Elder Greg J, Taylor John-Paul
Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
Alzheimers Res Ther. 2014 Nov 10;6(9):74. doi: 10.1186/s13195-014-0074-1. eCollection 2014.
Two methods of non-invasive brain stimulation, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have demonstrable positive effects on cognition and can ameliorate neuropsychiatric symptoms such as depression. Less is known about the efficacy of these approaches in common neurodegenerative diseases. In this review, we evaluate the effects of TMS and tDCS upon cognitive and neuropsychiatric symptoms in the major dementias, including Alzheimer's disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), and frontotemporal dementia (FTD), as well as the potential pre-dementia states of Mild Cognitive Impairment (MCI) and Parkinson's disease (PD).
PubMed (until 7 February 2014) and PsycINFO (from 1967 to January Week 3 2014) databases were searched in a semi-systematic manner in order to identify relevant treatment studies. A total of 762 studies were identified and 32 studies (18 in the dementias and 14 in PD populations) were included.
No studies were identified in patients with PDD, FTD or VaD. Of the dementias, 13 studies were conducted in patients with AD, one in DLB, and four in MCI. A total of 16 of the 18 studies showed improvements in at least one cognitive or neuropsychiatric outcome measure. Cognitive or neuropsychiatric improvements were observed in 12 of the 14 studies conducted in patients with PD.
Both TMS and tDCS may have potential as interventions for the treatment of symptoms associated with dementia and PD. These results are promising; however, available data were limited, particularly within VaD, PDD and FTD, and major challenges exist in order to maximise the efficacy and clinical utility of both techniques. In particular, stimulation parameters vary considerably between studies and are likely to subsequently impact upon treatment efficacy.
两种非侵入性脑刺激方法，即经颅磁刺激（TMS）和经颅直流电刺激（tDCS），已被证明对认知有积极影响，并可改善抑郁等神经精神症状。关于这些方法在常见神经退行性疾病中的疗效，人们了解较少。在本综述中，我们评估了TMS和tDCS对主要痴呆症（包括阿尔茨海默病（AD）、血管性痴呆（VaD）、路易体痴呆（DLB）、帕金森病痴呆（PDD）和额颞叶痴呆（FTD））以及轻度认知障碍（MCI）和帕金森病（PD）等潜在的痴呆前期状态的认知和神经精神症状的影响。
以半系统的方式检索了PubMed（截至2014年2月7日）和PsycINFO（从1967年至2014年第3周）数据库，以确定相关的治疗研究。共识别出762项研究，纳入了32项研究（18项针对痴呆症患者，14项针对帕金森病患者）。
未发现针对PDD、FTD或VaD患者的研究。在痴呆症方面，13项研究针对AD患者进行，1项针对DLB患者，4项针对MCI患者。18项研究中的16项显示至少一项认知或神经精神结局指标有所改善。在针对帕金森病患者进行的14项研究中，12项观察到了认知或神经精神方面的改善。
TMS和tDCS都可能有潜力作为治疗与痴呆症和帕金森病相关症状的干预措施。这些结果很有前景；然而，现有数据有限，特别是在VaD、PDD和FTD方面，并且为了使这两种技术的疗效和临床实用性最大化，还存在重大挑战。特别是，不同研究之间的刺激参数差异很大，可能会随后影响治疗效果。
