Department of Neurology, University Campus Biomedico, Via Alvaro del Portillo 200, Rome, Italy.
Neurosci Lett. 2011 Apr 1;492(2):94-8. doi: 10.1016/j.neulet.2011.01.064. Epub 2011 Jan 31.
Transient cognitive and behavioral stabilization of patients with Alzheimer's disease (AD) is the main goal of acetylcholinesterase inhibitor (AChEI) therapy. Response to treatment is variable and it is usually assessed clinically via neuropsychological scales. Functional neuroimaging could ideally permit the objective evaluation of the topographic correlates of therapy on brain functioning, but is expensive and little available on a large scale. On the other hand, neurophysiological methods such as transcranial magnetic stimulation (TMS) could offer an alternative, low-cost and risk free tool of assessing response to treatment in AD. Previous TMS studies have demonstrated hyperexcitability and asymptomatic motor cortex reorganization in the early stages of AD in patients with normal motor function. The aim of this study was to compare motor cortex functionality in 10 AD patients before and after long-term AchEIs therapy in order to monitor potential drug-related changes in cortical excitability and organization. Examined parameters of motor cortex physiology were found to be unchanged in patients with stabilized cognitive performance during the therapy. TMS, along with clinical, neuropsychological, and neuroimaging data, could be an inexpensive measure of biological progression in AD and it might supplement traditional methods to assess the effects of therapy.
阿尔茨海默病（AD）患者的认知和行为短暂稳定是乙酰胆碱酯酶抑制剂（AChEI）治疗的主要目标。治疗反应具有变异性，通常通过神经心理学量表进行临床评估。功能神经影像学可以理想地允许对治疗对大脑功能的拓扑相关性进行客观评估，但费用昂贵，大规模应用较少。另一方面，神经生理学方法，如经颅磁刺激（TMS），可以提供一种替代的、低成本和无风险的工具，用于评估 AD 患者的治疗反应。先前的 TMS 研究表明，在运动功能正常的 AD 早期患者中，运动皮层存在过度兴奋和无症状的运动皮层重组。本研究旨在比较 10 例 AD 患者在长期 AchEIs 治疗前后的运动皮层功能，以监测皮质兴奋性和组织潜在的药物相关变化。在治疗过程中认知表现稳定的患者中，运动皮层生理学的检查参数没有变化。TMS 与临床、神经心理学和神经影像学数据一起，可能是 AD 生物学进展的一种廉价衡量标准，它可能会补充传统方法来评估治疗效果。
