经颅直流电刺激可调节轻中度创伤性脑损伤后的工作记忆和前额叶-脑岛连接。

Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury.

作者信息

Quinn Davin K, Story-Remer Jacqueline, Brandt Emma, Fratzke Violet, Rieger Rebecca, Wilson John Kevin, Gill Darbi, Mertens Nickolas, Hunter Michael, Upston Joel, Jones Thomas R, Richardson Jessica D, Myers Orrin, Arciniegas David B, Campbell Richard, Clark Vincent P, Yeo Ronald A, Shuttleworth C William, Mayer Andrew R

机构信息

Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States.

Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.

出版信息

Front Hum Neurosci. 2022 Oct 13;16:1026639. doi: 10.3389/fnhum.2022.1026639. eCollection 2022.

Abstract

Persistent posttraumatic symptoms (PPS) may manifest after a mild-moderate traumatic brain injury (mmTBI) even when standard brain imaging appears normal. Transcranial direct current stimulation (tDCS) represents a promising treatment that may ameliorate pathophysiological processes contributing to PPS. We hypothesized that in a mmTBI population, active tDCS combined with training would result in greater improvement in executive functions and post-TBI cognitive symptoms and increased resting state connectivity of the stimulated region, i.e., left dorsolateral prefrontal cortex (DLPFC) compared to control tDCS. Thirty-four subjects with mmTBI underwent baseline assessments of demographics, symptoms, and cognitive function as well as resting state functional magnetic resonance imaging (rsfMRI) in a subset of patients ( = 24). Primary outcome measures included NIH EXAMINER composite scores, and the Neurobehavioral Symptom Inventory (NSI). All participants received 10 daily sessions of 30 min of executive function training coupled with active or control tDCS (2 mA, anode F3, cathode right deltoid). Imaging and assessments were re-obtained after the final training session, and assessments were repeated after 1 month. Mixed-models linear regression and repeated measures analyses of variance were calculated for main effects and interactions. Both active and control groups demonstrated improvements in executive function (EXAMINER composite: < 0.001) and posttraumatic symptoms (NSI cognitive: = 0.01) from baseline to 1 month. Active anodal tDCS was associated with greater improvements in working memory reaction time compared to control ( = 0.007). Reaction time improvement correlated significantly with the degree of connectivity change between the right DLPFC and the left anterior insula ( = 0.02). Anodal tDCS improved reaction time on an online working memory task in a mmTBI population, and decreased connectivity between executive network and salience network nodes. These findings generate important hypotheses for the mechanism of recovery from PPS after mild-moderate TBI.

摘要

即使标准脑成像显示正常,轻度至中度创伤性脑损伤(mmTBI)后仍可能出现持续性创伤后症状(PPS)。经颅直流电刺激(tDCS)是一种很有前景的治疗方法,可能改善导致PPS的病理生理过程。我们假设,在mmTBI人群中,与对照tDCS相比,主动tDCS联合训练将使执行功能和创伤性脑损伤后认知症状有更大改善,并增加受刺激区域(即左侧背外侧前额叶皮层,DLPFC)的静息态连接性。34名mmTBI患者接受了人口统计学、症状和认知功能的基线评估,部分患者(n = 24)还进行了静息态功能磁共振成像(rsfMRI)。主要结局指标包括美国国立卫生研究院检查者综合评分和神经行为症状量表(NSI)。所有参与者每天接受10次、每次30分钟的执行功能训练,并结合主动或对照tDCS(2 mA,阳极置于F3,阴极置于右侧三角肌)。在最后一次训练后重新进行成像和评估,并在1个月后重复评估。计算混合模型线性回归和重复测量方差分析以分析主要效应和相互作用。从基线到1个月,主动组和对照组的执行功能(检查者综合评分:P < 0.001)和创伤后症状(NSI认知评分:P = 0.01)均有改善。与对照组相比,主动阳极tDCS使工作记忆反应时间有更大改善(P = 0.007)。反应时间的改善与右侧DLPFC和左侧前岛叶之间的连接性变化程度显著相关(P = 0.02)。阳极tDCS改善了mmTBI人群在线工作记忆任务中的反应时间,并降低了执行网络和突显网络节点之间的连接性。这些发现为轻度至中度TBI后PPS的恢复机制提出了重要假设。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef51/9608772/c6ec1674cedb/fnhum-16-1026639-g0001.jpg

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