Luo Jiali, Shang Pan, Tan Zefeng, Huang Shuyun, Liu Yajing, Wang Yukai, Chen Qi, Xie Haiqun
Department of Neurology, First People's Hospital of Foshan, Foshan, 528000, China.
School of Psychology, South China Normal University, Guangzhou, 510631, China.
Neurol Sci. 2025 Jul 14. doi: 10.1007/s10072-025-08315-3.
This double-blinded randomized trial investigated the effects of accelerated intermittent theta-burst stimulation (iTBS) and adaptive cognitive training on brain function in 24 patients with amnestic mild cognitive impairment (aMCI).
Participants received real (n=12) or sham (n=12) iTBS targeting the left dorsolateral prefrontal cortex (DLPFC) thrice daily alongside cognitive training for 14 days. The Montreal Cognitive Assessment (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and functional near-infrared spectroscopy (fNIRS) during rest and N-back tasks, which measure cognitive function and brain activity respectively, were administered pre-and post-intervention.
The active group demonstrated significant cognitive improvement. Compared to sham controls, postintervention fNIRS results revealed reduced global brain activation during the 1-back task in the active group, particularly in the left prefrontal cortex, and the brain activation correlated with reaction time. In the 2-back task after treatment, the active group exhibited decreased activation in the right motor cortex, while the sham group showed increased activation in the left motor cortex. The overall brain connectivity in the sham group enhanced following the intervention, with significant differences in the correlations between the left prefrontal cortex and left motor cortex between groups.
These findings suggest that the combined intervention can effectively promote cognitive performance and brain function in aMCI patients. iTBS causes enhanced functional engagement of the left DLPFC, which further facilitates neural efficiency and restores the capacity to modulate the allocation of neural resources rather than relying on global compensatory hyperactivation. These may be the underlying neural mechanisms for memory improvement in aMCI patients (Chinese Clinical Trial Registry: ChiCTR2400087943).
本双盲随机试验研究了加速间歇性theta波爆发刺激（iTBS）和适应性认知训练对24例遗忘型轻度认知障碍（aMCI）患者脑功能的影响。
参与者每天接受3次针对左侧背外侧前额叶皮质（DLPFC）的真实（n = 12）或假（n = 12）iTBS刺激，并同时进行认知训练，为期14天。干预前后分别进行蒙特利尔认知评估（MoCA）、阿尔茨海默病评估量表-认知分量表（ADAS-Cog）以及静息和N-back任务期间的功能近红外光谱（fNIRS）检查，后者分别用于测量认知功能和脑活动。
主动治疗组显示出显著的认知改善。与假刺激对照组相比，干预后fNIRS结果显示，主动治疗组在1-back任务期间全脑激活减少，尤其是在左侧前额叶皮质，且脑激活与反应时间相关。治疗后的2-back任务中，主动治疗组右侧运动皮质的激活减少，而假刺激组左侧运动皮质的激活增加。干预后假刺激组的整体脑连接性增强，两组之间左侧前额叶皮质与左侧运动皮质之间的相关性存在显著差异。
这些发现表明，联合干预可有效促进aMCI患者的认知表现和脑功能。iTBS可增强左侧DLPFC的功能参与度，进而促进神经效率，并恢复调节神经资源分配的能力，而非依赖于整体代偿性过度激活。这些可能是aMCI患者记忆改善的潜在神经机制（中国临床试验注册中心：ChiCTR2400087943）。
