经颅磁刺激(TMS)在抑郁患者认知控制研究中的应用:系统评价。

Use of transcranial magnetic stimulation (TMS) for studying cognitive control in depressed patients: A systematic review.

机构信息

Cognitive Neurolab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Rambla del Poblenou 156, Barcelona, Spain.

Instituto Brain360, Unidad Neuromodulación y Neuroimagen, Calle Maó 9, Barcelona, Spain.

出版信息

Cogn Affect Behav Neurosci. 2024 Dec;24(6):972-1007. doi: 10.3758/s13415-024-01193-w. Epub 2024 May 21.

Abstract

Major depressive disorder (MDD) is a debilitating mental disorder and the leading cause of disease burden. Major depressive disorder is associated with emotional impairment and cognitive deficit. Cognitive control, which is the ability to use perceptions, knowledge, and information about goals and motivations to shape the selection of goal-directed actions or thoughts, is a primary function of the prefrontal cortex (PFC). Psychotropic medications are one of the main treatments for MDD, but they are not effective for all patients. An alternative treatment is transcranial magnetic stimulation (TMS). Previous studies have provided mixed results on the cognitive-enhancing effects of TMS treatment in patients with MDD. Some studies have found significant improvement, while others have not. There is a lack of understanding of the specific effects of different TMS protocols and stimulation parameters on cognitive control in MDD. Thus, this review aims to synthesize the effectiveness of the TMS methods and a qualitative assessment of their potential benefits in improving cognitive functioning in patients with MDD. We reviewed 21 studies in which participants underwent a treatment of any transcranial magnetic stimulation protocol, such as repetitive TMS or theta-burst stimulation. One of the primary outcome measures was any change in the cognitive control process. Overall, the findings indicate that transcranial magnetic stimulation (TMS) may enhance cognitive function in patients with MDD. Most of the reviewed studies supported the notion of cognitive improvement following TMS treatment. Notably, improvements were predominantly observed in inhibition, attention, set shifting/flexibility, and memory domains. However, fewer significant improvements were detected in evaluations of visuospatial function and recognition, executive function, phonemic fluency, and speed of information processing. This review found evidence supporting the use of TMS as a treatment for cognitive deficits in patients with MDD. The results are promising, but further research is needed to clarify the specific TMS protocol and stimulation locations that are most effective.

摘要

重度抑郁症(MDD)是一种使人衰弱的精神障碍,也是疾病负担的主要原因。重度抑郁症与情绪损伤和认知缺陷有关。认知控制是指利用感知、知识和关于目标和动机的信息来塑造目标导向的行动或思维的选择的能力,是前额叶皮层(PFC)的主要功能之一。精神药物是治疗 MDD 的主要方法之一,但并非对所有患者都有效。替代疗法是经颅磁刺激(TMS)。先前的研究对 TMS 治疗 MDD 患者的认知增强效果提供了混合结果。一些研究发现有显著改善,而另一些则没有。目前对于不同 TMS 方案和刺激参数对 MDD 认知控制的具体影响还缺乏了解。因此,本综述旨在综合 TMS 方法的有效性,并对其改善 MDD 患者认知功能的潜在益处进行定性评估。我们综述了 21 项研究,这些研究中的参与者接受了任何经颅磁刺激方案的治疗,如重复经颅磁刺激或 theta 爆发刺激。主要的结果测量之一是认知控制过程的任何变化。总的来说,研究结果表明,经颅磁刺激(TMS)可能会增强 MDD 患者的认知功能。大多数综述研究支持 TMS 治疗后认知改善的观点。值得注意的是,在抑制、注意力、定势转移/灵活性和记忆等领域观察到了改善。然而,在视觉空间功能和识别、执行功能、语音流畅性和信息处理速度的评估中,发现的显著改善较少。本综述发现了支持 TMS 作为治疗 MDD 患者认知缺陷的方法的证据。结果很有希望,但需要进一步的研究来阐明最有效的特定 TMS 方案和刺激位置。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce2c/11525394/d6d9c4a43de8/13415_2024_1193_Fig1_HTML.jpg

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