Koch Giacomo, Altomare Daniele, Benussi Alberto, Bréchet Lucie, Casula Elias P, Dodich Alessandra, Pievani Michela, Santarnecchi Emiliano, Frisoni Giovanni B
Experimental Neuropsychophysiology Lab, Santa Lucia Foundation IRCCS, 00179 Rome, Italy.
Department of Neuroscience and Rehabilitation, University of Ferrara and Center for Translational Neurophysiology of Speech and Communication, Italian Institute of Technology (IIT), 44121 Ferrara, Italy.
Brain. 2024 Dec 3;147(12):4003-4016. doi: 10.1093/brain/awae292.
Treating cognitive impairment is a holy grail of modern clinical neuroscience. In the past few years, non-invasive brain stimulation is increasingly emerging as a therapeutic approach to ameliorate performance in patients with cognitive impairment and as an augmentation approach in persons whose cognitive performance is within normal limits. In patients with Alzheimer's disease, better understanding of brain connectivity and function has allowed for the development of different non-invasive brain stimulation protocols. Recent studies have shown that transcranial stimulation methods enhancing brain plasticity with several modalities have beneficial effects on cognitive functions. Amelioration has been shown in preclinical studies on behaviour of transgenic mouse models for Alzheimer's pathology and in clinical studies with variable severity of cognitive impairment. While the field is still grappling with issues related to the standardization of target population, frequency, intensity, treatment duration and stimulated region, positive outcomes have been reported on cognitive functions and on markers of brain pathology. Here we review the most encouraging protocols based on repetitive transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating current stimulation, visual-auditory stimulation, photobiomodulation and transcranial focused ultrasound, which have demonstrated efficacy to enhance cognitive functions or slow cognitive decline in patients with Alzheimer's disease. Beneficial non-invasive brain stimulation effects on cognitive functions are associated with the modulation of specific brain networks. The most promising results have been obtained targeting key hubs of higher-level cognitive networks, such as the frontal-parietal network and the default mode network. The personalization of stimulation parameters according to individual brain features sheds new light on optimizing non-invasive brain stimulation protocols for future applications.
治疗认知障碍是现代临床神经科学的圣杯。在过去几年中,非侵入性脑刺激越来越多地作为一种治疗方法出现,用于改善认知障碍患者的表现,并作为认知表现正常者的增强方法。在阿尔茨海默病患者中,对脑连接性和功能的更好理解推动了不同非侵入性脑刺激方案的发展。最近的研究表明,多种方式增强脑可塑性的经颅刺激方法对认知功能有有益影响。在阿尔茨海默病病理转基因小鼠模型的行为临床前研究以及认知障碍严重程度各异的临床研究中均显示出改善效果。尽管该领域仍在努力解决与目标人群、频率、强度、治疗持续时间和刺激区域标准化相关的问题,但在认知功能和脑病理学标志物方面已报告了积极成果。在此,我们回顾基于重复经颅磁刺激、经颅直流电刺激、经颅交流电刺激、视觉-听觉刺激、光生物调节和经颅聚焦超声的最令人鼓舞的方案,这些方案已证明在阿尔茨海默病患者中增强认知功能或减缓认知衰退的疗效。非侵入性脑刺激对认知功能的有益影响与特定脑网络的调制有关。针对高级认知网络的关键枢纽,如额顶叶网络和默认模式网络,已取得了最有前景的结果。根据个体脑特征对刺激参数进行个性化调整为优化未来应用的非侵入性脑刺激方案提供了新的思路。
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