Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States of America.
Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America.
PLoS One. 2022 Jun 3;17(6):e0269491. doi: 10.1371/journal.pone.0269491. eCollection 2022.
Neuronal dysfunction plays an important role in the high prevalence of HIV-associated neurocognitive disorders (HAND) in people with HIV (PWH). Transcranial direct current stimulation (tDCS)-with its capability to improve neuronal function-may have the potential to serve as an alternative therapeutic approach for HAND. Brain imaging and neurobehavioral studies provide converging evidence that injury to the anterior cingulate cortex (ACC) is highly prevalent and contributes to HAND in PWH, suggesting that ACC may serve as a potential neuromodulation target for HAND. Here we conducted a randomized, double-blind, placebo-controlled, partial crossover pilot study to test the safety, tolerability, and potential efficacy of anodal tDCS over cingulate cortex in adults with HIV, with a focus on the dorsal ACC (dACC).
Eleven PWH (47-69 years old, 2 females, 100% African Americans, disease duration 16-36 years) participated in the study, which had two phases, Phase 1 and Phase 2. During Phase 1, participants were randomized to receive ten sessions of sham (n = 4) or cingulate tDCS (n = 7) over the course of 2-3 weeks. Treatment assignments were unknown to the participants and the technicians. Neuropsychology and MRI data were collected from four additional study visits to assess treatment effects, including one baseline visit (BL, prior to treatment) and three follow-up visits (FU1, FU2, and FU3, approximately 1 week, 3 weeks, and 3 months after treatment, respectively). Treatment assignment was unblinded after FU3. Participants in the sham group repeated the study with open-label cingulate tDCS during Phase 2. Statistical analysis was limited to data from Phase 1.
Compared to sham tDCS, cingulate tDCS led to a decrease in Perseverative Errors in Wisconsin Card Sorting Test (WCST), but not Non-Perseverative Errors, as well as a decrease in the ratio score of Trail Making Test-Part B (TMT-B) to TMT-Part A (TMT-A). Seed-to-voxel analysis with resting state functional MRI data revealed an increase in functional connectivity between the bilateral dACC and a cluster in the right dorsal striatum after cingulate tDCS. There were no differences in self-reported discomfort ratings between sham and cingulate tDCS.
Cingulate tDCS is safe and well-tolerated in PWH, and may have the potential to improve cognitive performance and brain function. A future study with a larger sample is warranted.
神经元功能障碍在 HIV 相关认知障碍（HAND）的高患病率中起着重要作用。经颅直流电刺激（tDCS）具有改善神经元功能的能力，可能有潜力作为 HAND 的替代治疗方法。脑影像学和神经行为研究提供了一致的证据，表明前扣带皮层（ACC）的损伤非常普遍，并导致 HIV 感染者（PWH）HAND，表明 ACC 可能是 HAND 的潜在神经调节靶点。在这里，我们进行了一项随机、双盲、安慰剂对照、部分交叉试验研究，以测试阳极 tDCS 对 HIV 成人背侧 ACC（dACC）的安全性、耐受性和潜在疗效。
11 名 PWH（47-69 岁，女性 2 名，100%非裔美国人，病程 16-36 年）参加了这项研究，该研究分为两个阶段，第 1 阶段和第 2 阶段。在第 1 阶段，参与者随机分为 sham（n = 4）或 cingulate tDCS（n = 7）组，在 2-3 周内接受十次治疗。参与者和技术人员均不知道治疗分配。在评估治疗效果的四个额外研究访问中收集神经心理学和 MRI 数据，包括一个基线访问（BL，在治疗前）和三个随访访问（FU1、FU2 和 FU3，分别约在治疗后 1 周、3 周和 3 个月）。FU3 后治疗分配被揭开。在第 2 阶段，sham 组接受开放标签的背侧 ACC tDCS 重复研究。统计分析仅限于第 1 阶段的数据。
与 sham tDCS 相比，背侧 ACC tDCS 导致威斯康星卡片分类测验（WCST）中持续性错误减少，但非持续性错误没有减少，同时 Trail Making Test-Part B（TMT-B）与 TMT-Part A（TMT-A）的比值降低。静息态功能磁共振成像数据的种子到体素分析显示，背侧 ACC 双侧与右侧背侧纹状体的一个簇之间的功能连接增加。 sham 和背侧 ACC tDCS 之间的自我报告不适感评分没有差异。
背侧 ACC tDCS 在 HIV 感染者中是安全且耐受良好的，并且可能有潜力改善认知表现和大脑功能。需要更大样本的未来研究。
