用Zarit Caregiver负担访谈量表（ZBI）评估了看护者的负担。总体来讲，DBS后早期(1.5-3个月)患者的认知能力有不同程度的改善，看护者的负担减轻。在3例中观察到更好的精神状态或社交表现，其中1例在长期记忆功能明显改善，另1例由于看护者给予不适当的抗精神病药物，致使其病情恶化。说明穹窿脑深部电刺激在早期阶段能够部分改善严重阿尔茨海默病患者的认知功能。该研究已经解放军总医院伦理委员会批准（审批号：2015-013-02），并在北美临床试验注册中心注册（NCT03115814）。

orcid:0000-0001-8202-8290(Xin-Guang Yu)

 

关键词: 阿尔茨海默病, 深部脑刺激, 穹窿, 认知, 记忆, 情绪, 早期阶段, 功能性神经外科, 痴呆, 神经再生

Abstract:

Deep brain stimulation is a therapy for Alzheimer’s disease (AD) that has previously been used for mainly mild to moderate cases. This study provides the first evidence of early alterations in performance induced by stimulation targeted at the fornix in severe AD patients. The performance of the five cases enrolled in this study was scored with specialized assessments including the Mini-Mental State Examination and Clinical Dementia Rating, both before and at an early stage after deep brain stimulation. The burden of caregivers was also evaluated using the Zarit Caregiver Burden Interview. As a whole, the cognitive performance of patients remained stable or improved to varying degrees, and caregiver burden was decreased. Individually, an improved mental state or social performance was observed in three patients, and one of these three patients showed remarkable improvement in long-term memory. The conditions of another patient deteriorated because of inappropriate antipsychotic medications that were administered by his caregivers. Taken together, deep brain stimulation was capable of improving some cognitive aspects in patients with severe AD, and of ameliorating their emotional and social performance, at least at an early stage. However, long-term effects induced by deep brain stimulation in patients with severe AD need to be further validated. More research should focus on clarifying the mechanism of deep brain stimulation. This study was registered with ClinicalTrials.gov (NCT03115814) on April 14, 2017.

Key words: Alzheimer’s disease, deep brain stimulation, fornix, cognition, memory, mood, performance, early stage, functional neurosurgery, dementia