目的 探讨低频及高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合多巴丝肼对帕金森病(Parkinson disease,PD)患者的认知功能的影响.方法 选取2020年1月—2022年6月就诊的存在轻度认知功能障碍的PD患者90例,按入院顺序分为单纯药物组(n=30)、低频+药物组(n=30)及高频+药物组(n=30).单纯药物组患者采用口服多巴丝肼治疗,低频+药物组、高频+药物组患者在口服多巴丝肼的基础上分别联合低频、高频rTMS治疗.应用数字广度测验(digital span,DS)、中文听觉词汇学习测验(Chinese auditory learning test,CALT)、线段方向判定测验(judgment of line orientation test,JLOT)及词汇流畅性测验(verbal fluency test,VFT)分别在治疗前及治疗4周后对所有被试进行认知功能评估.应用SPSS 26.0进行统计分析.组内治疗前后比较采用配对t检验,组间比较采用单因素方差分析.结果 单纯用药组患者治疗前和治疗4周后比较MoCA、DS顺背、DS倒背、CALT即刻回忆、CALT延迟回忆、JLOT、VFT评分均差异无统计学意义(t=-1.157,-0.648,-0.215,-0.290,-0.154,-0.782,-0.960,均 P＞0.05).低频+药物组及高频+药物组治疗4周后MoCA、DS顺背、DS倒背、CALT即刻回忆、CALT延迟回忆、JLOT、VFT评分均较治疗前升高(低频+药物组:t=-16.357,-11.379,-7.999,-11.805,-16.624,-15.996,-17.241,均 P＜0.05;高频+药物组:t=-25.198,-13.971,-13.904,-25.831,-26.382,-20.108,-15.643,均 P＜0.05).三组治疗前MoCA、DS顺背、DS倒背、CALT即刻回忆、CALT延迟回忆、JLOT、VFT评分,均差异无统计学意义(均P＞0.05),三组治疗后MoCA、DS顺背、DS倒背、CALT即刻回忆、CALT延迟回忆、JLOT、VFT评分[单纯药物组:(20.37±1.96)分,(4.37±1.19)分,(2.80±0.55)分,(6.93±1.70)分,(5.17± 1.09)分,(15.50±2.69)分,(10.73±1.55)分;低频+药物组:(23.83±2.32)分,(5.87±0.94)分,(3.87±0.73)分,(9.17±1.74)分,(8.13±1.50)分,(20.77±2.19)分,(13.30±1.73)分;高频+药物组:(27.17±1.64)分,(6.73±1.01)分,(4.80±0.81)分,(11.20±2.06)分,(10.03±1.54)分,(25.17± 3.14)分,(15.87±2.05)分]均差异有统计学意义(均P＜0.05),其中低频+药物组及高频+药物组均高于单纯用药组,高频+药物组的评分均高于低频+药物组(均P＜0.05).结论 PD患者接受低频或高频的rTMS联合药物治疗均可改善其认知功能,其中高频rTMS的疗效可能更为显著,为临床治疗PD提供了新的思路.
Effects of low-frequency and high-frequency repetitive transcranial magnetic stimulation combined with levodopa and benserazide hydrochloride on mild cognitive impairment in patients with Parkin-son disease
Objective To investigate the effects of low-frequency and high frequency repetitive transcranial magnetic stimulation(rTMS)combined with levodopa and benserazide hydrochloride on mild cognitive impairment in patients with Parkinson disease(PD).Methods Totally 90 PD patients with mild cognitive impairment who visited from January 2020 to June 2022 were included,and they were divided into a simple drug group(n=30),drug+low-frequency group(n=30),and drug+high-frequency group(n=30)according to the order of admission.The patients in the simple drug group were treated with oral levodopa and benserazide hydrochloride,while the patients in drug+low-frequency and drug+high-frequency groups were treated with low-frequency or high-frequency rTMS on the basis of oral levodopa and benserazide hydrochlo-ride.Montreal cognitive assessment(MoCA),digital span(DS),Chinese auditory learning test(CALT),the judgment of line orientation test(JLOT)and verbal fluency test(VFT)were used to evaluate the cognitive function of patients before and after 4 weeks of treatment.SPSS 26.0 was used for statistical analysis.The paired t-test was used for intra-group comparison before and after treatment,while one-way ANOVA was used for inter-group comparison.Results There were no significant differences in MoCA,DS anterograde,DS backward,CALT immediate recall,CALT delayed recall,J LOT,and VFT scores among patients in the simple drug group before and after 4 weeks of treatment(t=-1.157,-0.648,-0.215,-0.290,-0.154,-0.782,-0.960,all P＞0.05).After 4 weeks of treatment,MoCA,DS anterograde,DS backward,CALT immediate re-call,CALT delayed recall,JLOT and VFT scores in drug+low-frequency group and drug+high-frequency group were higher than before treatment(drug+low frequency group:t=-16.357,-11.379,-7.999,-11.805,-16.624,-15.996,-17.241,all P＜0.05;drug+high-frequency group:t=-25.198,-13.971,-13.904,-25.831,-26.382,-20.108,-15.643,all P＜0.05).There were no statistically significant differ-ences in the scores of MoCA,DS anterograde,DS backward,CALT immediate recall,CALT delayed recall,JLOT and VFT among the three groups before treatment(all P＞0.05).After treatment,there were statistical-ly significant differences in the scores of MoCA,DS anterograde,DS backward,CALT immediate recall,CALT delayed recall,JLOT and VFT among the three groups(simple drug group:(20.37±1.96),(4.37±1.19),(2.80±0.55),(6.93±1.70),(5.17±1.09),(15.50±2.69),(10.73±1.55);drug+low-frequency group:(23.83±2.32),(5.87±0.94),(3.87±0.73),(9.17±1.74),(8.13±1.50),(20.77±2.19),(13.30±1.73);drug+high-frequency group:(27.17±1.64),(6.73±1.01),(4.80±0.81),(11.20± 2.06),(10.03±1.54),(25.17±3.14),(15.87±2.05))(all P＜0.05).Further analysis showed that both the drug+low-frequency and drug+high-frequency groups had higher scores than the simple drug group,and the drug+high-frequency group had higher scores than the drug+low-frequency group(all P＜0.05).Conclu-sion The combination of drug+low-frequency or drug+high-frequency rTMS and drug therapy can help im-prove cognitive function in patients with PD,and the efficacy of drug+high-frequency rTMS may be more sig-nificant,which provides a new therapeutic idea for clinical treatment of patients with PD.
Repetitive transcranial magnetic stimulationLevodopa and benserazide hydrochlo-rideParkinson diseaseCognitive function
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NSTL
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