中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (6): 1111-1120.doi: 10.4103/1673-5374.300450

• 原著:退行性病与再生 • 上一篇    下一篇

基于网络的认知训练可增强复发缓解型多发性硬化症患者神经可塑性:探索性病例对照研究

  

  • 出版日期:2021-06-15 发布日期:2020-12-31

A network-based cognitive training induces cognitive improvements and neuroplastic changes in patients with relapsing-remitting multiple sclerosis: #br# an exploratory case-control study#br#

Riccardo Manca1, #, Micaela Mitolo1, 2, #, Iain D. Wilkinson3, David Paling1, 4, Basil Sharrack4, Annalena Venneri1, *   

  1. 1 Department of Neuroscience, University of Sheffield, Sheffield, UK;  2 Istituto di Ricovero e Cura a Carattere Scientifico Istituto delle Scienze Neurologiche di Bologna, Diagnostica Funzionale Neuroradiologica, Bologna, Italy;  3 Academic Unit of Radiology, University of Sheffield, Sheffield, UK;  4 Academic Department of Neuroscience, Sheffield Teaching Hospital, National Health Service Foundation Trust, Sheffield, UK
  • Online:2021-06-15 Published:2020-12-31
  • Contact: Annalena Venneri, PhD, a.venneri@sheffield.ac.uk.

摘要:

如何用非药理学方法有效改善多发性硬化症患者的认知功能障碍尚无共识。为了解旨在通过促进不同大脑区域的同步共激活的认知训练对复发缓解型多发性硬化症患者大脑功能连接的影响,试验纳入稳定性复发缓解型多发性硬化症的45例患者接受标准认知训练、假训练,并设未激活脑区患者为对照组。标准认知训练包括20次计算机化练习,其中涉及由独特大脑网络支持的各种认知功能。所有患者在基线时和5周后均接受了布施克选择联想测试、语义流畅性测试和磁共振成像(MRI)评估。使用重复测量模型分析认知和静止状态MRI数据。结果显示,与假训练组和对照组相比,标准训练组在记忆任务中未明显提高认知功能。标准训练组显示出与布施克选择联想测试结果改善有关的前扣带回皮质突显网络功能连接性降低,但在假训练组中未观察这种变化。这些结果表明,基于不同大脑区域同步共激活的认知训练可改善复发缓解型多发性硬化症患者的认知功能,其机制可能在于该认知训练可增强神经可塑性。

https://orcid.org/0000-0002-9488-2301 (Annalena Venneri) 

Abstract: Cognitive impairments are commonly observed in patients with multiple sclerosis and are associated with lower levels of quality of life. No consensus has been reached on how to tackle effectively cognitive decline in this clinical population non-pharmacologically. This exploratory case-control study aims to investigate the effectiveness of a hypothesis-based cognitive training designed to target multiple domains by promoting the synchronous co-activation of different brain areas and thereby improve cognition and induce changes in functional connectivity in patients with relapsing-remitting multiple sclerosis. Forty-five patients (36 females and 9 males, mean age 44.62 ± 8.80 years) with clinically stable relapsing-remitting multiple sclerosis were assigned to either a standard cognitive training or to control groups (sham training and non-active control). The standard training included twenty sessions of computerized exercises involving various cognitive functions supported by distinct brain networks. The sham training was a modified version of the standard training that comprised the same exercises and number of sessions but with increased processing speed load. The non-active control group received no cognitive training. All patients underwent comprehensive neuropsychological and magnetic resonance imaging assessments at baseline and after 5 weeks. Cognitive and resting-state magnetic resonance imaging data were analyzed using repeated measures models. At reassessment, the standard training group showed significant cognitive improvements compared to both control groups in memory tasks not specifically targeted by the training: the Buschke Selective Reminding Test and the Semantic Fluency test. The standard training group showed reductions in functional connectivity of the salience network, in the anterior cingulate cortex, associated with improvements on the Buschke Selective Reminding Test. No changes were observed in the sham training group. These findings suggest that multi-domain training that stimulates multiple brain areas synchronously may improve cognition in people with relapsing-remitting multiple sclerosis if sufficient time to process training material is allowed. The associated reduction in functional connectivity of the salience network suggests that training-induced neuroplastic functional reorganization may be the mechanism supporting performance gains. This study was approved by the Regional Ethics Committee of Yorkshire and Humber (approval No. 12/YH/0474) on November 20, 2013.

Key words: cognitive training, magnetic resonance imaging, multiple sclerosis, neuroplasticity, neuropsychology, rehabilitation, salience network