| Objectives:Alzheimer’s disease is the most common type of dementia in elderly dementia,which seriously affects the quality of life of patients and families,and the number of people suffering from Alzheimer’s disease has increased in recent years.The typical manifestations of the disease include cognitive dysfunction(such as memory impairment,aphasia,loss,loss,visual disorder,etc.),personality and behavior abnormalities,insomnia and physical autonomy dysfunction,advanced disease can lead to incontinence,Limb stiffness,bed rest because of malnutrition and other complications caused by death.Early treatment can improve symptoms and slow the progression of the disease,so it is important to treat the early treatment of Alzheimer’s disease in an early stage.The current drug treatment program mainly includes control of mental disorders associated with symptomatic drug therapy and improve cognitive function,delay the progress of the disease puzzle drug treatment.Although the improvement of cognitive function of drug research and development in the ascendant,but the choice of drug treatment is limited,the efficacy is not clear.In recent years,non-pharmacological strategies have been gradually emerging,where transcranial magnetic stimulation can be used as an effective noninvasive treatment option.Repeated transcranial magnetic stimulation(rTMS Repetitive transcranial magnetic stimulation)is a noninvasive,painless,safe and easy to operate nerve electrophysiological treatment,past clinical evidence and related studies have shown that rTMS can effectively improve Alzheimer’s disease Kindergarten,depression and schizophrenia in patients with clinical symptoms,and the combination of a number of different drugs or other treatment methods or can achieve synergistic effect.rTMS can play a role in regulating the activity of nerve cells by regulating and balancing the activity of nerve cells.rTMS can mediate neural plasticity and relieve neuronal cell activity imbalance,and it is found that rTMS may play an important role in the regulation of nerve cells and the mechanism of rTMS.rTMS can stimulate the neurons in the cerebral cortex by activating the magnetic field and activate the synaptic activity of the neuronal circuits of the central nervous system,thereby exciting or inhibiting the nerve conduction signals.The main symptoms of Alzheimer’s disease in early and mid-term to cognitive dysfunction,especially in memory disorders,the current rTMS Alzheimer’s disease to improve the cognitive function of treatment research focused on the prefrontal lobe lateral stimulation.Pathological study found that AD patients with reduced brain volume and weight loss,deep groove,brain atrophy,and atrophy of the most obvious part of the temporal lobe,especially its internal hippocampus.At present,there is little research on the treatment of AD in patients with advanced temporal and vertebral stimulus treatment,which includes important auditory and verbal functional areas such as Wernicke area and margin,and are limited by the technical conditions of TMS itself.The effect of stimulating hippocampus on cognitive function is not relevant Reported.Recent studies have found that functional magnetic resonance imaging confirmed that the transcranial magnetic stimulation of the temporal parietal cortex can improve the normal association memory function,further study found that by stimulating the parietal cortex can activate the cortex and subcortical function between the nerve fibers To improve the function of the underlying structure of the cortex,including the memory of the cognitive function of the significance of the hippocampus structure.In this study,we used rTMS to stimulate the temporal parietal lobe of patients with Alzheimer’s disease.The cognitive behavioral scale was used to evaluate the changes of cognitive function.Further,the rtMS was used to evaluate the rituxia And to improve the clinical efficacy of rTMS in stimulating the temporal lobe of patients with mild and moderate Alzheimer’s disease.Materials and MethodsThis prospective,randomized,double-blind,controlled study enrolled a total of 30 patients who were diagnosed with Alzheimer’s disease.These patients were randomly divided into two groups:the rTMS group who received rTMS treatment,and the sham group who received non-rTMS sham treatment.The severity of Alzheimer’ s disease was evaluated according to the Mini-Mental State Examination(MMSE),and then the patients were classified into mild-stage(MMSE = 21-26 points)and moderate-stage(MMSE<20 points).Neuropsychological assessment was performed to evaluate the individual comprehensive cognitive function before rTMS treatment,immediately after rTMS treatment and 6 weeks after rTMS treatment,respectively.Neuropsychological assessment included Alzheimer ’s Disease Assessment Scale-Cognitive Subscale(ADAS-cog),MMSE,and Montreal Cognitive Assessment(MoCA).Additionally,we used World Health Organization-University of California-Los Angeles Auditory Verbal Learning Test(WHO-UCLA AVLT)to evaluate the individual auditory verbal cognitive function.The neuropsychological test scores at different time points were compared,and the data were grouped and analyzed according to the severity of Alzheimer’ s disease(mild-or moderate-stage).Results1.Grouping and baseline cognitive levels of participants:In the current study,17 patients with Alzheimer’s disease was randomly divided into the rTMS group,and 13 patients with Alzheimer’s disease was randomly divided into the sham group.There was no significant difference in age(p=0.313),male-to-female ratio(p=l),educational background(p=0.921)and donepezil dosage(p=0.751)between the rTMS group and the sham group.During this trial,three participants including two patients in rTMS treatment group and one in the sham group had the adverse effect,and they had the mild headache and fatigue after the first treatment.But these three participants were willing to finish this trial.Subsequently they did not have these adverse effects.There was no significant difference in the baseline cognitive levels between the rTMS group and the sham group,including ADAS-cog scores(p=0.474),MMSE scores(p=0.536),MoCA scores(p=0.810),and WHO-UCLA AVLT scores(p=0.591).According to the MMSE scores,there were 20 patients with mild-stage Alzheimer’s disease and 10 patients with moderate-stage Alzheimer’s disease;in the rTMS group,there were 12 patients with mild-stage Alzheimer’s disease and 5 patients with moderate-stage Alzheimer’s disease;in the sham group,there were 8 patients with mild-stage Alzheimer’s disease and 5 patients with moderate-stage Alzheimer’s disease.2.ADAS-cog assessment:There was no significant difference in the group-by-time interaction(p=0.332).In the rTMS group,the average ADAS-cog scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 22.6,18.5 and 16.8,respectively.Intergroup comparisons showed the average ADAS-cog score immediately after the rTMS treatment was significantly lower than the baseline level(p=0.042),and the average ADAS-cog score 6 weeks after the rTMS treatment was significantly lower than the baseline level(p=0.013)as well.In the sham group,the average ADAS-cog scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 24.2,22.9 and 21.2,respectively.There was no significant difference between the average ADAS-cog score immediately after the rTMS treatment and the baseline level(p=0.668)as well as between the average ADAS-cog score 6 weeks after the rTMS treatment and the baseline level(p=0.315).In the 12 patients with mild-stage Alzheimer’s disease who received rTMS treatment,the average ADAS-cog score immediately after the rTMS treatment was significantly lower than the baseline level(p=0.044),and the average ADAS-cog score 6 weeks after the rTMS treatment was significantly lower than the baseline level(p=0.017)as well;however,no significant ADAS-cog score change was noted in the moderate-stage rTMS treatment group(n=5),in the mild-satge sham group(n=8),and in the moderate-stage sham group(n=5)(all p>0.05).3.MMSE evaluation:In the rTMS group,the average MMSE scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 22.2,23.9 and 25.5,respectively.Intergroup comparisons showed the average MMSE score 6 weeks after the rTMS treatment was significantly higher than the baseline level(p=0.017),while these was no significant difference between the average MMSE score immediately after the rTMS treatment and the baseline level(p=0.071).In the sham group,the average MMSE scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 22.8,23.1 and 24.2,respectively.Intergroup comparisons showed there was no significant difference(all p>0.05).In the 12 patients with mild-stage Alzheimer’s disease who received rTMS treatment,the average MMSE score 6 weeks after the rTMS treatment was significantly higher than the baseline level(p=0.042),while these was no significant difference between the average MMSE score immediately after the rTMS treatment and the baseline level(p=0.147);additionally,no significant MMSE score change was noted in the moderate-stage rTMS treatment group(n=5),in the mild-satge sham group(n=8),and in the moderate-stage sham group(n=5)(all p>0.05).4.MoCA evaluation:In the rTMS group,the average MoCA scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 17.5,19.8 and 21.5,respectively.Intergroup comparisons showed there was no significant difference(all p>0.05).In the sham group,the average MoCA scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 18.1,19.3 and 20.1,respectively.Intergroup comparisons showed there was no significant difference as well(all p>0.05).In the 12 patients with mild-stage Alzheimer’s disease who received rTMS treatment,the average MoCA score 6 weeks after the rTMS treatment was significantly higher than the baseline level(p=0.046),while these was no significant difference between the average MoCA score immediately after the rTMS treatment and the baseline level(p=0.208);additionally,no significant MoCA score change was noted in the moderate-stage rTMS treatment group(n=5),in the mild-satge sham group(n=8),and in the moderate-stage sham group(n=5)(all p>0.05).5.WHO-UCLA AVLT evaluation:In the rTMS group,the average WHO-UCLA AVLT scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 32.5,35.8 and 38.7,respectively.Intergroup comparisons showed the average WHO-UCLA AVLT score 6 weeks after the rTMS treatment was significantly higher than the baseline level(p=0.039),while these was no significant difference between the average WHO-UCLA AVLT score immediately after the rTMS treatment and the baseline level(p=0.229).In the sham group,the average WHO-UCLA AVLT scores at baseline,immediately after,and 6 weeks after the rTMS treatment were 34.1,35.8 and 37.8,respectively.Intergroup comparisons showed there was no significant difference(all p>0.05).In the 12 patients with mild-stage Alzheimer’s disease who received rTMS treatment,the average WHO-UCLA AVLT score 6 weeks after the rTMS treatment was significantly higher than the baseline level(p=0.021),while these was no significant difference between the average WHO-UCLA AVLT score immediately after the rTMS treatment and the baseline level(p=0.363);additionally,no significant WHO-UCLA AVLT score change was noted in the moderate-stage rTMS treatment group(n=5),in the mild-satge sham group(n=8),and in the moderate-stage sham group(n=5)(all p>0.05).ConclusionsEvaluation of MMSE,ADAS-cog,MoCA and WHO-UCLAVLT cognitive function in patients with AD after stimulation in Temporoparietal lobe with rTMS can significantly improve the cognitive function and auditory memory function of Alzheimer’s disease patients,especially for mild Alz The efficacy of patients with nausea is more significant.Studies have shown that rTMS can be used as a noninvasive adjuvant therapy,combined with a variety of current treatment and prevention of disease progression of the application of Alzheimer’s disease patients,has a wide range of applications. |
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