摘要
目的探讨高频重复经颅磁刺激(rTMS)不同靶点治疗帕金森病(PD)认知障碍的效果。方法选取2020年3月至2022年2月聊城市第四人民医院神经内科门诊及住院患者中的60例PD患者作为研究对象,按照随机数字表法分为右侧组(30例)与左侧组(30例),右侧组给予高频rTMS(25 Hz)刺激右侧前额叶背外侧区(DLPFC)治疗,左侧组给予高频rTMS(25 Hz)刺激左侧DLPFC治疗。比较两组患者治疗前,治疗后即刻,治疗后1、2、3个月的简易精神状态检查量表(MMSE)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、蒙特利尔认知评估量表(MoCA)评分及P300检测潜伏期(PL)与波幅(Amp)的评定分值变化情况,对两组患者的认知功能进行评价。结果治疗后即刻及治疗后1、2个月,右侧组的MMSE量表评分高于本组治疗前,HAMA、HAMD评分低于本组治疗前,MoCA评分高于本组治疗前,P300检测PL短于本组治疗前,Amp高于本组治疗前,差异有统计学意义(P<0.05)。治疗后即刻及治疗后1个月,左侧组的HAMA、HAMD评分低于本组治疗前,差异有统计学意义(P<0.05);左侧组治疗前与治疗后即刻及治疗后1、2、3个月的MMSE量表评分、MoCA评分、P300检测PL及Amp比较,差异无统计学意义(P>0.05)。治疗后即刻及治疗后1、2个月,右侧组的MMSE量表评分、MoCA评分高于左侧组,P300检测PL短于左侧组,Amp高于左侧组,差异有统计学意义(P<0.05);治疗后2个月,右侧组的HAMA、HAMD评分低于左侧组,差异有统计学意义(P<0.05)。结论高频rTMS刺激右侧DLPFC区治疗可明显改善PD患者的认知障碍,且此种疗效可维持到治疗后2个月。高频rTMS刺激左侧DLPFC区治疗仅可短时改善焦虑、抑郁症状。无论整体疗效还是疗效持续时间,高频rTMS刺激右侧DLPFC区靶点治疗均优于高频rTMS刺激左侧DLPFC区靶点治疗。
Objective To investigate the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on cognitive impairment in Parkinson's disease(PD)with different targets.Methods A total of 60 PD patients from the Department of Neurology,Liaocheng Fourth People's Hospital from March 2020 to February 2022 were selected as the research objects.According to the random number table method,they were divided into the right group(30 cases)and the left group(30 cases).The right group received high frequency rTMS(25 Hz)stimulation of the right dorso lateral prefrontal cortex(DLPFC),and the left group received high frequency rTMS(25 Hz)stimulation of the left DLPFC.The scores of mini-mental state examination(MMSE),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),Montreal cognitive assessment scale(MoCA)and the latency(PL)and amplitude(Amp)of P300 were compared between the two groups before treatment,immediately after treatment,and 1,2 and 3 months after treatment.The cognitive function of the two groups was evaluated.Results Immediately after treatment and 1 and 2 months after treatment,the MMSE scores of the right group were higher than those before treatment,the HAMA and HAMD scores were lower than those before treatment,the MoCA scores were higher than those before treatment,the PL were shorter than those before treatment,and the Amp were higher than those before treatment,and the differences were statistically significant(P<0.05).Immediately after treatment and 1 month after treatment,HAMA and HAMD scores in the left group were lower than those before treatment,and the differences were statistically significant(P<0.05).In the left group,there were no significant differences in MMSE score,MoCA score,PL and Amp detected by P300 before treatment, immediately after treatment, and 1, 2 and 3 months after treatment (P>0.05). Immediately after treatment and 1 and 2 months after treatment, the MMSE scores and MoCA scores of the right group were higher than those of the left group, the PL of P300 detection were shorter than those of the left group, and the Amp were higher than those of the left group, and the differences were statistically significant (P<0.05). After 2 months of treatment, the HAMA and HAMD scores of the right group were lower than those of the left group, and the differences were statistically significant (P<0.05). Conclusion High frequency rTMS stimulation of the right DLPFC can significantly improve the cognitive impairment of PD patients, and this effect can be maintained for 2 months after treatment. High frequency rTMS stimulation of the left DLPFC can only improve the symptoms of anxiety and depression in a short time. High frequency rTMS stimulation of right DLPFC target is superior to high frequency rTMS stimulation of left DLPFC target in both overall efficacy and efficacy duration.
作者
杨明健
YANG Mingjian(Department of Neurology,Liaocheng Fourth People's Hospital,Shandong Province,Liaocheng252000,China)
出处
《中国当代医药》
CAS
2023年第23期22-27,共6页
China Modern Medicine
关键词
帕金森病
认知障碍
重复经颅磁刺激
治疗
Parkinson's disease
Cognitive dysfunction
Repetitive transcranial magnetic stimulation
Treatment
作者简介
杨明健(1972-),男,副主任医师,聊城市第四人民医院神经内科科主任,研究方向:脑血管病、帕金森病、心身疾病及认知障碍。
