基于认知重塑模式下重复经颅磁刺激对阿尔茨海默病患者认知功能的影响  

Effects of repetitive transcranial magnetic stimulation on cognitive function in patients with Alzheimer's disease based on cognitive remodeling mode

作　　者：付笑笑 刘欣欣[1] 宋祎晗 付美霞 FU Xiao-xiao;LIU Xin-xin;SONG Yi-han;FU Mei-xia

机构地区：[1]河南大学第一附属医院老年病科,河南开封475000

出　　处：《中国疗养医学》2025年第3期48-52,共5页Chinese Journal of Convalescent Medicine

基　　金：河南省医学科技攻关计划项目(LHGJ20210562)。

摘　　要：目的探究基于认知重塑模式下重复经颅磁刺激(rTMS)对阿尔茨海默病(AD)患者精神状况、认知功能等的影响。方法纳入2021年1月至2023年1月河南大学第一附属医院104例AD患者,以随机数字表分为两组,均给予药物、有氧运动及认知训练等综合治疗,对照组52例给予认知重塑模式,观察组52例增加rTMS,两组均连续治疗12周,随访24周,对比两组患者认知功能、精神状况、激越行为、神经递质水平及血清炎性因子水平。结果干预前,两组患者各数据比较,差异无统计学意义(P>0.05),干预后,观察组阿尔茨海默病认知功能评估量表(ADAS-cog)(14.05±2.96)分低于对照组的(18.89±3.40)分(P<0.05);蒙特利尔认知评估量表(MoCA)(27.96±2.11)分高于对照组的(24.03±3.09)分(P<0.05);精神状态评价量表(MMSE)(25.93±2.54)分高于对照组的(19.58±3.01)分(P<0.05);神经精神量表(NPI)(53.10±4.96)分低于对照组的(58.05±6.32)分(P<0.05);老年抑郁量表(GDS)(10.28±1.96)分低于对照组的(15.25±2.18)分;激越行为量表(CMAI)(52.23±7.01)分低于对照组的(71.46±6.59)分;血清5-羟色胺(5-HT)(72.47±5.02)ng/mL高于对照组的(60.02±5.15)ng/mL;乙酰胆碱(Ach)(58.68±7.28)nmol/L高于对照组的(45.20±6.12)nmol/L;γ-氨基丁酸(GAGB)(28.87±0.42)μmol/L高于对照组的(25.20±0.31)μmol/L;白介素-6(IL-6)(18.35±3.28)ng/L低于对照组的(29.62±3.69)ng/L;肿瘤坏死因子-α(TNF-α)(22.56±2.84)ng/L低于对照组的(33.79±3.62)ng/L;γ干扰素(IFN-γ)(36.85±3.82)ng/L低于对照组的(52.46±4.19)ng/L;辅助T细胞(Th17)(0.82±0.29)个/μL低于对照组的(1.05±0.32)个/μL(P<0.05)。每组指标干预后与干预前相比差异有统计学意义(P<0.05)。结论rTMS联合认知重塑模式应用于AD患者中疗效显著,可有效改善认知功能,控制激越行为和精神状况,促进神经功能修复。Objective To explore the effects of repetitive transcranial magnetic stimulation(rTMS)based on cognitive remodeling mode on mental status and cognitive function of patients with Alzheimer's disease(AD).Methods A total of 104 patients with Alzheimer's disease from the First Affiliated Hospital of Henan University from January 2021 to January 2023 were included and divided into two groups according to random number table.Both groups were given comprehensive treatment including drugs,aerobic exercise and cognitive training;52 patients in the control group were given cognitive remodeling mode;52 patients in the observation group were added rTMS.Both groups were treated for 12 weeks continuously and followed up for 24 weeks.Cognitive function,mental status,agitated behavior,neurotransmitter levels and serum inflammatory factors were compared between the two groups.Results Before intervention,there was no difference of statistical significance in the data between the two groups(P>0.05).After intervention,the score of ADAS-cog(14.05±2.96)of the observation group was lower than that of the control group(18.89±3.40),P<0.05;The score of Montreal cognitive assessment scale(MoCA)(27.96±2.11)was higher than that of the control group(24.03±3.09),P<0.05;The score of mini-mental state examination(MMSE)(25.93±2.54)was higher than that of the control group(19.58±3.01),P<0.05;The score of neuropsychiatric inventory(NPI)(53.10±4.96)was lower than that of the control group(58.05±6.32),P<0.05;The score of geriatric depression scale(GDS)(10.28±1.96)was lower than that of the control group(15.25±2.18);The score of Cohen-Mansfield agitation inventory(CMAI)(52.23±7.01)was lower than that of the control group(71.46±6.59);Serum 5-hydroxytryptamine(5-HT)(72.47±5.02)ng/mL was higher than that of the control group(60.02±5.15)ng/mL;Ach(58.68±7.28)nmol/L was higher than that of the control group(45.20±6.12)nmol/L;γ-aminobutyric acid(GAGB)(28.87±0.42)μmol/L was higher than that of the control group(25.20±0.31)μmol/L;Interleuk

关 键 词：认知重塑模式 重复经颅磁刺激 阿尔茨海默病 认知功能 神经递质 

分 类 号：R749.16[医药卫生—神经病学与精神病学]