高频重复经颅磁刺激治疗阿尔茨海默病的研究进展

doi:10.3969/j.issn.1003-9198.2024.06.021

摘要/Abstract

摘要： 重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)作为一种安全有效的物理治疗方式,已被广泛运用于多种神经精神疾病的治疗。然而,在AD的治疗中,其应用仍存在一定的局限性。本文综述了不同治疗参数对AD病人疗效的影响,发现高频重复经颅磁刺激(high frequency rTMS,H-rTMS)能够取得更显著的治疗效果。此外,本文进一步分析了H-rTMS治疗AD的病理生理学机制,并研究了H-rTMS与其他非药物治疗方式(如认知训练)联合应用所产生的综合效果,旨在为临床实践提供指导。

关键词: 经颅磁刺激, 阿尔茨海默病, 认知功能障碍, 认知训练

中图分类号:

R749.16

庞学妍, 李绪领. 高频重复经颅磁刺激治疗阿尔茨海默病的研究进展[J]. 实用老年医学, 2024, 38(6): 634-638.

参考文献

[1] WEI N, LIU H, YE W, et al. Repetitive transcranial magnetic stimulation may be superior to drug therapy in the treatment of Alzheimer’s disease: a systematic review and Bayesian network meta-analysis [J]. CNS Neurosci Ther, 2023, 29(10):2912-2924.
[2] CHOUNG J S, KIM J M, KO M H, et al. Therapeutic efficacy of repetitive transcranial magnetic stimulation in an animal model of Alzheimer’s disease [J]. Sci Rep, 2021, 11(1): 437.
[3] AHMED M A, DARWISH E S, KHEDR E M, et al. Effects of low versus high frequencies of repetitive transcranial magnetic stimulation on cognitive function and cortical excitability in Alzheimer’s dementia[J]. J Neurol, 2011, 259(1): 83-92.
[4] JIANG W, WU Z, WEN L, et al. The efficacy of high- or low-frequency transcranial magnetic stimulation in Alzheimer’s disease patients with behavioral and psychological symptoms of dementia[J]. Adv Ther, 2022, 39(1): 286-295.
[5] MANO T. Application of repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex in Alzheimer’s disease: a pilot study [J]. J Clin Med, 2022, 11(3): 798.
[6] ZHANG T, SUI Y, LU Q, et al. Effects of rTMS treatment on global cognitive function in Alzheimer’s disease: a systematic review and meta-analysis [J]. Front Aging Neurosci, 2022, 14: 984708.
[7] MOHAN A, ROBERTO A J, MOHAN A, et al. Focus: the aging brain: the significance of the default mode network (DMN) in neurological and neuropsychiatric disorders: a review [J]. Yale J Biol Med, 2016, 89(1): 49.
[8] KOCH G, BONNì S, PELLICCIARI M C, et al. Transcranial magnetic stimulation of the precuneus enhances memory and neural activity in prodromal Alzheimer’s disease [J]. Neuroimage, 2018, 169: 302-311.
[9] KOCH G, CASULA E P, BONNì S, et al. Precuneus magnetic stimulation for Alzheimer’s disease: a randomized, sham-controlled trial [J]. Brain, 2022, 145(11): 3776-3786.
[10] WEI L, ZHANG Y, WANG J, et al. Parietal-hippocampal rTMS improves cognitive function in Alzheimer’s disease and increases dynamic functional connectivity of default mode network [J]. Psychiatry Res, 2022, 315: 114721.
[11] VELIOGLU H A, HANOGLU L, BAYRAKTAROGLU Z, et al. Left lateral parietal rTMS improves cognition and modulates resting brain connectivity in patients with Alzheimer’s disease: possible role of BDNF and oxidative stress [J]. Neurobiol Learn Mem, 2021, 180: 107410.
[12] YAO Q, TANG F, WANG Y, et al. Effect of cerebellum stimulation on cognitive recovery in patients with Alzheimer disease: a randomized clinical trial [J]. Brain Stimul, 2022, 15(4): 910-920.
[13] TURI Z, LENZ M, PAULUS W, et al. Selecting stimulation intensity in repetitive transcranial magnetic stimulation studies: a systematic review between 1991 and 2020 [J]. Eur J Neurosci, 2021, 53(10): 3404-3415.
[14] CASH R, JEGATHEESWARAN G, NI Z, et al. Modulation of the direction and magnitude of hebbian plasticity in human motor cortex by stimulus intensity and concurrent inhibition [J]. Brain Stimul, 2017, 10(1): 83-90.
[15] LÜSCHER C, MALENKA R C. NMDA receptor-dependent long-term potentiation and long-term depression (LTP/LTD) [J]. Cold Spring Harb Perspect Biol, 2012, 4(6): a005710.
[16] WANG X, MAO Z, LING Z, et al. Repetitive transcranial magnetic stimulation for cognitive impairment in Alzheimer’s disease: a meta-analysis of randomized controlled trials [J]. J Neurol, 2020, 267(3): 791-801.
[17] 王金涛,黄蕾,魏丽丽,等. 重复经颅磁刺激治疗阿尔茨海默病患者的疗效影响因素[J]. 浙江大学学报(医学版), 2021, 50(3): 383-389.
[18] LIN Y, JIN J, LV R, et al. Repetitive transcranial magnetic stimulation increases the brain’s drainage efficiency in a mouse model of Alzheimer’s disease [J]. Acta Neuropathol Commun, 2021, 9(1): 102.
[19] LI K, WANG X, JIANG Y, et al. Early intervention attenuates synaptic plasticity impairment and neuroinflammation in 5xFAD mice [J]. J Psychiatr Res, 2021, 136: 204-216.
[20] BAI R, GUO J, YE X Y, et al. Oxidative stress: the core pathogenesis and mechanism of Alzheimer’s disease [J]. Ageing Res Rev, 2022, 77: 101619.
[21] WANG F, ZHANG Y, WANG L, et al. Improvement of spatial learning by facilitating large-conductance calcium-activated potassium channel with transcranial magnetic stimulation in Alzheimer’s disease model mice [J]. Neuropharmacology, 2015, 97: 210-219.
[22] MCNERNEY M W, HEATH A, NARAYANAN S K, et al. Repetitive transcranial magnetic stimulation improves brain-derived neurotrophic factor and cholinergic signaling in the 3xTgAD mouse model of alzheimer’s disease [J]. J Alzheimers Dis, 2022, 86(1): 499-507.
[23] KAUR S, DASGUPTA G, SINGH S. Altered neurochemistry in Alzheimer’s disease: targeting neurotransmitter receptor mechanisms and therapeutic strategy [J]. Neurophysiology, 2019, 51(4): 293-309.
[24] CHO S S, STRAFELLA A P. rTMS of the left dorsolateral prefrontal cortex modulates dopamine release in the ipsilateral anterior cingulate cortex and orbitofrontal cortex [J]. PloS One, 2009, 4(8): e6725.
[25] MAGEE J C, GRIENBERGER C. Synaptic plasticity forms and functions [J]. Annu Rev Neurosci, 2020, 43: 95-117.
[26] DI LORENZO F, PONZO V, BONNÌ S, et al. Long-term potentiation-like cortical plasticity is disrupted in Alzheimer’s disease patients independently from age of onset [J]. Ann Neurol, 2016, 80(2): 202-210.
[27] MOTTA C, DI LORENZO F, PONZO V, et al. Transcranial magnetic stimulation predicts cognitive decline in patients with Alzheimer’s disease [J]. J Neurol Neurosurg Psychiatry, 2018, 89(12): 1237-1242.
[28] DI LORENZO F, MOTTA C, BONNÌ S, et al. LTP-like cortical plasticity is associated with verbal memory impairment in Alzheimer’s disease patients [J]. Brain Stimul, 2019, 12(1): 148-151.
[29] LI X, QI G, YU C, et al. Cortical plasticity is correlated with cognitive improvement in Alzheimer’s disease patients after rTMS treatment [J]. Brain Stimul, 2021, 14(3): 503-510.
[30] REBOK G W, BALL K, GUEY L T, et al. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults [J]. J Am Geriatr Soc, 2014, 62(1): 16-24.
[31] HILL N T M, MOWSZOWSKI L, NAISMITH S L, et al. Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis [J]. Am J Psychiatry, 2022, 174(4): 329-340.
[32] BAGATTINI C, ZANNI M, BAROCCO F, et al. Enhancing cognitive training effects in Alzheimer’s disease: rTMS as an add-on treatment [J]. Brain Stimul, 2020, 13(6): 1655-1664.
[33] QIN Y, BA L, ZHANG F, et al. Cerebral blood flow changes induced by high-frequency repetitive transcranial magnetic stimulation combined with cognitive training in Alzheimer’s disease [J]. Front Neurol, 2023, 14: 1037864.
[34] ZHANG F, QIN Y, XIE L, et al. High-frequency repetitive transcranial magnetic stimulation combined with cognitive training improves cognitive function and cortical metabolic ratios in Alzheimer’s disease [J]. J Neural Transm, 2019, 126(8): 1081-1094.
[35] ROSSI S, HALLETT M, ROSSINI P M, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research [J]. Clin Neurophysiol, 2009, 120(12): 2008-2039.