Neural Regeneration Research ›› 2018, Vol. 13 ›› Issue (12): 2164-2172.doi: 10.4103/1673-5374.241468

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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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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