Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, China.
Department of Neurology, Nanjing Drum Tower Hospital of The Affiliated Hospital of Nanjing University Medical School, and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing 210008, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing 210008, China; Nanjing Neuropsychiatry Clinic Medical Center, Nanjing 210008, China.
Behav Brain Res. 2023 Feb 15;439:114226. doi: 10.1016/j.bbr.2022.114226. Epub 2022 Nov 24.
Default-mode network (DMN) may be the earliest affected network and is associated with cognitive decline in Alzheimer's disease (AD). Repetitive transcranial magnetic stimulation (rTMS) may help to modulate DMN plasticity. Still, stimulation effects substantially vary across studies and individuals. Global left frontal cortex (gLFC) connectivity, a substitute for reserve capacity, may contribute to the heterogeneous physiological effects of neuro-navigated rTMS. This study investigated the effects of left angular gyrus-navigated rTMS on DMN connectivity in different reserve capacity participants. gLFC connectivity, was computed through resting-state fMRI correlations. Thirty-one prodromal AD patients were divided into low connection group (LCG) and high connection group (HCG) by the median of gLFC connectivity. Distinct reserve capacity impacts on DMN in response to rTMS were identified in these two groups. Then, brain-behavior relationships were examined. gLFC connectivity within a certain range is directly proportional to cognitive reserve ability (i.e., LCG), and the effectiveness of functional connectivity beyond this range decreases (i.e, HCG). Moreover, LCG exhibited increased DMN connectivity and significantly positive memory improvements, while HCG showed a contrary connectivity decline and maintained or slightly improved their cognitive function after neuro-navigated rTMS treatment. The prodromal AD patients with the distinct reserve capacity may benefit differently from left angular gyrus-navigated rTMS, which may lead to increasing attention in defining personalized medicine approach of AD.
默认模式网络（DMN）可能是最早受影响的网络，与阿尔茨海默病（AD）的认知能力下降有关。重复经颅磁刺激（rTMS）可能有助于调节 DMN 的可塑性。然而，刺激效果在不同的研究和个体中存在显著差异。全局左额皮质（gLFC）连接，作为储备能力的替代物，可能对神经导航 rTMS 的异质生理效应有贡献。本研究调查了左角回导航 rTMS 对不同储备能力参与者 DMN 连接的影响。gLFC 连接通过静息状态 fMRI 相关性计算得出。31 名前驱 AD 患者根据 gLFC 连接的中位数分为低连接组（LCG）和高连接组（HCG）。在这两组中，发现了不同储备能力对 rTMS 反应的 DMN 的影响。然后，检查了大脑与行为之间的关系。在一定范围内，gLFC 连接与认知储备能力成正比（即 LCG），而超过此范围的功能连接有效性会降低（即 HCG）。此外，LCG 表现出 DMN 连接的增加和记忆功能的显著改善，而 HCG 则表现出相反的连接下降，并且在接受神经导航 rTMS 治疗后保持或略有改善其认知功能。具有不同储备能力的前驱 AD 患者可能会从左角回导航 rTMS 中受益不同，这可能会增加对 AD 个体化医学方法的关注。
