经颅磁刺激联合认知训练对AD患者认知及精神行为的影响研究

Effects of transcranial magnetic stimulation combined with cognitive training on cognition and BPSD of AD

目的:研究高低频重复经颅磁刺激(high and low frequency repetitive of transcranial magnetic stimulation, rTMS联合认知训练对阿尔茨海默病(Alzheimer’s disease, AD)认知功能及精神行为症状(behavioral and psychological symptoms of dementia, BPSD)的影响。方法:选取2019年10月~2020年9月重庆市精神卫生中心老年记忆门诊收治的120例阿尔茨海默病患者作为此次研究对象,并采用随机数字表法将其分为低频刺激(1HZ)组、高频刺激(10HZ)组、对照组(伪刺激),各40例。三组均采用认知训练+口服美金刚10mg/d干预,而对照组联合伪刺激,低频刺激组联合低频经颅磁刺激,高频刺激组联合高频经颅磁刺激。对比三组干预前、干预3个月后的认知功能和精神行为症状改善情况。结果:干预3个月后,低频刺激组、高频刺激组的ADAS-Cog记忆因子、语言因子及总分均低于对照组;且高频刺激组较低频刺激组低(P<0.05);低频刺激组、高频刺激组的MMSE评分高于对照组,且高频刺激组较低频刺激组高(P<0.05);低频刺激组、高频刺激组的NPI、BEHAVE-AD评分均低于对照组(P<0.05),而高频刺激组与低频刺激组对比差异无统计学意义(P>0.05)。结论:在阿尔茨海默病中采用重复经颅磁刺激联合认知训练,能有效改善患者的认知功能和精神行为症状,且高频刺激在认知功能方面的改善效果更为显著。

Objective: To study the effects of high and low frequency repetitive transcranial magnetic stimulation combined with cognitive training on cognition and mental behavioral symptoms of Alzheimer’s disease. Methods: A total of 120 patients with Alzheimer’s disease admitted to memory Clinic of Chongqing Mental Health Center from October 2019 to September 2020 were selected as the subjects of this study, and they were divided into low frequency stimulation group(1HZ), high frequency stimulation group(10HZ) and control group(pseudo-stimulation) by random number table method, with 40 patients in each group. All three groups received cognitive training + memantine 10mg/d intervention, while the control group combined with pseudo-stimulation, low frequency stimulation group combined with low frequency transcranial magnetic stimulation, and high frequency stimulation group combined with high frequency transcranial magnetic stimulation. The improvement of cognitive function and mental behavioral symptoms before and 3 months after intervention were compared among the three groups. Results: After 3 months of interve ntion, the ADAS-Cog memory factor, language factor and total score of low frequency stimulation group and high frequency stimulation group were lower than those of control group. The high frequency stimulation group was lower than the low frequency stimulation group(P<0.05). MMSE scores of low frequency stimulation group and high frequency stimulation group were higher than those of control group, and high frequency stimulation group was higher than low frequency stimulation group(P<0.05). NPI and BEHAVE-AD scores of low frequency stimulation group and high frequency stimulation group were lower than those of control group(P<0.05),and there was no statistical difference between high frequency stimulation group and low frequency stimulation group(P>0.05). Conclusion: In Alzheimer’s disease, repeated transcranial magnetic stimulation combined with cognitive training can effectively improve the cognitive function and mental behavioral symptoms of patients, and the improvement effect of high frequency stimulation on cognitive function is more significant.