本文選題：輕度認知損害 + 經(jīng)顱磁刺激　； 參考：《河北醫(yī)科大學》2012年碩士論文

【摘要】：目的：輕度認知損害(Mild cognitive impairment, MCI)是指出現(xiàn)輕度記憶或認知功能障礙，但不影響日常生活能力，是介于正常老化和早期老年癡呆之間的一種臨床狀態(tài)。MCI是老年癡呆的高危人群，對其進行積極的干預(yù)治療將有利于中止癡呆的發(fā)生。目前關(guān)于重復(fù)經(jīng)顱磁刺激（repetitive transcranial magnetic stimulation, rTMS）改善MCI的研究相對較少。本研究目的旨在觀察高頻rTMS對MCI老人的認知功能有無影響，為老年癡呆的預(yù)防提供一定的依據(jù)。 方法：選取患有輕度認知損害的老年人40例（年齡≥60歲)，磁刺激組22例，偽刺激組18例。磁刺激組（rTMS組）接受rTMS治療，刺激部位為左、右前額葉背外側(cè)2個腦區(qū)，每個腦區(qū)30個序列，頻率為20Hz。每周rTMS治療5次，8周共40次。rTMS偽刺激組治療參數(shù)的設(shè)置方法與rTMS組相同，但刺激時將線圈與頭皮的表面呈90°角。在rTMS治療前、rTMS治療4周、rTMS治療8周后采用蒙特利爾認知評估量表（MoCA）、詞語流暢性測驗、數(shù)字符號測驗、連線測驗A、聯(lián)想學習、情景記憶、相似性測驗、算數(shù)測驗評定其認知功能有無改善,用威斯康星卡片分類測驗(WCST)評定治療前后執(zhí)行功能的變化。 采用SPSS13.0統(tǒng)計軟件對數(shù)據(jù)進行統(tǒng)計學分析，運用一般線性模型里的重復(fù)測量資料的單因素方差分析方法，分析測查時間、分組因素的作用以及測查時間和分組因素之間的交互作用；并用多元方差分析方法實現(xiàn)同一時間兩組間的兩兩比較；使用重復(fù)測量數(shù)據(jù)多重比較配對的t檢驗法，進行每個分組組內(nèi)各個時間點上的兩兩比較。對威斯康星卡片分類測驗治療前后評分的比較采用配對t檢驗和Wilcoxon秩和檢驗。 結(jié)果：1磁刺激組和偽刺激組在性別、年齡、平均受教育程度等方面均無顯著性差異（P值分別為0.921，0.915，0.802）。 2治療前磁刺激組和偽刺激組在MoCA、詞語流暢性測驗、數(shù)字符號測驗、連線測驗A、聯(lián)想學習、情景記憶、相似性測驗、算數(shù)測驗、威斯康星卡片成績均無顯著性差異（P0.05）。 3治療后MoCA（F=10.55，P=0.003）、相似性測驗（F=9.01，P=0.01）的分組因素有統(tǒng)計學意義；MoCA評分（F=37.60，P=0.00）、詞語流暢性測驗（F=6.63，P=0.00）、數(shù)字符號測驗（F=5.79，P=0.01）、連線測驗A（F=6.19，P=0.01)、聯(lián)想學習(F=8.14，P=0.00)、情景記憶(F=5.54，P=0.01)、相似性測驗(F=23.65，P=0.00)、算數(shù)測驗(F=10.23，P=0.00)的時間因素均有統(tǒng)計學意義，且上述心理學評估量表的評估時間和分組因素均存在交互作用(P0.05)。 4治療4周后，磁刺激組的MoCA評分（F=7.62，P=0.009）、相似性測驗（F=9.39，P=0.004）的評分高于偽刺激組；治療8周后，磁刺激組的MoCA（F=41.916，P=0.000）、詞語流暢性測驗（F=7.89，P=0.008）、聯(lián)想學習（F=4.15，P=0.049）、情景記憶（F=4.48，，P=0.041）、相似性測驗（F=24.18，P=0.000）、算數(shù)測驗（F=9.59，P=0.004）高于偽刺激組；無論治療4周還是治療8周后，兩組的數(shù)字符號測驗、連線測驗A和臨摹測驗評分差別均無統(tǒng)計學意義。 5磁刺激組的MoCA、相似性測驗在治療前、治療4周、治療8周的評分兩兩比較均有顯著差別（P0.05）；詞語流暢性測驗、數(shù)字符號測驗、連線測驗A、聯(lián)想學習、情景記憶、算數(shù)測驗的治療前與治療8周、治療4周與治療8周比較，差異有統(tǒng)計學意義（P0.05），而治療前與治療4周比較差異無統(tǒng)計學意義（P0.05）；臨摹測驗的評分在治療前、治療4周、治療8周兩兩比較均無差別（P0.05）。 偽刺激組的MoCA、詞語流暢性測驗、數(shù)字符號、連線測驗A、臨摹測驗、聯(lián)想學習、情景記憶、相似性測驗、算數(shù)測驗得分的兩兩比較均無顯著差別。 6治療后結(jié)束后磁刺激組的正確應(yīng)答數(shù)、正確應(yīng)答數(shù)百分率、持續(xù)性錯誤數(shù)、非持續(xù)性錯誤數(shù)、錯誤應(yīng)答數(shù)成績均高于偽刺激組（P0.05）；磁刺激組治療后WCST評分較治療前增加（P0.05），而偽刺激組的WCST成績前后比較差異無統(tǒng)計學意義（P0.05）。 結(jié)論：1rTMS明顯改善MCI病人的記憶、執(zhí)行功能、抽象思維能力、計算推理能力，對視空間功能無影響。 2rTMS治療8周比治療4周能更進一步改善患者的認知功能。 3rTMS作為一種常用的無痛、無創(chuàng)、操作方便、安全可靠的腦部刺激技術(shù)，在治療輕度認知損害中具有重要的應(yīng)用價值。
[Abstract]:Objective: mild cognitive impairment (Mild cognitive impairment, MCI) refers to the emergence of mild memory or cognitive impairment, but does not affect daily living capacity. It is a clinical state between normal aging and early Alzheimer's disease..MCI is a high-risk group of Alzheimer's disease. Active intervention in the treatment of it will be beneficial to discontinue dementia. There are relatively few studies on repetitive transcranial magnetic stimulation (rTMS) to improve MCI. The purpose of this study is to observe the effect of high frequency rTMS on the cognitive function of MCI elderly, and to provide a certain basis for the prevention of Alzheimer's disease.
Methods: 40 aged people with mild cognitive impairment (age 60 years old), 22 cases of magnetic stimulation and 18 pseudo stimulus group. The magnetic stimulation group (group rTMS) received rTMS treatment, the stimulation site was left, the right prefrontal lobes were in 2 brain regions and 30 sequences in each brain region, the frequency was 5 times a week of 20Hz. rTMS, and the 40 times of the 40.RTMS pseudo stimulus group were treated for 8 weeks. The setting method was the same as that in the rTMS group, but the surface of the coil and the scalp was 90 degrees. Before rTMS treatment, rTMS was treated for 4 weeks. After 8 weeks of rTMS treatment, the Montreal cognitive assessment scale (MoCA), word fluency test, digital symbol test, connection test A, associative learning, situational memory, similarity test, and arithmetic test were used to evaluate their cognition. Whether the function was improved or not, the Wisconsin Card Sorting Test (WCST) was used to assess the changes of executive function before and after treatment.
The SPSS13.0 statistical software was used to analyze the data, and the single factor variance analysis method of the repeated measurement data in the general linear model was used to analyze the test time, the role of the grouping factors and the interaction between the test time and the grouping factors, and the 22 of the two groups at the same time were realized by the multivariate square difference analysis method. Comparison; 22 comparison of each time point in each group was carried out by the multiple comparison paired t test with repeated measurement data. The comparison of the scores before and after the treatment of the Wisconsin card classification test was matched with the paired t test and the Wilcoxon rank test.
Results: 1 there was no significant difference in gender, age and average education level between the magnetic stimulation group and the pseudo stimulation group (P = 0.921,0.915,0.802).
2 before the treatment, the magnetic stimulation group and the pseudo stimulus group were in MoCA, the word fluency test, the digital symbol test, the connection test A, the association learning, the situational memory, the similarity test, the arithmetic test, and the Wisconsin card scores had no significant difference (P0.05).
The group factors of MoCA (F=10.55, P=0.003) after 3 treatment (F=9.01, P=0.01) were statistically significant; MoCA score (F=37.60, P=0.00), word fluency test (F=6.63, P=0.00), digital symbol test (F=5.79, P=0.01), conjunction test (6.19), associative learning, situational memory, similarity test 23.65, P=0.00), the time factor of the arithmetic test (F=10.23, P=0.00) had statistical significance, and the assessment time and the group factor of the psychological assessment scale were both interactive (P0.05).
4 after 4 weeks of treatment, the MoCA score of the magnetic stimulation group (F=7.62, P=0.009), the score of the similarity test (F=9.39, P=0.004) was higher than that of the pseudo stimulus group; after 8 weeks of treatment, the MoCA (F=41.916, P=0.000) in the magnetic stimulation group, the fluency test (F=7.89, P=0.008), the association learning (F=4.15, P=0.049), the situational memory, the similarity test, The F=9.59 (P=0.004) was higher than that of the pseudo stimulus group; no significant difference was found between the two groups of digital symbols, A and the copy test scores, no matter 4 weeks or 8 weeks of treatment.
5 magnetic stimulation group MoCA, similarity test before treatment, 4 weeks of treatment, 8 weeks of score 22 compared significant difference (P0.05); word fluency test, digital symbol test, connection test A, association learning, situation memory, arithmetic test before and treatment 8 weeks, 4 weeks and 8 weeks, the difference is statistically significant (P0.05) There was no significant difference between the 4 weeks before treatment and 4 weeks, and there was no difference between the scores of the copy test before the treatment, the treatment for 4 weeks, and the treatment for 8 weeks 22 (P0.05).
There were no significant differences between the MoCA of the pseudo stimulus group, the word fluency test, the digital symbol, the connection test A, the copy test, the associative learning, the situational memory, the similarity test, and the arithmetic test.
6 the correct answer of the magnetic stimulation group after the end of treatment, the correct answer percentage, the correct number of errors, the number of non persistent errors, the error response scores were higher than the pseudo stimulus group (P0.05); the WCST score of the magnetic stimulation group was increased (P0.05) after treatment (P0.05), while the difference of the WCST scores in the pseudo stimulus group was not statistically significant (P0.05).
Conclusion: 1rTMS can significantly improve memory, executive function, abstract thinking ability and computational reasoning ability of MCI patients, and has no effect on visual spatial function.
2rTMS treatment for 8 weeks can further improve the cognitive function of patients than 4 weeks.
As a commonly used painless, noninvasive, safe and reliable brain stimulation technology, 3rTMS has important application value in the treatment of mild cognitive impairment.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R749.1

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