神经导航 rTMS 通过调节 AD 谱系患者睡眠相关网络的自发性活动改善睡眠和认知障碍。
Neuro-Navigated rTMS Improves Sleep and Cognitive Impairment via Regulating Sleep-Related Networks' Spontaneous Activity in AD Spectrum Patients.
机构信息
Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210008, People's Republic of China.
Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, People's Republic of China.
出版信息
Clin Interv Aging. 2023 Aug 15;18:1333-1349. doi: 10.2147/CIA.S416992. eCollection 2023.
STUDY OBJECTIVES
By examining spontaneous activity changes of sleep-related networks in patients with the Alzheimer's disease (AD) spectrum with or without insomnia disorder (ID) over time via neuro-navigated repetitive transcranial magnetic stimulation (rTMS), we revealed the effect and mechanism of rTMS targeting the left-angular gyrus in improving the comorbidity symptoms of the AD spectrum with ID.
METHODS
A total of 34 AD spectrum patients were recruited in this study, including 18 patients with ID and the remaining 16 patients without ID. All of them were measured for cognitive function and sleep by using the cognitive and sleep subscales of the neuropsychiatric inventory. The amplitude of low-frequency fluctuation changes in sleep-related networks was revealed before and after neuro-navigated rTMS treatment between these two groups, and the behavioral significance was further explored.
RESULTS
Affective auditory processing and sensory-motor collaborative sleep-related networks with hypo-spontaneous activity were observed at baseline in the AD spectrum with ID group, while substantial increases in activity were evident at follow-up in these subjects. In addition, longitudinal affective auditory processing, sensory-motor and default mode collaborative sleep-related networks with hyper-spontaneous activity were also revealed at follow-up in the AD spectrum with ID group. In particular, longitudinal changes in sleep-related networks were associated with improvements in sleep quality and episodic memory scores in AD spectrum with ID patients.
CONCLUSION
We speculated that left angular gyrus-navigated rTMS therapy may enhance the memory function of AD spectrum patients by regulating the spontaneous activity of sleep-related networks, and it was associated with memory consolidation in the hippocampus-cortical circuit during sleep.
CLINICAL TRIAL REGISTRATION
The study was registered at the Chinese Clinical Trial Registry, registration ID: ChiCTR2100050496, China.
研究目的
通过神经导航重复经颅磁刺激（rTMS），随时间观察阿尔茨海默病（AD）谱中伴有或不伴有失眠障碍（ID）的患者睡眠相关网络的自发性活动变化，揭示靶向左角回 rTMS 改善 ID 合并 AD 谱共病症状的作用和机制。
方法
本研究共纳入 34 例 AD 谱患者，包括 18 例 ID 患者和 16 例无 ID 患者。所有患者均采用神经精神病学清单的认知和睡眠子量表进行认知和睡眠测量。在两组之间，在神经导航 rTMS 治疗前后，揭示了睡眠相关网络的低频波动变化幅度，并进一步探讨了行为意义。
结果
在 ID 合并 AD 谱组中，基线时观察到情感听觉处理和感觉运动协同睡眠相关网络的自发性活动减少，而在随访时这些患者的活动明显增加。此外，在 ID 合并 AD 谱组中，在随访时还发现了纵向情感听觉处理、感觉运动和默认模式协同睡眠相关网络的自发性活动增加。特别是，睡眠相关网络的纵向变化与 ID 合并 AD 谱患者的睡眠质量和情景记忆评分的改善相关。
结论
我们推测，左角回导航 rTMS 治疗可能通过调节睡眠相关网络的自发性活动增强 AD 谱患者的记忆功能，并且与睡眠期间海马皮质回路中的记忆巩固有关。
临床试验注册
该研究在中国临床试验注册中心注册，注册号：ChiCTR2100050496，中国。
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