重复经颅磁刺激治疗抑郁症的认知效应
Cognitive effects of treatment of depression with repetitive transcranial magnetic stimulation.
作者信息
Nadeau Stephen E, Bowers Dawn, Jones Tamekia L, Wu Samuel S, Triggs William J, Heilman Kenneth M
机构信息
*Research Service and Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center, and Department of Neurology, University of Florida College of Medicine, Gainesville, FL ∥Neurology Service, Malcom Randall Veterans Affairs Medical Center, and Department of Neurology, University of Florida College of Medicine, Gainesville, FL ¶Geriatric Research, Education, and Clinical Center and Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center, and Department of Neurology, University of Florida College of Medicine, Gainesville, FL †Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL ‡Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN §Department of Biostatistics, University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL.
出版信息
Cogn Behav Neurol. 2014 Jun;27(2):77-87. doi: 10.1097/WNN.0000000000000031.
BACKGROUND AND OBJECTIVE
We previously reported a randomized, sham-controlled trial of 5 Hz dorsolateral prefrontal left- and right-side repetitive transcranial magnetic stimulation (rTMS) in 48 participants with a medically refractory major depressive disorder. Depression improved most with right-side cranial stimulation, both rTMS and sham, and to a lesser degree with left rTMS. Because depression is often associated with cognitive impairment, in this study we sought to determine whether our earlier participants had treatment-induced changes in cognition, which cognitive domains (language, executive, visuospatial, verbal episodic memory, attention) were affected, and whether treatment-induced cognitive changes were related either to improvement in depression or to other treatment variables, such as right versus left treatment and rTMS versus sham.
METHODS
We used hierarchical regression analyses to determine how variables measured at baseline or associated with treatment affected changes in neuropsychological functions. The variables were neuropsychological function in the 5 domains, severity of depression, change in depression with treatment, rTMS versus sham, laterality of stimulation, and rTMS-laterality interaction.
RESULTS
Compared to sham, right rTMS was associated with 1.24 standard deviations greater gain in language function, 1.09 standard deviations greater gain in visuospatial function, and 2.38 standard deviations greater gain in verbal episodic memory than left rTMS. These improvements did not appear to be directly related to the relief from depression.
CONCLUSIONS
Our results suggest that disorders of cognition and mood in depression may have different mechanisms, but right rTMS may treat both. We propose potential mechanisms underlying the right-side rTMS effect.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.gov NCT00711568.
背景与目的
我们之前报告了一项针对48名患有药物难治性重度抑郁症患者的随机、假对照试验，该试验采用5赫兹左右侧背外侧前额叶重复经颅磁刺激（rTMS）。右侧颅骨刺激（包括rTMS和假刺激）对抑郁症的改善最为明显，左侧rTMS的改善程度较小。由于抑郁症常与认知障碍相关，在本研究中，我们试图确定我们早期的参与者是否有治疗引起的认知变化，哪些认知领域（语言、执行功能、视觉空间、言语情景记忆、注意力）受到影响，以及治疗引起的认知变化是否与抑郁症的改善或其他治疗变量相关，如右侧与左侧治疗以及rTMS与假刺激。
方法
我们使用分层回归分析来确定在基线测量或与治疗相关的变量如何影响神经心理功能的变化。这些变量包括5个领域的神经心理功能、抑郁严重程度、治疗引起的抑郁变化、rTMS与假刺激、刺激的侧别以及rTMS - 侧别相互作用。
结果
与假刺激相比，右侧rTMS在语言功能方面的增益比左侧rTMS高1.24个标准差，在视觉空间功能方面高1.09个标准差，在言语情景记忆方面高2.38个标准差。这些改善似乎与抑郁症的缓解没有直接关系。
结论
我们的结果表明，抑郁症中的认知和情绪障碍可能有不同的机制，但右侧rTMS可能对两者都有治疗作用。我们提出了右侧rTMS效应的潜在机制。
临床试验注册
Clinicaltrials.gov NCT00711568。
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