Martin Donel M, Berryhill Marian E, Dielenberg Victoria
Sydney Neurostimulation Centre, Discipline of Psychiatry and Mental Health UNSW, Black Dog Institute, Sydney, New South Wales, Australia.
Memory and Brain Lab, Programs in Cognitive and Brain Sciences, and Integrative Neuroscience, University of Nevada, Reno, NV, USA.
Restor Neurol Neurosci. 2022;40(4-6):241-259. doi: 10.3233/RNN-211230.
Many psychiatric and neurological conditions are associated with cognitive impairment for which there are very limited treatment options. Brain stimulation methodologies show promise as novel therapeutics and have cognitive effects. Electroconvulsive therapy (ECT), known more for its related transient adverse cognitive effects, can produce significant cognitive improvement in the weeks following acute treatment. Transcranial magnetic stimulation (TMS) is increasingly used as a treatment for major depression and has acute cognitive effects. Emerging research from controlled studies suggests that repeated TMS treatments may additionally have cognitive benefit. ECT and TMS treatment cause neurotrophic changes, although whether these are associated with cognitive effects remains unclear. Transcranial electrical stimulation methods including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) are in development as novel treatments for multiple psychiatric conditions. These treatments may also produce cognitive enhancement particularly when stimulation occurs concurrently with a cognitive task. This review summarizes the current clinical evidence for these brain stimulation treatments as therapeutics for enhancing cognition. Acute, or short-lasting, effects as well as longer-term effects from repeated treatments are reviewed, together with potential putative neural mechanisms. Areas of future research are highlighted to assist with optimization of these approaches for enhancing cognition.
许多精神和神经疾病都与认知障碍相关，而针对这些认知障碍的治疗选择非常有限。脑刺激方法作为新型治疗手段显示出前景，且具有认知效应。电休克疗法（ECT），更多地因其相关的短暂不良认知效应而为人所知，但在急性治疗后的几周内可产生显著的认知改善。经颅磁刺激（TMS）越来越多地被用作治疗重度抑郁症的方法，并且具有急性认知效应。来自对照研究的新研究表明，重复进行TMS治疗可能还具有认知益处。ECT和TMS治疗会引起神经营养变化，尽管这些变化是否与认知效应相关仍不清楚。包括经颅直流电刺激（tDCS）和经颅交流电刺激（tACS）在内的经颅电刺激方法正在开发中，作为治疗多种精神疾病的新型疗法。这些治疗也可能产生认知增强作用，尤其是当刺激与认知任务同时发生时。本综述总结了这些脑刺激治疗作为增强认知的疗法的当前临床证据。对急性或短期效应以及重复治疗的长期效应进行了综述，并探讨了潜在的假定神经机制。强调了未来的研究领域，以帮助优化这些增强认知的方法。
