低频Meynert基底核脑深部电刺激对早发型重度阿尔茨海默病患者的长期改善作用研究  

Long-term improvement of low frequency deep brain stimulation on the nucleus basalis of Meynert in patients with early-onset severe Alzheimer's disease

作　　者：许军鹏 余新光[2] 张艳阳[2] 刘斌[1] 陈芋含 毛之奇[2] Xu Junpeng;Yu Xinguang;Zhang Yanyang;Liu Bin;Chen Yuhan;Mao Zhiqi(Graduate School of PLA General Hospital,Beijing 100853,China;Department of Neurosurgery,First Medical Center of PLA General Hospital,Beijing 100853,China;First Clinical Medical School of Hebei North University,Zhangjiakou 050051,China)

机构地区：[1]解放军总医院研究生院,北京100853 [2]解放军总医院第一医学中心神经外科医学部,北京100853 [3]河北北方学院第一临床医学院,张家口050051

出　　处：《中华神经医学杂志》2024年第2期152-158,共7页Chinese Journal of Neuromedicine

基　　金：科技部科技创新2030"脑科学与类脑研究"重大项目(2021ZD0200407)。

摘　　要：目的初步探讨低频Meynert基底核脑深部电刺激(DBS)对早发型重度阿尔茨海默病(AD)患者认知障碍、神经精神症状及睡眠障碍的长期改善作用。方法回顾性收集解放军总医院第一医学中心神经外科自2016年1月至2022年12月收治的18例早发型重度AD患者,依据治疗方式的不同分为NBM-DBS组与对照组,其中6例NBM-DBS组患者在常规药物保守治疗基础上接受低频NBM-DBS,12例对照组患者接受常规药物保守治疗。分析2组患者治疗前及随访1年后简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、神经精神问卷(NPI)、汉密尔顿抑郁量表(HAMD)、倍克-拉范森躁狂量表(BRMS)、匹兹堡睡眠质量指数(PSQI)、Zarit照顾者负担量表(ZBI)评分的变化情况。结果随访1年后,NBM-DBS及对照组患者的MMSE、MoCA量表评分较治疗前均有所降低,但NBM-DBS组患者治疗前后的差异均无统计学意义(P>0.05),而对照组患者治疗前后的差异有统计学意义(P<0.05);2组患者间随访1年时的MMSE、MoCA量表评分差异均无统计学意义(P>0.05)。NBM-DBS组患者的NPI、HAMD、BRMS、ZBI量表评分较治疗前差异均有统计学意义(P<0.05),对照组患者的NPI、HAMD、ZBI量表评分较治疗前差异均无统计学意义(P>0.05),BRMS量表评分较治疗前明显升高,差异有统计学意义(P<0.05);2组患者间随访1年时的NPI、HAMD、BRMS、ZBI量表评分差异均有统计学意义(P<0.05)。结论相较于单纯药物治疗,联合低频NBM-DBS能在控制早发型重度AD患者认知障碍进展同时,也可有效改善其神经精神症状及睡眠障碍,以及降低照顾者的负担。Objective To preliminarily explore the long-term improvement of low-frequency deep brain stimulation(DBS)on the nucleus basalis of Meynert(NBM)in cognitive disorders,neuropsychiatric symptoms and sleep disorders of patients with early-onset severe Alzheimer's disease(AD).Methods A retrospective study was performed;18 patients with early-onset severe AD admitted to Department of Neurosurgery,First Medical Center of PLA General Hospital from January 2016 to December 2022 were included.These patients were divided into NBM-DBS group and control group according to different treatments;6 patients received low-frequency NBM-DBS on basis of conservative treatments;12 patients accepted conservative treatments.Changes in Brief Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Neuropsychiatric Inventory(NPI),Hamilton Depression Rating Scale(HAMD),Becker-Lavanson Mania Scale(BRMS),Pittsburgh Sleep Quality Index(PSQI),and Zarit Caregiver Burden Interview(ZBI)were observed before treatment and 1 year after follow up.Results MMSE and MoCA scores 1 year after follow up obviously reduced compared with those before treatment in both NBM-DBS and control patients;MMSE and MoCA scores in NBM-DBS patients showed no significant differences between 1 year after follow up and before treatment(P>0.05),while significant differences were noted in the control group between 1 year after follow-up and before treatment(P<0.05);and no significant differences in MMSE and MoCA scores were noted between the 2 groups 1 year after follow up(P>0.05).NPI,HAMD,BRMS and ZBI scores in the NBM-DBS group 1 year after follow up were significantly different compared with those before treatment(P<0.05);no significant differences were noted in NPI,HAMD and ZBI scores in the control group between 1 year after follow up and before treatment(P>0.05),while significant difference was noted in BRMS scores(P<0.05);significant differences in NPI,HAMD,BRMS and ZBI scores were noted between the 2 groups 1 year after follow up(P<0.05).Conclusion Low-frequ

关 键 词：阿尔茨海默病 脑深部电刺激 MEYNERT基底核 认知障碍 神经精神症状 睡眠障碍 照顾者负担 

分 类 号：R749.16[医药卫生—神经病学与精神病学]