重复经颅磁刺激对轻度认知损害影响的对照研究

发布时间：2018-04-23 18:21

本文选题：轻度认知损害 + 经颅磁刺激　；参考：《河北医科大学》2012年硕士论文

【摘要】：目的：轻度认知损害(Mild cognitive impairment, MCI)是指出现轻度记忆或认知功能障碍，但不影响日常生活能力，是介于正常老化和早期老年痴呆之间的一种临床状态。MCI是老年痴呆的高危人群，对其进行积极的干预治疗将有利于中止痴呆的发生。目前关于重复经颅磁刺激（repetitive transcranial magnetic stimulation, rTMS）改善MCI的研究相对较少。本研究目的旨在观察高频rTMS对MCI老人的认知功能有无影响，为老年痴呆的预防提供一定的依据。方法：选取患有轻度认知损害的老年人40例（年龄≥60岁)，磁刺激组22例，伪刺激组18例。磁刺激组（rTMS组）接受rTMS治疗，刺激部位为左、右前额叶背外侧2个脑区，每个脑区30个序列，频率为20Hz。每周rTMS治疗5次，8周共40次。rTMS伪刺激组治疗参数的设置方法与rTMS组相同，但刺激时将线圈与头皮的表面呈90°角。在rTMS治疗前、rTMS治疗4周、rTMS治疗8周后采用蒙特利尔认知评估量表（MoCA）、词语流畅性测验、数字符号测验、连线测验A、联想学习、情景记忆、相似性测验、算数测验评定其认知功能有无改善,用威斯康星卡片分类测验(WCST)评定治疗前后执行功能的变化。采用SPSS13.0统计软件对数据进行统计学分析，运用一般线性模型里的重复测量资料的单因素方差分析方法，分析测查时间、分组因素的作用以及测查时间和分组因素之间的交互作用；并用多元方差分析方法实现同一时间两组间的两两比较；使用重复测量数据多重比较配对的t检验法，进行每个分组组内各个时间点上的两两比较。对威斯康星卡片分类测验治疗前后评分的比较采用配对t检验和Wilcoxon秩和检验。结果：1磁刺激组和伪刺激组在性别、年龄、平均受教育程度等方面均无显著性差异（P值分别为0.921，0.915，0.802）。 2治疗前磁刺激组和伪刺激组在MoCA、词语流畅性测验、数字符号测验、连线测验A、联想学习、情景记忆、相似性测验、算数测验、威斯康星卡片成绩均无显著性差异（P0.05）。 3治疗后MoCA（F=10.55，P=0.003）、相似性测验（F=9.01，P=0.01）的分组因素有统计学意义；MoCA评分（F=37.60，P=0.00）、词语流畅性测验（F=6.63，P=0.00）、数字符号测验（F=5.79，P=0.01）、连线测验A（F=6.19，P=0.01)、联想学习(F=8.14，P=0.00)、情景记忆(F=5.54，P=0.01)、相似性测验(F=23.65，P=0.00)、算数测验(F=10.23，P=0.00)的时间因素均有统计学意义，且上述心理学评估量表的评估时间和分组因素均存在交互作用(P0.05)。 4治疗4周后，磁刺激组的MoCA评分（F=7.62，P=0.009）、相似性测验（F=9.39，P=0.004）的评分高于伪刺激组；治疗8周后，磁刺激组的MoCA（F=41.916，P=0.000）、词语流畅性测验（F=7.89，P=0.008）、联想学习（F=4.15，P=0.049）、情景记忆（F=4.48，，P=0.041）、相似性测验（F=24.18，P=0.000）、算数测验（F=9.59，P=0.004）高于伪刺激组；无论治疗4周还是治疗8周后，两组的数字符号测验、连线测验A和临摹测验评分差别均无统计学意义。 5磁刺激组的MoCA、相似性测验在治疗前、治疗4周、治疗8周的评分两两比较均有显著差别（P0.05）；词语流畅性测验、数字符号测验、连线测验A、联想学习、情景记忆、算数测验的治疗前与治疗8周、治疗4周与治疗8周比较，差异有统计学意义（P0.05），而治疗前与治疗4周比较差异无统计学意义（P0.05）；临摹测验的评分在治疗前、治疗4周、治疗8周两两比较均无差别（P0.05）。伪刺激组的MoCA、词语流畅性测验、数字符号、连线测验A、临摹测验、联想学习、情景记忆、相似性测验、算数测验得分的两两比较均无显著差别。 6治疗后结束后磁刺激组的正确应答数、正确应答数百分率、持续性错误数、非持续性错误数、错误应答数成绩均高于伪刺激组（P0.05）；磁刺激组治疗后WCST评分较治疗前增加（P0.05），而伪刺激组的WCST成绩前后比较差异无统计学意义（P0.05）。结论：1rTMS明显改善MCI病人的记忆、执行功能、抽象思维能力、计算推理能力，对视空间功能无影响。 2rTMS治疗8周比治疗4周能更进一步改善患者的认知功能。 3rTMS作为一种常用的无痛、无创、操作方便、安全可靠的脑部刺激技术，在治疗轻度认知损害中具有重要的应用价值。
[Abstract]:Objective: mild cognitive impairment (Mild cognitive impairment, MCI) refers to the emergence of mild memory or cognitive impairment, but does not affect daily living capacity. It is a clinical state between normal aging and early Alzheimer's disease..MCI is a high-risk group of Alzheimer's disease. Active intervention in the treatment of it will be beneficial to discontinue dementia. There are relatively few studies on repetitive transcranial magnetic stimulation (rTMS) to improve MCI. The purpose of this study is to observe the effect of high frequency rTMS on the cognitive function of MCI elderly, and to provide a certain basis for the prevention of Alzheimer's disease.
Methods: 40 aged people with mild cognitive impairment (age 60 years old), 22 cases of magnetic stimulation and 18 pseudo stimulus group. The magnetic stimulation group (group rTMS) received rTMS treatment, the stimulation site was left, the right prefrontal lobes were in 2 brain regions and 30 sequences in each brain region, the frequency was 5 times a week of 20Hz. rTMS, and the 40 times of the 40.RTMS pseudo stimulus group were treated for 8 weeks. The setting method was the same as that in the rTMS group, but the surface of the coil and the scalp was 90 degrees. Before rTMS treatment, rTMS was treated for 4 weeks. After 8 weeks of rTMS treatment, the Montreal cognitive assessment scale (MoCA), word fluency test, digital symbol test, connection test A, associative learning, situational memory, similarity test, and arithmetic test were used to evaluate their cognition. Whether the function was improved or not, the Wisconsin Card Sorting Test (WCST) was used to assess the changes of executive function before and after treatment.
The SPSS13.0 statistical software was used to analyze the data, and the single factor variance analysis method of the repeated measurement data in the general linear model was used to analyze the test time, the role of the grouping factors and the interaction between the test time and the grouping factors, and the 22 of the two groups at the same time were realized by the multivariate square difference analysis method. Comparison; 22 comparison of each time point in each group was carried out by the multiple comparison paired t test with repeated measurement data. The comparison of the scores before and after the treatment of the Wisconsin card classification test was matched with the paired t test and the Wilcoxon rank test.
Results: 1 there was no significant difference in gender, age and average education level between the magnetic stimulation group and the pseudo stimulation group (P = 0.921,0.915,0.802).
2 before the treatment, the magnetic stimulation group and the pseudo stimulus group were in MoCA, the word fluency test, the digital symbol test, the connection test A, the association learning, the situational memory, the similarity test, the arithmetic test, and the Wisconsin card scores had no significant difference (P0.05).
The group factors of MoCA (F=10.55, P=0.003) after 3 treatment (F=9.01, P=0.01) were statistically significant; MoCA score (F=37.60, P=0.00), word fluency test (F=6.63, P=0.00), digital symbol test (F=5.79, P=0.01), conjunction test (6.19), associative learning, situational memory, similarity test 23.65, P=0.00), the time factor of the arithmetic test (F=10.23, P=0.00) had statistical significance, and the assessment time and the group factor of the psychological assessment scale were both interactive (P0.05).
4 after 4 weeks of treatment, the MoCA score of the magnetic stimulation group (F=7.62, P=0.009), the score of the similarity test (F=9.39, P=0.004) was higher than that of the pseudo stimulus group; after 8 weeks of treatment, the MoCA (F=41.916, P=0.000) in the magnetic stimulation group, the fluency test (F=7.89, P=0.008), the association learning (F=4.15, P=0.049), the situational memory, the similarity test, The F=9.59 (P=0.004) was higher than that of the pseudo stimulus group; no significant difference was found between the two groups of digital symbols, A and the copy test scores, no matter 4 weeks or 8 weeks of treatment.
5 magnetic stimulation group MoCA, similarity test before treatment, 4 weeks of treatment, 8 weeks of score 22 compared significant difference (P0.05); word fluency test, digital symbol test, connection test A, association learning, situation memory, arithmetic test before and treatment 8 weeks, 4 weeks and 8 weeks, the difference is statistically significant (P0.05) There was no significant difference between the 4 weeks before treatment and 4 weeks, and there was no difference between the scores of the copy test before the treatment, the treatment for 4 weeks, and the treatment for 8 weeks 22 (P0.05).
There were no significant differences between the MoCA of the pseudo stimulus group, the word fluency test, the digital symbol, the connection test A, the copy test, the associative learning, the situational memory, the similarity test, and the arithmetic test.
6 the correct answer of the magnetic stimulation group after the end of treatment, the correct answer percentage, the correct number of errors, the number of non persistent errors, the error response scores were higher than the pseudo stimulus group (P0.05); the WCST score of the magnetic stimulation group was increased (P0.05) after treatment (P0.05), while the difference of the WCST scores in the pseudo stimulus group was not statistically significant (P0.05).
Conclusion: 1rTMS can significantly improve memory, executive function, abstract thinking ability and computational reasoning ability of MCI patients, and has no effect on visual spatial function.
2rTMS treatment for 8 weeks can further improve the cognitive function of patients than 4 weeks.
As a commonly used painless, noninvasive, safe and reliable brain stimulation technology, 3rTMS has important application value in the treatment of mild cognitive impairment.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1

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