Rombouts S A R B, Barkhof F, Van Meel C S, Scheltens P
Department of Neurology/Alzheimer Centre, Vrije Universiteit Medical Centre, Amsterdam, Netherlands.
J Neurol Neurosurg Psychiatry. 2002 Dec;73(6):665-71. doi: 10.1136/jnnp.73.6.665.
Rivastigmine enhances cholinergic activity and has been shown in clinical trials to decrease the rate of deterioration in Alzheimer's disease. It remains unclear where in the brain it exerts its effect. Functional magnetic resonance imaging (fMRI) can be used to measure changes in brain function and relate these to cognition.
To use fMRI to study brain activation with rivastigmine treatment.
The effect on brain activation of a single dose of rivastigmine was tested in seven patients with mild Alzheimer's disease using fMRI during face encoding, and in five patients during a parametric working memory task.
During face encoding, rivastigmine increased bilateral activation in the fusiform gyrus. Brain activation was also enhanced in the prefrontal cortex in a simple working memory task. When working memory load was further increased, not only was increased activation seen, but in certain areas there was also decreased activation.
These findings link the previously observed increase in cognitive performance in Alzheimer's disease after treatment with a cholinesterase inhibitor to altered brain activation. Although the results cannot be generalised to the Alzheimer's disease population at large, they provide evidence that in mild Alzheimer's disease, rivastigmine enhances brain activation in the fusiform and frontal cortices. This is compatible with the concept of cholinergic circuitry.
卡巴拉汀可增强胆碱能活性，临床试验表明其能降低阿尔茨海默病的病情恶化速率。目前尚不清楚其在大脑中的作用部位。功能磁共振成像（fMRI）可用于测量脑功能变化并将其与认知联系起来。
使用fMRI研究卡巴拉汀治疗时的脑激活情况。
在七名轻度阿尔茨海默病患者进行面部编码期间，以及五名患者进行参数化工作记忆任务期间，使用fMRI测试单剂量卡巴拉汀对脑激活的影响。
在面部编码期间，卡巴拉汀增加了梭状回的双侧激活。在简单工作记忆任务中，前额叶皮质的脑激活也增强。当工作记忆负荷进一步增加时，不仅激活增加，而且在某些区域激活也减少。
这些发现将先前观察到的胆碱酯酶抑制剂治疗后阿尔茨海默病认知能力提高与脑激活改变联系起来。虽然结果不能推广到整个阿尔茨海默病患者群体，但它们提供了证据，表明在轻度阿尔茨海默病中，卡巴拉汀可增强梭状回和额叶皮质的脑激活。这与胆碱能神经回路的概念相符。
