神经调控技术在阿尔茨海默病认知障碍研究中的应用

The Application of Neuromodulation Technology in Cognitive Impairment of Alzheimer’s Disease

阿尔茨海默病(Alzheimer’s disease,AD)是发生于老年和老年前期的中枢神经系统退行性疾病,其临床主要表现为进行性认知障碍。目前针对AD尚无有效的治疗方法,药物治疗只能延缓其病情进展,治疗效果有限,且常伴随副作用。近些年,神经调控作为一种可以靶向刺激调节目标脑区活动的方法受到广泛关注,逐渐被应用于AD的治疗和研究,包括无创的经颅磁刺激、电刺激以及有创的脑深部电刺激、光遗传刺激等。本文从作用效果、作用机制、刺激脑区、刺激参数等方面对这四种典型的神经调控方法在AD的应用研究现状进行综述,为今后神经调控应用于临床治疗AD提供新思路。

Alzheimer’s disease(AD)is a degenerative disorder of the central nervous system in the elderly and the pre-aging period,whose main clinical manifestation is progressive cognitive impairment.Till now,no treatment for AD has been found effective and the drugs can only delay the progression of the disease with limited efficacy,and often accompanied by side effects.In recent years,neuromodulation,as a method of targeting stimulation to regulate the activity of target brain regions,has gained much attention.It has been widely used in the treatment and research of AD.Repetitive transcranial magnetic stimulation(rTMS)and transcranial direct current stimulation(tDCS)modulate cortical neuronal activity and excitability by changing neuronal membrane potential.Clinical studies have shown that these two non-invasive methods can improve cognitive impairment in AD patients to a certain extent.However,due to the low spatial accuracy and various effect sizes,the optimal stimulation target area,parameters and modes of these two methods have not been unified yet.Deep brain stimulation(DBS)can improve cognitive function in AD patients by regulating cognition-related neural circuits and optogenetics stimulation precisely regulates the activity of specific neurons and neural circuits through genetic and optical means.The research results of cognitive function related circuits and specific neurons by the two innovative methods provide a theoretical basis for identifying the injury mechanism of AD cognitive impairment and the therapeutic targets at the level of brain functional network.This paper reviews the application and research status of the above mentioned four typical neuromodulation methods from the aspects of effect,mechanism,stimulation of brain area and stimulation parameters,so as to provide new ideas for the application of neuromodulation in clinical treatment of AD in the future.