双靶点重复经颅磁刺激对阿尔茨海默症患者大脑半球间结构连接改变

The changes in interhemispheric structural in Alzheimer"s disease patients treated with dual-target repetitive transcranial magnetic stimulation

摘要:

目的:探究双靶点重复经颅磁刺激(rTMS)对阿尔茨海默症(AD)患者大脑半球间结构的调控作用。方法:选取2020年1月到2025年1月在我院治疗的130例轻中度阿尔茨海默病患者为研究对象,根据患者治疗意愿分为对照组(n=59)和实验组(n=71)。实验组接受双靶点rTMS治疗,对照组接受伪刺激治疗。进一步采用了倾向性评分匹配法,按照1:1的比例进行匹配,最终使得对照组和实验组各包含50例患者。采用重复测量方差分析比较两组在不同时间点的评分变化。结果:(1)从治疗后第2周开始,实验组阿尔茨海默病评估量表-认知部分量表(ADAS-cog)评分明显低于对照组(P<0.001)。(2)与治疗前相比,两组患者治疗2周、4周、6周后的日常生活活动能力量表(ADL)评分、神经精神科问卷(NPI)呈现下降趋势,蒙特利尔认知评估量表(MoCA)评分、简明精神状态检查量表(MMSE)评分呈现上升趋势。(3)治疗后,实验组胼胝体膝部、体部、压部及前额叶-颞叶、顶叶-枕叶联合束的FA值明显升高,MD值明显降低(均P<0.001),且变化幅度明显大于对照组(均P<0.001)。(4)两组治疗期间均未出现癫痫发作、颅内出血、重度头痛等严重不良反应。实验组不良反应发生率为10.0%,对照组不良反应发生率为6.0%。两组不良反应发生率比较差异无统计学意义(χ2=0.532,P=0.466)。结论:双靶点rTMS可有效改善轻中度阿尔茨海默症患者的认知功能、日常生活活动能力及神经精神症状,其作用机制可能与增强大脑半球间关键白质纤维束的结构完整性有关。

Abstract:

Objective: To investigate the regulatory effect of dual-target repetitive transcranial magnetic stimulation (rTMS) on interhemispheric structural connectivity in patients with Alzheimer’s disease (AD). Methods: A total of 130 patients with mild-to-moderate AD admitted to our hospital from January 2020 to January 2025 were enrolled. They were divided into control (n=59) and experimental (n=71) groups based on treatment preference. The experimental group received dual-target rTMS, while the control group received sham stimulation. Propensity score matching (1:1 ratio) was applied to balance baseline characteristics, yielding 50 patients per group. Repeated-measures ANOVA was used to compare score changes at different time points and analyze time, group, and interaction effects. Results: (1) From the 2nd week of treatment onward, ADAS-cog scores in the experimental group were significantly lower than in the control group, with differences widening over time (P < 0.001). (2) After 2, 4, and 6 weeks of treatment, both groups showed decreased ADL and NPI scores and increased MoCA and MMSE scores compared with baseline. Significant between-group differences emerged from the 2nd week (P < 0.05). (3) Post-treatment, the experimental group exhibited significantly increased FA values and decreased MD values in the genu, body, and splenium of the corpus callosum, as well as in anterior temporal and parieto-occipital tracts (all P<0.001), with significantly greater changes than the control group (all P<0.001). (4) No severe adverse events occurred in either group. The adverse reaction rate was 10.0% in the experimental group and 6.0% in the control group, with no significant difference (χ2 = 0.532, P = 0.466). Conclusion: Dual-target rTMS can effectively improve the cognitive function, activities of daily living, and neuropsychiatric symptoms of patients with mild to moderate AD. The mechanism of action may be related to enhancing the structural integrity of key interhemispheric white matter tracts.