Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
Brain Topogr. 2021 Jul;34(4):461-466. doi: 10.1007/s10548-021-00836-2. Epub 2021 Apr 8.
The clock drawing test (CDT) is widely used in clinical neuropsychological practice. However, its neuroanatomical correlates have not been well established. This study investigated the effects of theta burst stimulation (TBS) applied over different brain regions on CDT scores in patients with Alzheimer's disease (AD). The 10-20 positions F3, F4, T3, T4, TP3, TP4, P3, P4, as determined by a 10-20 positioning cap, were targeted. Excitatory intermittent TBS (iTBS) was given over the above-mentioned eight regions to ten AD patients and ten control subjects on separate days. CDT was administered at baseline (T0), during the 5 min following the TBS (T1) and 60 min after TBS (T2), with an inter-session interval of at least 4 days. iTBS over TP4 and P4 transiently increased Rouleau CDT score in AD patients. When targeting TP4 and P4, mainly the area of the supramarginal/angular gyrus and the inferior parietal lobe, corresponding respectively to the Brodmann areas 40/39 and 7/40, are reached. iTBS thus seems able to modulate activity of the right posterior parietal cortex in AD patients performing the CDT. Our results provide physiological evidence that those parietal regions are functionally important for the execution of the Rouleau CDT. This finding suggests that CDT has reliable neuroanatomical correlates, and support the notion that this test can be used as a good marker of right parietal brain dysfunction. The present study also highlights the therapeutic potential of the induction of neuromodulatory effects using non-invasive brain stimulation techniques.
画钟测验（CDT）在临床神经心理学实践中得到广泛应用。然而，其神经解剖学相关性尚未得到很好的确定。本研究旨在探讨经颅磁刺激（TBS）应用于不同脑区对阿尔茨海默病（AD）患者 CDT 评分的影响。根据 10-20 定位帽，选取 F3、F4、T3、T4、TP3、TP4、P3、P4 的 10-20 位置作为靶点。在不同的日子里，10 名 AD 患者和 10 名对照者分别接受了上述 8 个区域的兴奋性间歇性 TBS（iTBS）刺激。在基线（T0）、TBS 后 5 分钟（T1）和 TBS 后 60 分钟（T2）进行 CDT，两次测试之间的间隔至少为 4 天。iTBS 刺激 TP4 和 P4 可使 AD 患者的 Rouleau CDT 评分短暂升高。当刺激 TP4 和 P4 时，主要刺激到顶下小叶和下顶叶的区域，分别对应 Brodmann 区 40/39 和 7/40。因此，iTBS 似乎能够调节 AD 患者执行 CDT 时的右后顶叶皮质的活动。我们的结果提供了生理证据，表明这些顶叶区域在执行 Rouleau CDT 中具有重要的功能。这一发现表明 CDT 具有可靠的神经解剖学相关性，并支持了该测试可作为右顶叶脑功能障碍的良好标志物的观点。本研究还强调了使用非侵入性脑刺激技术诱导神经调节效应的治疗潜力。
