Effects of intermittent theta-burst stimulation on cognition and glymphatic system activity in mild cognitive impairment and very mild Alzheimer's disease: a randomized controlled trial.

IF 5.2 2区医学 Q1 ENGINEERING, BIOMEDICAL

Journal of NeuroEngineering and Rehabilitation Pub Date : 2025-09-26 DOI:10.1186/s12984-025-01738-1

Cheng-Chang Yang, Ko-Yen Huang, Jung-Lung Hsu, Chaur-Jong Hu, Yueh-Hsun Lu, Yi-Chun Kuan

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引用次数: 0

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in alleviating cognitive symptoms in Alzheimer's disease (AD) and mild cognitive impairment (MCI). Although animal studies suggest rTMS may enhance glymphatic system efficiency and reduce amyloid deposits, its impact on human glymphatic activity remains uncertain.

Methods: This double-blind, randomized, sham-controlled trial investigated the effects of intermittent theta-burst stimulation (iTBS), a novel rTMS technique, on cognitive function and glymphatic system activity using diffusion tensor image analysis along the perivascular space (DTI-ALPS) in 52 participants with amnestic MCI or very mild AD. Participants underwent 10 sessions of iTBS targeting the left dorsolateral prefrontal cortex over two weeks. Cognitive and glymphatic assessments were conducted at baseline, week 2, and week 6. Of the 52 participants, 28 received active iTBS, while 24 received sham stimulation. After the first two weeks, the sham group transitioned to active iTBS.

Results: Significant cognitive improvements were observed at week 6 in the iTBS group, indicating delayed cognitive enhancement, though no immediate changes in cognition or glymphatic system activity (measured by the ALPS index) were observed. No adverse events were reported.

Conclusions: These findings suggest that iTBS can produce delayed cognitive enhancement in individuals with amnestic MCI and very mild AD, while the impact on the glymphatic system remains uncertain and requires further investigation.

Trial registration: Clinicaltrials.gov (NCT04555941).

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间歇性脉冲刺激对轻度认知障碍和极轻度阿尔茨海默病患者认知和淋巴系统活动的影响：一项随机对照试验

背景：重复经颅磁刺激（rTMS）在缓解阿尔茨海默病（AD）和轻度认知障碍（MCI）的认知症状方面已被证明有效。虽然动物研究表明，rTMS可以提高淋巴系统效率，减少淀粉样蛋白沉积，但其对人类淋巴活性的影响仍不确定。方法：本双盲、随机、假对照试验采用沿血管周围间隙弥散张量图像分析（DTI-ALPS）对52例遗忘性MCI或极轻度AD患者的认知功能和淋巴系统活性进行了间歇性发作刺激（iTBS）（一种新型rTMS技术）的研究。参与者在两周内接受了10次针对左背外侧前额皮质的iTBS。在基线、第2周和第6周进行认知和淋巴系统评估。在52名参与者中，28人接受主动iTBS， 24人接受假刺激。前两周后，假手术组过渡到主动iTBS。结果：iTBS组在第6周观察到显著的认知改善，表明延迟的认知增强，尽管没有观察到认知或淋巴系统活性（由ALPS指数测量）的立即变化。无不良事件报告。结论：这些研究结果表明，iTBS可以在遗忘型MCI和极轻度AD患者中产生延迟性认知增强，但对淋巴系统的影响仍不确定，需要进一步研究。试验注册：Clinicaltrials.gov （NCT04555941）。

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来源期刊

Journal of NeuroEngineering and Rehabilitation 工程技术-工程：生物医学

CiteScore

9.60

自引率

3.90%

发文量

122

审稿时长

24 months

期刊介绍： Journal of NeuroEngineering and Rehabilitation considers manuscripts on all aspects of research that result from cross-fertilization of the fields of neuroscience, biomedical engineering, and physical medicine & rehabilitation.