右侧低频rTMS对老年抑郁症患者抑郁症状及认知功能的影响

Low-frequency transcranial magnetic stimulation can relieve depression and improve cognitive functioning among the elderly

目的探讨右侧低频重复经颅磁刺激(rTMS)对老年抑郁症患者抑郁症状及认知功能的影响。方法采用随机数字表法将86例老年抑郁症患者分为低频组(43例)和对照组(43例)。2组在抗抑郁药物治疗的基础上,低频组给予1.0 Hz的rTMS治疗,刺激部位为右侧背外侧前额叶皮质区,每日治疗1次,每次20 min,每周5次,治疗4周,共20次;对照组给予相同时间和频次的伪刺激治疗。分别于治疗前及治疗第1、2、3、4、6、8周末,采用汉密尔顿抑郁量表(HAMD-24)评估2组患者的抑郁情况,采用威斯康星卡片分类测验(WCST)、连线测试A(TMT-A)评估患者治疗前及治疗4、8周末的认知功能,治疗期间记录患者的不良反应。结果治疗前,2组患者的HAMD评分及WCST评分组间差异均无统计学意义(P>0.05)。治疗第1、2、3、4、6、8周时,2组患者的HAMD评分均较组内治疗前明显下降(P<0.05);治疗3、4、6、8周后,各时间点低频组的HAMD评分均低于对照组,且组间差异均有统计学意义(P<0.05)。治疗4、8周后,2组患者WCST评分中的完成分类数和正确应答数评分均增加,而错误应答数和持续错误数评分均较组内治疗前明显减少(P<0.05);治疗4、8周后,各时点低频组较对照组患者WCST中完成分类数、正确应答数均增加,错误应答数、持续错误数均减少,且组间差异有统计学意义(P<0.05)。治疗4、8周后,2组的TMT-A总时间与组内治疗前比较,差异有统计学意义(P<0.05),但治疗前后组间各时间点TMT-A总时间差异无统计学意义(P>0.05)。2组患者治疗后的不良反应发生率组间差异无统计学意义(P>0.05)。结论抗抑郁药物治疗基础上,右侧低频rTMS可更快改善老年抑郁症患者的抑郁症状和认知功能,且不良反应少、耐受性好。

Objective To explore any effect of repeated application of low-frequency transcranial magnetic stimulation(rTMS)on depression and the cognition of depressed elderly persons.Methods Eighty-six elderly persons with depression were randomly divided into an rTMS group and a control group,each of 43.In addition to anti-depressant treatment,the rTMS group was given 20 minutes of 1Hz rTMS daily applied over the right dorsolateral prefrontal cortex,five times a week for 4 weeks.The control group was given sham treatment on the same schedule.Before the experiment and after 1,2,3,4,6 and 8 weeks of the treatment,depression in both groups was evaluated using the Hamilton Depression Scale(HAMD-24).At the 4-and 8-week evaluations the Wisconsin Card Sorting Test(WCST)and the Trail Making Test Part A(TMT-A)were also administered.Results Before the treatment there were no significant differences in the 2 groups′average HAMD or WCST scores.At each subsequent evaluation both groups′average HAMD score had decreased significantly.After 3 weeks the average HAMD score of the rTMS group consistently remained significantly lower than the control group′s average.At the 4-and 8-week evaluations both groups′WCST and TMT-A scores had improved significantly compared with before the treatment,with significantly greater improvement in the rTMS group′s average WCST result,though not in their TPT-A result.There was no signi-ficant difference in the incidence of adverse reactions between the 2 groups.Conclusion As a supplement to antidepressant treatment,right-side low-frequency rTMS can relieve depressive symptoms and improve the cognitive functioning of depressed elderly persons.It is well tolerated with few adverse reactions.