深部脑磁刺激技术治疗阿尔茨海默病的临床研究

摘要

Objective To explore the effectiveness and safety of deep brain magnetic stimulation technique (dTMS) for treatment of Alzheimer's disease (AD).Methods Totally 116 patients with AD were randomly divided into 4 groups:(1) dTMS:given dTMS really stimulation therapy,(2)medication group:treatment with donepezil 5 mg/d,(3) combination treatment group:given dTMS and donepezil therapy,(4) blank control group:given pseudorandom stimulation treatment.33 healthy control cases were given dTMS's stimulation treatment.The treatment course was 6 months.Application of mini mental state examination scale (MMSE),the Montreal cognitive assessment scale (MoCA),Hamilton Depression Scale (HAMD),ischemic scale (HIS),Boston naming test,activity of daily living(ADL) and neuropsychological questionnaire (NPI) were used to evaluate the cognitive function.All the participants received blood tests and ECG in order to evaluate the safety of dTMS.Results After 6 months treatment,compair with the blank control group,all scale scoresof dTMS group,medication group and combined treatment group were improved significantly in MMSE (t=2.49,2.46,2.20),MoCA(t=2.59,2.39,2.87),ADL(t=2.35,2.17,2.83),NPI(t=3.05,2.40,2.65) and sub-cognitive scale score (all P＜0.05).All scale scores of combination treatment group were better than dTMS group and medication group (P＜0.05).There's no significant difference between drug treatment groups and dTMS group (P＞0.05).After 6 months treatment,compared with healthy control group,the scale scores were aggravated in 4 groups of AD (P＜0.05)Conclusions dTMS can be effective and safe in the treatment of AD patients with cognitive and noncognitive symptoms.%目的 探讨深部脑磁刺激技术(dTMS)治疗阿尔茨海默病患者(AD)的有效性及安全性. 方法 AD患者116例和年龄相匹配的健康对照组33例,AD患者随机分为(1)dTMS组dTMS真刺激治疗；(2)药物组给予盐酸多奈哌齐5 mg/d治疗；(3)联合治疗组同时给予dTMS和盐酸多奈哌齐药物治疗；(4)空白对照组伪刺激治疗.健康对照组dTMS真刺激治疗.疗程6个月.应用简明精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、汉密尔顿抑郁量表(HAMD)、缺血量表(HIS)、听觉词语测试、词语流畅性测试、数字广度测试、画钟测验(CDT)、Boston命名测试、韦氏积木图、日常行为能力量表(ADL)及神经精神问卷(NPI)评价dTMS治疗的疗效和安全性.结果 dTMS组、药物组和联合治疗组治疗6个月后MMSE、MoCA、ADL、NPI及认知亚项评分均较空白对照组改善(t值MMSE分别为2.49、2.46、2.20,t值MoCA分别为2.59、2.39、2.87,t值ADL分别为2.35、2.17、2.83,t值NPI分别为3.05、2.40、2.65,均P＜0.05),联合治疗组各量表评分较药物组和dTMS组认知功能和日常行为能力改善(均为P＜0.05),但dTMS组、药物组及联合治疗组治疗后各量表评分仍较健康对照组差(P＜0.05). 结论 dTMS可以有效安全地治疗AD患者的认知及非认知症状,为AD提供非药物治疗手段.