Treatment of Alzheimer’s Disease with Repetitive Transcranial Magnetic Stimulation Combined with Cognitive Training: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
1
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background and Purpose Repetitive transcranial magnetic stimulation (rTMS) has been examined as a potential treatment for many neurological disorders. High-frequency rTMS in particular improves cognitive functions such as verbal fuency and memory. Tis study explored the efect of rTMS combined with cognitive training (rTMS-COG) on patients with Alzheimer’s disease (AD). Methods A prospective, randomized, double-blind, placebo-controlled study was performed with 27 AD patients (18 and 8 in the treatment and sham groups, respectively, and 1 dropout). Te participants were categorized into mild [Mini-Mental State Examination (MMSE) score=21–26] and moderate (MMSE score=18–20) AD groups. The rTMS protocols were confgured for six cortical areas (both dorsolateral prefrontal and parietal somatosensory associated cortices and Broca’s and Wernicke’s areas; 10 Hz, 90–110% intensity, and 5 days/ week for 6 weeks). Neuropsychological assessments were performed using the AD Assessment Scale-cognitive subscale (ADAS-cog), Clinical Global Impression of Change (CGIC), and MMSE before, immediately afer, and 6 weeks afer the end of rTMS-COG treatment. Results Data from 26 AD patients were analyzed in this study. Tere was no signifcant interactive efect of time between the groups. Te ADAS-cog score in the treatment group was signifcantly improved compared to the sham group (4.28 and 5.39 in the treatment group vs. 1.75 and 2.88 in the sham group at immediately and 6 weeks afer treatment, respectively). Te MMSE and CGIC scores were also improved in the treatment group. Based on subgroup analysis, the efect of rTMS-COG was superior for the mild group compared to the total patients, especially in the domains of memory and language. Conclusions The present results suggest that rTMS-COG represents a useful adjuvant therapy with cholinesterase inhibitors, particularly during the mild stage of AD. Te efect of rTMS-COG was remarkable in the memory and language domains, which are severely affected by AD.
Abstract
Background and Purpose Repetitive transcranial magnetic stimulation (rTMS) has been examined as a potential treatment for many neurological disorders. High-frequency rTMS in particular improves cognitive functions such as verbal fuency and memory. Tis study explored the efect of rTMS combined with cognitive training (rTMS-COG) on patients with Alzheimer’s disease (AD). Methods A prospective, randomized, double-blind, placebo-controlled study was performed with 27 AD patients (18 and 8 in the treatment and sham groups, respectively, and 1 dropout). Te participants were categorized into mild [Mini-Mental State Examination (MMSE) score=21–26] and moderate (MMSE score=18–20) AD groups. The rTMS protocols were confgured for six cortical areas (both dorsolateral prefrontal and parietal somatosensory associated cortices and Broca’s and Wernicke’s areas; 10 Hz, 90–110% intensity, and 5 days/ week for 6 weeks). Neuropsychological assessments were performed using the AD Assessment Scale-cognitive subscale (ADAS-cog), Clinical Global Impression of Change (CGIC), and MMSE before, immediately afer, and 6 weeks afer the end of rTMS-COG treatment. Results Data from 26 AD patients were analyzed in this study. Tere was no signifcant interactive efect of time between the groups. Te ADAS-cog score in the treatment group was signifcantly improved compared to the sham group (4.28 and 5.39 in the treatment group vs. 1.75 and 2.88 in the sham group at immediately and 6 weeks afer treatment, respectively). Te MMSE and CGIC scores were also improved in the treatment group. Based on subgroup analysis, the efect of rTMS-COG was superior for the mild group compared to the total patients, especially in the domains of memory and language. Conclusions The present results suggest that rTMS-COG represents a useful adjuvant therapy with cholinesterase inhibitors, particularly during the mild stage of AD. Te efect of rTMS-COG was remarkable in the memory and language domains, which are severely affected by AD.
참고문헌 (31)
- Sosa-Ortiz AL, "Epidemiology of dementias and Alzheimer’s disease", Arch Med Res, 43, pp.600~608 (2012)
- Wisniewski T, "Amyloid-beta immunisation for Alzheimer’s disease", Lancet Neurol, 7, pp.805~811 (2008)
- Holmes C, "Long-term effects of Abeta42 immunisation in Alzheimer’s disease: follow-up of a randomised, placebo-controlled phase I trial", Lancet, 372, pp.216~223 (2008)
- Birks J, "Cholinesterase inhibitors for Alzheimer’s disease", Cochrane Database Syst Rev, pp.CD005593~ (2006)
- 박경원, "Dementia with Lewy Bodies versus Alzheimer’s Disease and Parkinson’s Disease Dementia: A Comparison of Cognitive Profiles", Journal of Clinical Neurology, 7(1), pp.19~24 (2011), 대한신경과학회
- Kobayashi M, "Transcranial magnetic stimulation in neurology", Lancet Neurol, 2, pp.145~156 (2003)
- Rossini PM, "Transcranial magnetic stimulation: diagnostic, therapeutic, and research potential", Neurology, 68, pp.484~488 (2007)
- Pilato F, "Synaptic plasticity in neurodegenerative diseases evaluated and modulated by in vivo neurophysiological techniques", Mol Neurobiol, 46, pp.563~571 (2012)
- Tokay T, "High-frequency magnetic stimulation induces long-term potentiation in rat hippocampal slices", Neurosci Lett, 461, pp.150~154 (2009)
- Burt T, "Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis", Int J Neuropsychopharmacol, 5, pp.73~103 (2002)
- Jahanshahi M, "Transcranial magnetic stimulation studies of cognition: an emerging field", Exp Brain Res, 131, pp.1~9 (2000)
- George MS, "Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial", Arch Gen Psychiatry, 67, pp.507~516 (2010)
- Luber B, "Applications of transcranial magnetic stimulation and magnetic seizure therapy in the study and treatment of disorders related to cerebral aging", Dialogues Clin Neurosci, 15, pp.87~98 (2013)
- Anderkova L, "Cognitive effects of repetitive transcranial magnetic stimulation in patients with neurodegenerative diseasesclinician’s perspective", J Neurol Sci, 339, pp.15~25 (2014)
- Nardone R, "Transcranial magnetic stimulation (TMS)", repetitive TMS in mild cognitive impairment and Alzheimer’s disease, 2014, pp.129, 351~366
- Cotelli M, "Effect of transcranial magnetic stimulation on action naming in patients with Alzheimer disease", Arch Neurol, 63, pp.1602~1604 (2006)
- Cotelli M, "Transcranial magnetic stimulation improves naming in Alzheimer disease patients at different stages of cognitive decline", Eur J Neurol, 15, pp.1286~1292 (2008)
- Haffen E, "A case report of daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) as an adjunctive treatment for Alzheimer disease", Brain Stimul, 5, pp.264~266 (2012)
- Rosen WG, "A new rating scale for Alzheimer’s disease", Am J Psychiatry, 141, pp.1356~1364 (1984)
- Ahmed MA, "Effects of low versus high frequencies of repetitive transcranial magnetic stimulation on cognitive function and cortical excitability in Alzheimer’s dementia", J Neurol, 259, pp.83~92 (2012)
- Bentwich J, "Beneficial effect of repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer’s disease: a proof of concept study", J Neural Transm, 118, pp.463~471 (2011)
- Rabey JM, "Repetitive transcranial magnetic stimulation combined with cognitive training is a safe and effective modality for the treatment of Alzheimer’s disease: a randomized, double-blind study", J Neu ral Transm, 120, pp.813~819 (2013)
- Rossi S, "Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research", Clin Neurophysiol, 120, pp.2008~2039 (2009)
- 이재홍, "The Effects of Galantamine Treatment on Attention and Its Relationship with Cognition and Activities of Daily Living in Patients with Mild to Moderate Alzheimer’s Disease", Journal of Clinical Neurology, 11(1), pp.66~72 (2015), 대한신경과학회[DOI]
- Luber B, "Enhancement of human cognitive performance using transcranial magnetic stimulation (TMS)", Neuroimage, 85(Pt 3), pp.961~970 (2014)
- Tegenthoff M, "Improvement of tactile discrimination performance and enlargement of cortical somatosensory maps after 5 Hz rTMS", PLoS Biol, 3, pp.e362~ (2005)
- Thickbroom GW, "Transcranial magnetic stimulation and synaptic plasticity: experimental framework and human models", Exp Brain Res, 180, pp.583~593 (2007)
- Cotelli M, "Improved language performance in Alzheimer disease following brain stimulation", J Neurol Neurosurg Psychiatry, 82, pp.794~797 (2011)
- Devi G, "Open-label, short-term, repetitive transcranial magnetic stimulation in patients with Alzheimer’s disease with functional imaging correlates and literature review", Am J Alzheimers Dis Other Demen, 29, pp.248~255 (2014)
- Terao Y, "Shortening of simple reaction time by peripheral electrical and submotor-threshold magnetic cortical stimulation", Exp Brain Res, 115, pp.541~545 (1997)
- Horing B, "Prediction of placebo responses:a systematic review of the literature", Front Psychol, 5, pp.1079~ (2014)