Increased cerebral metabolism after 1 year of deep brain stimulation in Alzheimer disease.

Gwenn S Smith, Adrian W Laxton, David F Tang-Wai, Mary Pat McAndrews, Andreea Oliviana Diaconescu, Clifford I Workman, Andres M Lozano
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引用次数: 197

Abstract

Background: The importance of developing unique, neural circuitry-based treatments for the cognitive and neuropsychiatric symptoms of Alzheimer disease (AD) was the impetus for a phase I study of deep brain stimulation (DBS) in patients with AD that targeted the fornix.

Objective: To test the hypotheses that DBS would increase cerebral glucose metabolism in cortical and hippocampal circuits and that increased metabolism would be correlated with better clinical outcomes.

Design: Open-label trial.

Setting: Academic medical center.

Patients: A total of 5 patients with mild, probable AD (1 woman and 4 men, with a mean [SD] age of 62.6 [4.2] years).

Intervention: Deep brain stimulation of the fornix.

Main outcome measures: All patients underwent clinical follow-up and high-resolution positron emission tomography studies of cerebral glucose metabolism after 1 year of DBS.

Results: Functional connectivity analyses revealed that 1 year of DBS increased cerebral glucose metabolism in 2 orthogonal networks: a frontal-temporal-parietal-striatal-thalamic network and a frontal-temporal-parietal-occipital-hippocampal network. In similar cortical regions, higher baseline metabolism prior to DBS and increased metabolism after 1 year of DBS were correlated with better outcomes in global cognition, memory, and quality of life.

Conclusions: Increased connectivity after 1 year of DBS is observed, which is in contrast to the decreased connectivity observed over the course of AD. The persistent cortical metabolic increases after 1 year of DBS were associated with better clinical outcomes in this patient sample and are greater in magnitude and more extensive in the effects on cortical circuitry compared with the effects reported for pharmacotherapy over 1 year in AD.

阿尔茨海默病深部脑刺激1年后脑代谢增加。
背景:开发独特的、基于神经回路的阿尔茨海默病(AD)认知和神经精神症状治疗方法的重要性,推动了针对穹窿的AD患者深部脑刺激(DBS)的I期研究。目的:验证脑起跳刺激可增加皮质和海马回路的脑糖代谢,且代谢增加与更好的临床结果相关的假设。设计:开放标签试验。环境:学术医疗中心。患者:共5例轻度可能AD患者(1女4男,平均[SD]年龄62.6[4.2]岁)。干预:穹窿深部脑刺激。主要观察指标:所有患者在DBS治疗1年后均接受临床随访和高分辨率正电子发射断层扫描研究。结果:功能连接分析显示,1年的DBS增加了2个正交网络的脑葡萄糖代谢:额-颞-顶叶-纹状体-丘脑网络和额-颞-顶叶-枕-海马网络。在类似的皮质区域,DBS前较高的基线代谢和DBS后1年的代谢增加与整体认知、记忆和生活质量的更好结果相关。结论:在DBS治疗1年后,观察到连接性增加,这与AD治疗过程中观察到的连接性下降形成对比。在该患者样本中,DBS治疗1年后持续的皮质代谢增加与更好的临床结果相关,并且与药物治疗1年以上对AD的影响相比,对皮质回路的影响更大,更广泛。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Archives of neurology
Archives of neurology 医学-临床神经学
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