Wu Xingqi, Yan Yibing, Hu Panpan, Wang Lu, Wu Yue, Wu Pan, Geng Zhi, Xiao Guixian, Zhou Shanshan, Ji Gongjun, Qiu Bensheng, Wei Ling, Tian Yanghua, Liu Hesheng, Wang Kai
Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China.
Gen Psychiatr. 2024 Jan 8;37(1):e101106. doi: 10.1136/gpsych-2023-101106. eCollection 2024.
Previous studies have demonstrated that excitatory repetitive transcranial magnetic stimulation (rTMS) can improve the cognitive function of patients with Alzheimer's disease (AD). Intermittent theta burst stimulation (iTBS) is a novel excitatory rTMS protocol for brain activity stimulation with the ability to induce long-term potentiation-like plasticity and represents a promising treatment for AD. However, the long-term effects of iTBS on cognitive decline and brain structure in patients with AD are unknown.
We aimed to explore whether repeating accelerated iTBS every three months could slow down the cognitive decline in patients with AD.
In this randomised, assessor-blinded, controlled trial, iTBS was administered to the left dorsolateral prefrontal cortex (DLPFC) of 42 patients with AD for 14 days every 13 weeks. Measurements included the Montreal Cognitive Assessment (MoCA), a comprehensive neuropsychological battery, and the grey matter volume (GMV) of the hippocampus. Patients were evaluated at baseline and after follow-up. The longitudinal pipeline of the Computational Anatomy Toolbox for SPM was used to detect significant treatment-related changes over time.
The iTBS group maintained MoCA scores relative to the control group (t=3.26, p=0.013) and reduced hippocampal atrophy, which was significantly correlated with global degeneration scale changes. The baseline Mini-Mental State Examination (MMSE) score, apolipoprotein E genotype and Clinical Dementia Rating were indicative of MoCA scores at follow-up. Moreover, the GMV of the left (t=0.08, p=0.996) and right (t=0.19, p=0.977) hippocampus were maintained in the active group but significantly declined in the control group (left: t=4.13, p<0.001; right: t=5.31, p0.001). GMV change in the left (r=0.35, p=0.023) and right (r=0.36, p=0.021) hippocampus across the intervention positively correlated with MoCA changes; left hippocampal GMV change was negatively correlated with global degeneration scale (r=-0.32, p=0.041) changes.
DLPFC-iTBS may be a feasible and easy-to-implement non-pharmacological intervention to slow down the progressive decline of overall cognition and quality of life in patients with AD, providing a new AD treatment option.
NCT04754152.
先前的研究表明，兴奋性重复经颅磁刺激（rTMS）可改善阿尔茨海默病（AD）患者的认知功能。间歇性theta爆发刺激（iTBS）是一种用于脑活动刺激的新型兴奋性rTMS方案，具有诱导长期增强样可塑性的能力，是一种有前景的AD治疗方法。然而，iTBS对AD患者认知衰退和脑结构的长期影响尚不清楚。
我们旨在探讨每三个月重复进行加速iTBS是否能减缓AD患者的认知衰退。
在这项随机、评估者盲法、对照试验中，对42例AD患者的左侧背外侧前额叶皮质（DLPFC）每13周进行14天的iTBS治疗。测量指标包括蒙特利尔认知评估（MoCA）、一套综合神经心理测试以及海马体的灰质体积（GMV）。在基线和随访后对患者进行评估。使用用于统计参数映射（SPM）的计算解剖工具箱的纵向管道来检测随时间与治疗相关的显著变化。
与对照组相比，iTBS组维持了MoCA评分（t = 3.26，p = 0.013），并减少了海马萎缩，这与整体退化量表变化显著相关。基线简易精神状态检查表（MMSE）评分、载脂蛋白E基因型和临床痴呆评定量表可预测随访时的MoCA评分。此外，活跃组左侧（t = 0.08，p = 0.996）和右侧（t = 0.19，p = 0.977）海马体的GMV保持稳定，而对照组则显著下降（左侧：t = 4.13，p < 0.001；右侧：t = 5.31，p < 0.001）。整个干预过程中左侧（r = 0.35，p = 0.023）和右侧（r = 0.36，p = 0.021）海马体的GMV变化与MoCA变化呈正相关；左侧海马体GMV变化与整体退化量表变化呈负相关（r = -0.32，p = 0.041）。
DLPFC-iTBS可能是一种可行且易于实施的非药物干预措施，可减缓AD患者整体认知和生活质量的渐进性下降，为AD提供了一种新的治疗选择。
NCT04754152。
