Orlov Natasza D, Tracy Derek K, Joyce Daniel, Patel Shinal, Rodzinka-Pasko Joanna, Dolan Hayley, Hodsoll John, Collier Tracy, Rothwell John, Shergill Sukhwinder S
Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Oxleas National Health Service (NHS) Trust, London, United Kingdom.
Brain Stimul. 2017 May-Jun;10(3):560-566. doi: 10.1016/j.brs.2016.12.013. Epub 2016 Dec 28.
Schizophrenia is characterized by prominent cognitive deficits, impacting on memory and learning; these are strongly associated with the prefrontal cortex.
OBJECTIVE/HYPOTHESIS: To combine two interventions, transcranial direct current stimulation (tDCS) over the prefrontal cortex and cognitive training, to examine change in cognitive performance in patients with schizophrenia.
A double blind, sham-controlled pilot study of 49 patients with schizophrenia, randomized into real or sham tDCS stimulation groups. Subjects participated in 4 days of cognitive training (days 1, 2, 14, 56) with tDCS applied at day-1 and day-14. The primary outcome measure was change in accuracy on working memory and implicit learning tasks from baseline. The secondary outcome measure was the generalization of learning to non-trained task, indexed by the CogState neuropsychological battery. Data analysis was conducted using multilevel modelling and multiple regressions.
24 participants were randomized to real tDCS and 25 to sham. The working memory task demonstrated a significant mean difference in performance in the tDCS treatment group: at day-2 (b = 0.68, CI 0.14-1.21; p = 0.044) and at day-56 (b = 0.71, 0.16-1.26; p = 0.044). There were no significant effects of tDCS on implicit learning. Trend evidence of generalization onto untrained tasks of attention and vigilance task (b = 0.40, 0.43-0.77; p = 0.058) was found.
This is the first study to show a significant longer-term effect of tDCS on working memory in schizophrenia. Given the current lack of effective therapies for cognitive deficits, tDCS may offer an important novel approach to modulating brain networks to ameliorate cognitive deficits in schizophrenia.
精神分裂症的特征是存在显著的认知缺陷，影响记忆和学习；这些缺陷与前额叶皮质密切相关。
目的/假设：将两种干预措施相结合，即对前额叶皮质进行经颅直流电刺激（tDCS）和认知训练，以研究精神分裂症患者认知表现的变化。
一项针对49例精神分裂症患者的双盲、假刺激对照试验性研究，随机分为真正的tDCS刺激组或假刺激组。受试者参加为期4天的认知训练（第1天、第2天、第14天、第56天），tDCS在第1天和第14天应用。主要结局指标是工作记忆和内隐学习任务的准确性相对于基线的变化。次要结局指标是学习向未训练任务的泛化，由CogState神经心理成套测验进行评估。数据分析采用多水平模型和多重回归。
24名参与者被随机分配到真正的tDCS组，25名被分配到假刺激组。工作记忆任务显示tDCS治疗组在表现上有显著的平均差异：在第2天（b = 0.68，CI 0.14 - 1.21；p = 0.044）和第56天（b = 0.71，0.16 - 1.26；p = 0.044）。tDCS对内隐学习没有显著影响。发现了注意力和警觉任务向未训练任务泛化的趋势性证据（b = 0.40，0.43 - 0.77；p = 0.058）。
这是第一项显示tDCS对精神分裂症患者工作记忆有显著长期影响的研究。鉴于目前缺乏针对认知缺陷的有效疗法，tDCS可能为调节脑网络以改善精神分裂症患者的认知缺陷提供一种重要的新方法。
