Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Institut Guttmann de Neurorehabilitació, Universitat Autonoma de Barcelona, Badalona, Spain.
Curr Opin Neurol. 2019 Apr;32(2):292-304. doi: 10.1097/WCO.0000000000000669.
Alzheimer's disease is a progressive neurodegenerative disease without effective pharmacological treatment. Noninvasive brain stimulation (NIBS) techniques, such as repetitive transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES), are increasingly being investigated for their potential to ameliorate the symptoms of Alzheimer's disease and related dementias (ADRD).
A comprehensive literature review for primary research reports that investigated the ability of TMS/tES to improve cognition in ADRD patients yielded a total of 20 reports since 2016. Eight studies used repetitive TMS and 12 used transcranial direct current stimulation, the most common form of tES. Eight of the studies combined NIBS with cognitive training. Promising results should encourage continued investigation, however there is currently insufficient evidence to support widespread adoption of NIBS-based clinical treatments for ADRD.
NIBS remains an active area of investigation for treatment of ADRD, though the predominance of small, heterogeneous, proof-of-principle studies precludes definitive conclusions. We propose the establishment of a consortium to achieve the benefits of large-scale, controlled studies using biomarker-based diagnostic characterization of participants, development of neurophysiological markers to verify target engagement, and standardization of parameters.
阿尔茨海默病是一种进行性神经退行性疾病，目前尚无有效的药物治疗方法。非侵入性脑刺激（NIBS）技术，如重复经颅磁刺激（TMS）和经颅电刺激（tES），因其具有改善阿尔茨海默病和相关痴呆（ADRD）症状的潜力而越来越受到关注。
对自 2016 年以来调查 TMS/tES 改善 ADRD 患者认知能力的主要研究报告进行了全面的文献综述，共得到 20 份报告。八项研究使用重复 TMS，十二项研究使用经颅直流电刺激，这是 tES 最常见的形式。八项研究将 NIBS 与认知训练相结合。有希望的结果应该鼓励继续进行研究，然而，目前没有足够的证据支持广泛采用基于 NIBS 的 ADRD 临床治疗。
NIBS 仍然是治疗 ADRD 的一个活跃研究领域，尽管大多数是小规模、异质、原理验证研究，无法得出明确的结论。我们建议成立一个联盟，以利用基于生物标志物的参与者诊断特征来实现大规模、对照研究的优势，开发神经生理学标记物来验证目标参与，并使参数标准化。
