经颅直流电刺激背外侧前额叶可改善帕金森病患者的双重任务步态表现：一项双盲、 sham 对照研究。
Transcranial direct current stimulation of dorsolateral prefrontal cortex improves dual-task gait performance in patients with Parkinson's disease: A double blind, sham-controlled study.
机构信息
Center for Neuromotor and Biomechanics Research, University of Houston, TX, USA.
Center for Neuromotor and Biomechanics Research, University of Houston, TX, USA.
出版信息
Gait Posture. 2021 Feb;84:11-16. doi: 10.1016/j.gaitpost.2020.11.012. Epub 2020 Nov 16.
BACKGROUND
Despite advances in pharmacological treatments and surgical processes, the problem of impaired dual-tasking persists in people with Parkinson's disease (PD). Recently, transcranial direct current stimulation (tDCS) applied to the dorsolateral prefrontal cortex (DLPFC) has shown the potential to improve dual-task walking.
RESEARCH QUESTION
Can combining left DLPFC stimulation using tDCS with dual-task performance reduce the cost of dual-tasking in individuals with PD?
METHODS
We conducted a sham-controlled, cross-over, and double-blind study to investigate the effect of combining tDCS with the dual-task walk and its sustained effects among people with PD. Twenty participants with PD completed two sessions (anodal or sham tDCS) with at least a 1-week gap. Stimulation involved transferring 2 mA current through the left DLPFC for 30 min. Single- and dual-task gait was assessed before, during, immediately after, 15, and 30 min after stimulation ceased. Phoneme verbal fluency task was given as the cognitive distractor during dual task.
RESULTS AND CONCLUSION
The results of this study show that in the dual-task condition, participants walked faster at fifteen minutes (p = 0.017) and thirty minutes (p < 0.01) after anodal tDCS ceased compared to sham. Similarly, participants generated a higher number of words per minute at fifteen minutes (p = 0.017), and thirty minutes (p < 0.01) after anodal tDCS ceased compared to sham. Furthermore, the dual-task cost (DTC) associated with gait speed was significantly lower (p = 0.022) at fifteen minutes after anodal tDCS compared to sham tDCS. However, no significant effect of tDCS was observed on gait and cognitive performance under the single-task condition. In conclusion, left DLPFC stimulation can improve dual-tasking in participants with PD and the peaking of the tDCS effect was observed at fifteen minutes after stimulation ceased.
背景
尽管在药物治疗和手术过程方面取得了进展，但帕金森病（PD）患者的双重任务执行能力受损问题仍然存在。最近，经颅直流电刺激（tDCS）作用于背外侧前额叶皮层（DLPFC）已显示出改善双重任务行走的潜力。
研究问题
左 DLPFC 刺激与双重任务表现相结合是否可以降低 PD 患者的双重任务成本？
方法
我们进行了一项假刺激对照、交叉和双盲研究，以调查 tDCS 与双重任务行走相结合及其在 PD 患者中的持续效果。20 名 PD 患者完成了两次治疗（阳极或假刺激 tDCS），两次治疗之间至少间隔 1 周。刺激包括通过左 DLPFC 传递 2 mA 电流 30 分钟。在刺激之前、期间、立即之后、15 分钟和 30 分钟后评估单任务和双重任务步态。在双重任务中，语音流畅性任务作为认知干扰。
结果与结论
该研究结果表明，在双重任务条件下，与假刺激相比，阳极 tDCS 停止后 15 分钟（p = 0.017）和 30 分钟（p < 0.01）时，参与者行走速度更快。同样，与假刺激相比，阳极 tDCS 停止后 15 分钟（p = 0.017）和 30 分钟（p < 0.01）时，参与者每分钟产生的单词数更高。此外，与假刺激相比，阳极 tDCS 停止后 15 分钟时，与步态速度相关的双重任务成本（DTC）显著降低（p = 0.022）。然而，在单任务条件下，tDCS 没有显著影响步态和认知表现。总之，左 DLPFC 刺激可以改善 PD 患者的双重任务表现，刺激效果的峰值出现在刺激停止后 15 分钟。
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