Alzheimer's disease and other cognitive disorders Unit. Neurology Service, Hospital Clinic de Barcelona, Institutd'Investigació Biomèdica August Pi i Sunyer, Institute of Neuroscience, University of Barcelona, Barcelona, Spain.
Medical Psychology Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Insitute of Neurosciences, University of Barcelona; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain.
J Alzheimers Dis. 2023;93(3):1169-1180. doi: 10.3233/JAD-230069.
Primary progressive aphasia (PPA) is a group of neurodegenerative disorders including Alzheimer's disease and frontotemporal dementia characterized by language deterioration. Transcranial direct current stimulation (tDCS) is a non-invasive intervention for brain dysfunction.
To evaluate the tolerability and efficacy of tDCS combined with speech therapy in the three variants of PPA. We evaluate changes in fMRI activity in a subset of patients.
Double-blinded, randomized, cross-over, and sham-controlled tDCS study. 15 patients with PPA were included. Each patient underwent two interventions: a) speech therapy + active tDCS and b) speech therapy + sham tDCS stimulation. A multifocal strategy with anodes placed in the left frontal and parietal regions was used to stimulate the entire language network. Efficacy was evaluated by comparing the results of two independent sets of neuropsychological assessments administered at baseline, immediately after the intervention, and at 1 month and 3 months after the intervention. In a subsample, fMRI scanning was performed before and after each intervention.
The interventions were well tolerated. Participants in both arms showed clinical improvement, but no differences were found between active and sham tDCS interventions in any of the evaluations. There were trends toward better outcomes in the active tDCS group for semantic association and reading skills. fMRI identified an activity increase in the right frontal medial cortex and the bilateral paracingulate gyrus after the active tDCS intervention.
We did not find differences between active and sham tDCS stimulation in clinical scores of language function in PPA patients.
原发性进行性失语症（PPA）是一组神经退行性疾病，包括以语言恶化为特征的阿尔茨海默病和额颞叶痴呆。经颅直流电刺激（tDCS）是一种治疗大脑功能障碍的非侵入性干预措施。
评估 tDCS 联合言语治疗在 PPA 三种变体中的耐受性和疗效。我们评估了一部分患者的 fMRI 活动变化。
双盲、随机、交叉和假刺激 tDCS 研究。纳入 15 名 PPA 患者。每位患者接受两种干预措施：a）言语治疗+主动 tDCS 和 b）言语治疗+假 tDCS 刺激。使用多焦点策略，将阳极放置在左额和顶叶区域，以刺激整个语言网络。通过比较两组独立的神经心理学评估结果来评估疗效，这些评估结果在基线、干预后立即以及干预后 1 个月和 3 个月进行。在亚样本中，在每次干预前后进行 fMRI 扫描。
干预措施耐受性良好。两组参与者均表现出临床改善，但在任何评估中，主动 tDCS 干预与假刺激 tDCS 干预之间均未发现差异。在主动 tDCS 组中，语义联想和阅读技能的结果有更好的趋势。fMRI 显示，在主动 tDCS 干预后，右侧额内侧皮质和双侧旁中央回的活动增加。
我们没有发现 PPA 患者的语言功能临床评分在主动 tDCS 刺激和假刺激之间存在差异。
