Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing 210000, China.
Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China.
Cereb Cortex. 2024 Jul 3;34(7). doi: 10.1093/cercor/bhae310.
Repetitive transcranial magnetic stimulation is used in early-stage Alzheimer's disease to slow progression, but heterogeneity in response results in different treatment outcomes. The mechanisms underlying this heterogeneity are unclear. This study used resting-state neuroimaging to investigate the variability in episodic memory improvement from angular gyrus repetitive transcranial magnetic stimulation and tracked the neural circuits involved. Thirty-four amnestic mild cognitive impairment patients underwent angular gyrus repetitive transcranial magnetic stimulation (4 weeks, 20 Hz, 100% resting motor threshold) and were divided into high-response and low-response groups based on minimal clinically important differences in auditory verbal learning test scores. Baseline and pre/post-treatment neural circuit activities were compared. Results indicated that the orbital middle frontal gyrus in the orbitofrontal cortex network and the precuneus in the default mode network had higher local activity in the low-response group. After treatment, changes in local and remote connectivity within brain regions of the orbitofrontal cortex, default mode network, visual network, and sensorimotor network showed opposite trends and were related to treatment effects. This suggests that the activity states of brain regions within the orbitofrontal cortex and default mode network could serve as imaging markers for early cognitive compensation in amnestic mild cognitive impairment patients and predict the aftereffects of repetitive transcranial magnetic stimulation response.
重复经颅磁刺激被用于早期阿尔茨海默病以减缓疾病进展，但由于反应的异质性导致治疗效果不同。其背后的机制尚不清楚。本研究使用静息态神经影像学来研究从角回重复经颅磁刺激中获得的情节记忆改善的可变性，并追踪涉及的神经回路。34 名遗忘型轻度认知障碍患者接受了角回重复经颅磁刺激（4 周，20Hz，100%静息运动阈值），并根据听觉词语学习测试分数的最小临床重要差异分为高反应组和低反应组。比较了基线和治疗前后的神经回路活动。结果表明，在低反应组中，眶额皮质网络中的眶额中额回和默认模式网络中的楔前叶局部活动较高。治疗后，眶额皮质、默认模式网络、视觉网络和感觉运动网络区域内的局部和远程连接的变化呈现出相反的趋势，并且与治疗效果相关。这表明眶额皮质和默认模式网络内的脑区活动状态可以作为遗忘型轻度认知障碍患者早期认知补偿的影像学标志物，并预测重复经颅磁刺激反应的后效。
