한빛사논문
- 조회321
Young Hee Jung, MD, PhD1; Hyemin Jang, MD, PhD2,3,4; Sungbeen Park, MS5; Hee Jin Kim, MD, PhD3,4,7; Sang Won Seo, MD, PhD3,4,6,7; Guk Bae Kim, PhD8; Young-Min Shon, MD, PhD7,9; Sungshin Kim, PhD5,9,10,11; Duk L. Na, MD, PhD3,12
1Department of Neurology, Myongji Hospital, Hanyang University, Goyang, Korea
2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
3Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
4Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
5Department of Artificial Intelligence, Hanyang University, Seoul, Korea
6Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
7Department of Health Science and Technology, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
8Anymedi Inc, Seoul, Korea
9Smart Healthcare Research Institute, Samsung Medical Center, Seoul, Korea
10Department of Data Science, Hanyang University, Seoul, Korea
11Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Korea
12Happymind Clinic, Seoul, Korea
Drs Jung and Jang and Ms Park contributed equally to this work as first authors.
Corresponding Author: Duk L. Na, MD, PhD, Sungshin Kim, PhD
Abstract
Importance: Repetitive transcranial magnetic stimulation (rTMS) has emerged as a safe and promising intervention for Alzheimer disease (AD).
Objective: To investigate the effect of a 4-week personalized hippocampal network-targeted rTMS on cognitive and functional performance, as well as functional connectivity in AD.
Design, setting, and participants: This randomized clinical trial, which was sham-controlled and masked to participants and evaluators, was conducted between May 2020 and April 2022 at a single Korean memory clinic. Eligible participants were between ages 55 and 90 years and had confirmed early AD with evidence of an amyloid biomarker. Participants who met the inclusion criteria were randomly assigned to receive hippocampal network-targeted rTMS or sham stimulation. Participants received 4-week rTMS treatment, with assessment conducted at weeks 4 and 8. Data were analyzed between April 2022 and January 2024.
Interventions: Each patient received 20 sessions of personalized rTMS targeting the left parietal area, functionally connected to the hippocampus, based on fMRI connectivity analysis over 4 weeks. The sham group underwent the same procedure, excluding actual magnetic stimulation. A personalized 3-dimensional printed frame to fix the TMS coil to the optimal target site was produced.
Main outcomes and measures: The primary outcome was the change in the AD Assessment Scale-Cognitive Subscale test (ADAS-Cog) after 8 weeks from baseline. Secondary outcomes included changes in the Clinical Dementia Rating-Sum of Boxes (CDR-SOB) and Seoul-Instrumental Activity Daily Living (S-IADL) scales, as well as resting-state fMRI connectivity between the hippocampus and cortical areas.
Results: Among 30 participants (18 in the rTMS group; 12 in the sham group) who completed the 8-week trial, the mean (SD) age was 69.8 (9.1) years; 18 (60%) were female. As the primary outcome, the change in ADAS-Cog at the eighth week was significantly different between the rTMS and sham groups (coefficient [SE], -5.2 [1.6]; P = .002). The change in CDR-SOB (-4.5 [1.4]; P = .007) and S-IADL (1.7 [0.7]; P = .004) were significantly different between the groups favoring rTMS groups. The fMRI connectivity analysis revealed that rTMS increased the functional connectivity between the hippocampus and precuneus, with its changes associated with improvements in ADAS-Cog (r = -0.57; P = .005).
Conclusions and relevance: This randomized clinical trial demonstrated the positive effects of rTMS on cognitive and functional performance, and the plastic changes in the hippocampal-cortical network. Our results support the consideration of rTMS as a potential treatment for AD.
논문정보
- Research article
- 2024년 05월 (BRIC 등록일 2024-05-08)
- 국내 연구진
- 의약학 > 응용의학
관련 보도자료
- 아이뉴스24
- 2024. 05. 10
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