中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (4): 707-713.doi: 10.4103/1673-5374.295345

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

高频重复经颅磁刺激治疗遗忘型轻度认知障碍的神经影像学机制:一项双盲随机假手术对照试验

  

  • 出版日期:2021-04-15 发布日期:2020-12-21
  • 基金资助:

    国家自然科学基金项目(81874032);深圳市科学技术计划项目(JCYJ20160427191726109);广东省科学技术计划项目(2016A020215202);深圳市卫计委项目(SZXJ2017069

Neuroimaging mechanisms of high-frequency repetitive transcranial magnetic stimulation for treatment of amnestic mild cognitive impairment: a double-blind randomized sham-controlled trial

Li-Qiong Yuan1, #, Qing Zeng1, #, Dan Wang2, Xiu-Yun Wen2, Yu Shi1, Fen Zhu2, Shang-Jie Chen2, *, Guo-Zhi Huang1, 3, *#br#   

  1. 1 Department of Rehabilitation Medicine and Physiotherapy, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China;  2 Department of Rehabilitation Medicine and Physiotherapy, Shenzhen Baoan Hospital of Southern Medical University, Shenzhen, Guangdong Province, China;  3 Rehabilitation School of Southern Medical University, Guangzhou, Guangdong Province, China
  • Online:2021-04-15 Published:2020-12-21
  • Contact: Guo-Zhi Huang, PhD, drhuang66@163.com; Shang-Jie Chen, PhD, csjme@163.com.
  • Supported by:
    This work was supported by the National Natural Science Foundation of China, No. 81874032 (to GZH); the Science and Technology Planning Project of Shenzhen of China, No. JCYJ20160427191726109 (to FZ); the Science and Technology Planning Project of Guangdong Province of China, No. 2016A020215202 (to SHC); and Shenzhen Health and Family Planning System Research Project of China, No. SZXJ2017069 (to SHC).

摘要:

遗忘型轻度认知障碍转化为阿尔茨海默病的风险最高。尽管已有研究认为重复经颅磁刺激是一种治疗遗忘型轻度认知障碍认知障碍的潜在方法,但对其神经影像的机制尚知之甚少。因此研究从中山大学附属第三医院附近社区招募遗忘型轻度认知障碍患者,于大脑左侧前额叶背外侧区行高频重复经颅磁刺激的双盲随机假手术对照试验。(1)将24例遗忘型轻度认知障碍随机分为治疗组(n=12,6男6女,年龄65.08±4.89岁)和假手术组(n=12,5男7女,年龄64.67±4.77岁),分别接受真实或假的重复经颅磁刺激治疗,刺激参数为10 Hz,2s刺激,8s间歇,重复20次,80%运动阈值,400个脉冲。真实或假的重复经颅磁刺激治疗每周进行5次,连续治疗4周;(2)结果发现,与干预前相比,治疗结束时和治疗后1个月时患者的认知功能明显改善,且右中额叶回低频振幅明显升高,且与假手术组相比,右下额叶、三角部、右楔前叶、左侧角回和右缘上回低频振幅明显升高,右额叶上回低频振幅明显降低。提示高频重复经颅磁刺激可以有效地改善遗忘型轻度认知障碍患者的认知功能,并改变其多个认知相关脑区的自发性大脑活动。试验于2019年9月3日经南方医科大学深圳宝安医院伦理委员会批准,批准号BYL20190901,并于2019年12月14日在中国临床试验注册中心注册,注册号ChiCTR1900028180。

https://orcid.org/0000-0003-2797-1387 (Li-Qiong Yuan)

关键词:

认知障碍, 重复经颅磁刺激, 功能磁共振成像, 阿尔茨海默病, 认知功能, 神经功能, 临床试验

Abstract: Individuals with amnestic mild cognitive impairment (aMCI) have a high risk of developing Alzheimer’s disease. Although repetitive transcranial magnetic stimulation (rTMS) is considered a potentially effective treatment for cognitive impairment in patients with aMCI, the neuroimaging mechanisms are poorly understood. Therefore, we performed a double-blind randomized sham-controlled trial in which rTMS was applied to the left dorsolateral prefrontal cortex of aMCI patients recruited from a community near the Third Hospital Affiliated to Sun Yat-sen University, China. Twenty-four patients with aMCI were randomly assigned to receive true rTMS (treatment group, n = 12, 6 men and 6 women; age 65.08 ± 4.89 years) or sham stimulation (sham group, n = 12, 5 men and 7 women; age 64.67 ± 4.77 years). rTMS parameters included a stimulation frequency of 10 Hz, stimulation duration of 2 seconds, stimulation interval of 8 seconds, 20 repetitions at 80% of the motor threshold, and 400 pulses per session. rTMS/sham stimulation was performed five times per week over a period of 4 consecutive weeks. Our results showed that compared with baseline, Montreal Cognitive Assessment scores were significantly increased and the value of the amplitude of low-frequency fluctuation (ALFF) was significantly increased at the end of treatment and 1 month after treatment. Compared with the sham group, the ALFF values in the right inferior frontal gyrus, triangular part of the inferior frontal gyrus, right precuneus, left angular gyrus, and right supramarginal gyrus were significantly increased, and the ALFF values in the right superior frontal gyrus were significantly decreased in the treatment group. These findings suggest that high-frequency rTMS can effectively improve cognitive function in aMCI patients and alter spontaneous brain activity in cognitive-related brain areas. This study was approved by the Ethics Committee of Shenzhen Baoan Hospital of Southern Medical University, China (approval No. BYL20190901) on September 3, 2019 and registered in the Chinese Clinical Trials Registry (registration No. ChiCTR1900028180) on December 14, 2019.

Key words: Alzheimer’s disease, clinical trial, cognitive function, cognitive impairment, functional magnetic resonance imaging, neurological function, repetitive transcranial magnetic stimulation