Efficacy and Safety of Bilateral Deep Brain Stimulation (DBS) for Severe Alzheimer's Disease: A Comparative Analysis of Fornix Versus Basal Ganglia of Meynert

IF 4.8 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-04-17 DOI:10.1111/cns.70285

Junpeng Xu, Bin Liu, Guosong Shang, Zhebin Feng, Haonan Yang, Yuhan Chen, Xinguang Yu, Zhiqi Mao

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引用次数: 0

Abstract

Background

Deep brain stimulation (DBS) is a novel therapy for severe Alzheimer's disease (AD). However, there is an ongoing debate regarding the optimal target for DBS, particularly the fornix and the basal ganglia of Meynert (NBM).

Objective

This study aimed to investigate the safety and efficacy of DBS for severe AD and to compare the fornix and the NBM as potential targets.

Methods

We conducted a prospective, nonrandomized clinical study involving 20 patients with severe AD (MMSE score 0 to 10, CDR level 3) from January 2015 to August 2022, comprising 12 males and eight females, with a mean age of 59.05 ± 6.45 years. All patients underwent DBS treatment, among which 14 received bilateral fornix implantation, while six received bilateral implantation in the NBM. Electrical stimulation commenced 1 month postoperatively. We assessed the patients before surgery, followed by evaluations at 1 month, 3 months, 6 months, and 12 months poststimulation. Primary outcome measures focused on changes in cognitive function, assessed using the MMSE, MoCA, ADAS-Cog, and CDR scales. Secondary measures encompassed quality of life, caregiver burden, neuropsychiatric symptoms, and sleep disturbances, evaluated through the BI, FAQ, FIM, ZBI, NPI, HAMA, HAMD, and PSQI scales.

Results

All patients tolerated DBS well, with no serious adverse effects reported. Early on, DBS significantly improved cognitive function and quality of life. Long-term benefits include the improvement of neuropsychiatric symptoms and sleep disorders and the alleviation of caregiver burden. Comparison between DBS targeting the NBM and fornix revealed no significant differences in overall scale scores. However, upon deeper analysis, NBM-DBS exhibited a more pronounced improvement in neuropsychiatric symptoms, particularly in NPI scores.

Conclusion

DBS is a potential therapeutic approach for severe AD, capable of improving patients' cognitive function, quality of life, and neuropsychiatric symptoms. Notably, NBM-DBS showed distinct advantages in ameliorating neuropsychiatric symptoms, providing valuable insights for clinically selecting the optimal DBS target.

Trial Registration

ClinicalTrials.gov identifier: NCT03115814

Abstract Image

查看原文本刊更多论文

双侧深部脑刺激（DBS）治疗重度阿尔茨海默病的疗效和安全性：穹窿与Meynert基底神经节的比较分析

背景大脑深部刺激（DBS）是一种治疗严重阿尔茨海默病（AD）的新型疗法。然而，关于 DBS 的最佳靶点，尤其是穹窿和梅内特基底节（NBM），一直存在争议。目的本研究旨在探讨 DBS 治疗重度 AD 的安全性和有效性，并比较作为潜在靶点的穹窿和 NBM。方法我们在 2015 年 1 月至 2022 年 8 月期间进行了一项前瞻性、非随机临床研究，涉及 20 例重度 AD 患者（MMSE 评分 0 至 10 分，CDR 3 级），其中男性 12 例，女性 8 例，平均年龄（59.05±6.45）岁。所有患者均接受了 DBS 治疗，其中 14 人接受了双侧穹窿植入，6 人接受了双侧 NBM 植入。术后一个月开始电刺激。我们在手术前对患者进行评估，然后在刺激后 1 个月、3 个月、6 个月和 12 个月进行评估。主要结果测量侧重于认知功能的变化，使用 MMSE、MoCA、ADAS-Cog 和 CDR 量表进行评估。次要指标包括生活质量、护理负担、神经精神症状和睡眠障碍，通过 BI、FAQ、FIM、ZBI、NPI、HAMA、HAMD 和 PSQI 量表进行评估。结果所有患者对 DBS 耐受良好，无严重不良反应报告。在早期，DBS 明显改善了认知功能和生活质量。长期疗效包括改善神经精神症状和睡眠障碍，减轻护理人员的负担。对针对 NBM 和穹窿的 DBS 进行比较后发现，两者在总体量表评分上没有明显差异。然而，经过深入分析，NBM-DBS 对神经精神症状的改善更为明显，尤其是在 NPI 评分方面。结论 DBS 是一种治疗严重注意力缺失症的潜在方法，能够改善患者的认知功能、生活质量和神经精神症状。值得注意的是，NBM-DBS在改善神经精神症状方面表现出明显优势，为临床选择最佳DBS靶点提供了宝贵的启示。试验注册 ClinicalTrials.gov identifier：NCT03115814

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.