Cambios funcionales a corto plazo en la perfusión cerebral y el funcionamiento cognitivo con el uso de la estimulación cerebral no invasiva

Lázaro Gómez Fernández, Hermis Vega Treto, Sheila Berrillo Batista, Zayli Hernández Figueroa, Lilia Morales Chacón, Nelson Rodríguez Mesa, Raúl Valdés Sedeño, Karla Batista García-Ramos

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Resumen

Introducción: El deterioro cognitivo constituye un reto para las neurociencias contemporáneas. Con el desarrollo de la neuromodulación se han descrito resultados interesantes que apuntan hacia la posibilidad de mejorar las funciones cognitivas en pacientes con deterioro cognitivo leve (DCL) y demencias.

Objetivo: Describir el efecto neuromodulador de la aplicación de la estimulación transcraneal con corriente directa (tDCS) en 3 pacientes con diagnóstico de deterioro cognitivo leve.

Métodos: Se estudiaron tres pacientes con diagnóstico de deterioro cognitivo leve, a quienes se les aplicó Escala de Evaluación para la Enfermedad de Alzheimer (ADAS-Cog), un electroencefalograma, y una Tomografía de Fotón Único (SPECT), antes y unos días después de la aplicación de 20 sesiones de estimulación transcraneal con corriente directa en áreas frontales. El ánodo se colocó sobre la corteza prefrontal izquierda, y el cátodo en posición frontopolar derecha. Se utilizó una intensidad de 2mA, durante 20 minutos.

Resultados: Se observó una tendencia a la disminución en la puntuación total de la Escala de Evaluación para la Enfermedad de Alzheimer; siendo los ítems más favorecidos: recordatorio de palabras, denominación de objetos y dedos, praxia ideatoria y la orientación. Se identificó un incremento en la perfusión cerebral en el giro frontal superior, medio e inferior izquierdos, giro precentral bilateral, giro cingulado, putamen derecho, precúneo, corteza insular derecha y tálamo derecho.

Conclusiones: El uso de la tDCS en los pacientes con DCL se asoció con cambios favorables en algunos acápites de la escala ADAS-Cog, conjuntamente con incremento en la perfusión cerebral de varias estructuras corticales y subcorticales.

Palabras clave

deterioro cognitivo; estimulación transcraneal; corriente directa; perfusión cerebral

Referencias

Muniz R, Serra CM, Reisberg B, Rojo JM, Del Ser T, Pena Casanova J, et al. Cognitive-motor intervention in Alzheimer's disease: long-term results from the Maria Wolff trial. Journal of Alzheimer's disease : JAD. 2015;45(1):295-304. doi: 10.3233/JAD-142364.

Jia J, Wei C, Liang J, Zhou A, Zuo X, Song H, et al. The effects of DL-3-n-butylphthalide in patients with vascular cognitive impairment without dementia caused by subcortical ischemic small vessel disease: A multicentre, randomized, double-blind, placebo-controlled trial. Alzheimers Dement. 2016;12(2):89-99. doi: 10.1016/j.jalz.2015.04.010. Epub Jun 15.

Narasimhalu K, Effendy S, Sim CH, Lee JM, Chen I, Hia SB, et al. A randomized controlled trial of rivastigmine in patients with cognitive impairment no dementia because of cerebrovascular disease. J Lipid Res. 2010;51(5):1179-85. doi: 10.94/jlr.M002667. Epub 2009 Nov 24.

Penteado SH, Teodorov E, Kirsten TB, Eluf BP, Reis-Silva TM, Acenjo MK, et al. Obesity and diabetes cause cognitive dysfunction in the absence of accelerated beta-amyloid deposition in a novel murine model of mixed or vascular dementia. Eur J Pharmacol. 2014;738:342-51.(doi):10.1016/j.ejphar.2014.05.058. Epub Jun 11.

Samani A, Davagnanam I, Cockerell OC, Ramsay A, Patani R, Chataway J. Lymphomatosis cerebri: a treatable cause of rapidly progressive dementia. J Neurol Neurosurg Psychiatry. 2015;86(2):238-40. doi: 10.1136/jnnp-2013-307327. Epub 2014 May 20.

Peters R, Beckett N, Fagard R, Thijs L, Wang JG, Forette F, et al. Increased pulse pressure linked to dementia: further results from the Hypertension in the Very Elderly Trial - HYVET. J Hypertens. 2013;31(9):1868-75. doi: 10.097/HJH.0b013e3283622cc6.

van Straaten EC, Harvey D, Scheltens P, Barkhof F, Petersen RC, Thal LJ, et al. Periventricular white matter hyperintensities increase the likelihood of progression from amnestic mild cognitive impairment to dementia. Clinical trials (London, England). 2008;5(5):523-33. doi: 10.1177/1740774508096313.

Anderson K, Bird M, Macpherson S, McDonough V, Davis T. Incidence of dementia is increased in type 2 diabetes and reduced by the use of sulfonylureas and metformin. Geriatr Nurs. 2011;32(3):166-77. doi: 10.1016/j.gerinurse.2010.12.011. Epub 1 Feb 9.

Chen Y, Wang J, Wang LJ, Lin H, Huang PJ. Effect of different blood glucose intervention plans on elderly people with type 2 diabetes mellitus combined with dementia. Eur Rev Med Pharmacol Sci. 2017;21(11):2702-7.

Stanley MA, Calleo J, Bush AL, Wilson N, Snow AL, Kraus-Schuman C, et al. The peaceful mind program: a pilot test of a cognitive-behavioral therapy-based intervention for anxious patients with dementia. Am J Geriatr Psychiatry. 2013;21(7):696-708. doi: 10.1016/j.jagp.2013.01.007. Epub Feb 6.

Schulz KP, Clerkin SM, Fan J, Halperin JM, Newcorn JH. Guanfacine modulates the influence of emotional cues on prefrontal cortex activation for cognitive control. Psychopharmacology (Berl). 2013;226(2):261-71. doi: 10.1007/s00213-012-2893-8. Epub 2012 Oct 20.

Forstmeier S, Maercker A, Savaskan E, Roth T. Cognitive behavioural treatment for mild Alzheimer's patients and their caregivers (CBTAC): study protocol for a randomized controlled trial. Trials. 2015;16:526.(doi):10.1186/s13063-015-1043-0.

Gareri P, Putignano D, Castagna A, Cotroneo AM, De Palo G, Fabbo A, et al. Retrospective study on the benefits of combined Memantine and cholinEsterase inhibitor treatMent in AGEd Patients affected with Alzheimer's Disease: the MEMAGE study. Journal of Alzheimer's disease : JAD. 2014;41(2):633-40. doi: 10.3233/JAD-132735.

Reale M, Iarlori C, Gambi F, Feliciani C, Isabella L, Gambi D. The acetylcholinesterase inhibitor, Donepezil, regulates a Th2 bias in Alzheimer's disease patients. Pharmacogenomics J. 2006;6(4):246-54. doi: 10.1038/sj.tpj.6500369. Epub 2006 Jan 31.

Fleischhacker WW, Buchgeher A, Schubert H. Memantine in the treatment of senile dementia of the Alzheimer type. Acta Psychiatr Scand Suppl. 1986;329:81-91.(doi):10.1111/j.600-0447.1986.tb10541.x.

Iimori T, Nakajima S, Miyazaki T, Tarumi R, Ogyu K, Wada M, et al. Effectiveness of the prefrontal repetitive transcranial magnetic stimulation on cognitive profiles in depression, schizophrenia, and Alzheimer's disease: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry. 2019;88:31-40.(doi):10.1016/j.pnpbp.2018.06.014. Epub Jun 25.

Yulug B, Hanoglu L, Khanmammadov E, Duz OA, Polat B, Hanoglu T, et al. Beyond The Therapeutic Effect of rTMS in Alzheimer's Disease: A Possible Neuroprotective Role of Hippocampal BDNF? : A Minireview. Mini Rev Med Chem. 2018;18(17):1479-85. doi: 10.2174/1389557517666170927162537.

Nguyen JP, Boutoleau-Bretonniere C, Lefaucheur JP, Suarez A, Gaillard H, Chapelet G, et al. Efficacy of Transcranial Direct Current Stimulation Combined with Cognitive Training in the Treatment of Apathy in Patients with Alzheimer's Disease: Study Protocol for a Randomized Trial. Reviews on recent clinical trials. 2018;13(4):319-27. doi: 10.2174/1574887113666180416153316.

Liu CS, Rau A, Gallagher D, Rajji TK, Lanctot KL, Herrmann N. Using transcranial direct current stimulation to treat symptoms in mild cognitive impairment and Alzheimer's disease. Neurodegener Dis Manag. 2017;7(5):317-29. doi: 10.2217/nmt-017-0021. Epub 2017 Oct 18.

Borgesius NZ, de Waard MC, van der Pluijm I, Omrani A, Zondag GC, van der Horst GT, et al. Brain stimulation improves associative memory in an individual with amnestic mild cognitive impairment. J Neurosci. 2011;31(35):12543-53. doi: 10.1523/JNEUROSCI.1589-11.2011.

Miniussi C, Cappa SF, Cohen LG, Floel A, Fregni F, Nitsche MA, et al. Efficacy of repetitive transcranial magnetic stimulation/transcranial direct current stimulation in cognitive neurorehabilitation. Brain stimulation. 2008;1(4):326-36.

Kim J, Lee M, Yim J. A New Approach to Transcranial Direct Current Stimulation in Improving Cognitive Motor Learning and Hand Function with the Nintendo Switch in Stroke Survivors. Med Sci Monit. 2019;25:9555-9562.(doi):10.12659/MSM.921081.

Brem AK, Almquist JN, Mansfield K, Plessow F, Sella F, Santarnecchi E, et al. Modulating fluid intelligence performance through combined cognitive training and brain stimulation. Neuropsychologia. 2018;118(Pt A):107-14. doi: 10.1016/j.neuropsychologia.2018.04.008. Epub Apr 9.

Inagawa T, Yokoi Y, Narita Z, Maruo K, Okazaki M, Nakagome K. Safety and Feasibility of Transcranial Direct Current Stimulation for Cognitive Rehabilitation in Patients With Mild or Major Neurocognitive Disorders: A Randomized Sham-Controlled Pilot Study. Front Hum Neurosci. 2019;13:273.(doi):10.3389/fnhum.2019.00273. eCollection 2019.

Antal A, Alekseichuk I, Bikson M, Brockmöller J, Brunoni AR, Chen R, et al. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol. 2017;128(9):1774-809. doi: 10.016/j.clinph.2017.06.001. Epub Jun 19.

Batista Garcia-Ramo K, Sanchez Catasus CA, Morales Chacon L, Aguila Ruiz A, Sanchez Corneaux A, Rojas Lopez P, et al. A Novel Noninvasive Approach Based on SPECT and EEG for the Location of the Epileptogenic Zone in Pharmacoresistant Non-Lesional Epilepsy. Medicina (Kaunas). 2019;55(8).(pii):medicina55080478. doi: 10.3390/medicina.

Mazziotta JT, A. . A probabilistic atlas and reference system for the human brain: International Consortium for Brain Mapping (ICBM). Philosophical transactions of the Royal Society of London Series B, Biological sciences. 2001;356(1412):1293-322.

Broche AJ, P.; BIraben, A,; Bernard, A.; Haegelen, C.; Prigent, F.; Gibaud, B. Evaluation of methods to detect interhemispheric asymmetry on cerebral perfision SPECT: Application to epilepsy. Journal of Nuclear mEDICINE. 2005;46(4):707-13.

Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, et al. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain stimulation. 2016;9(5):641-61.

Horne KS, Filmer HL, Nott ZE, Hawi Z, Pugsley K, Mattingley JB, et al. Evidence against benefits from cognitive training and transcranial direct current stimulation in healthy older adults. Nat Hum Behav. 2021;5(1):146-58. doi: 10.1038/s41562-020-00979-5. Epub 2020 Oct 26.

Chu CS, Li CT, Brunoni AR, Yang FC, Tseng PT, Tu YK, et al. Cognitive effects and acceptability of non-invasive brain stimulation on Alzheimer's disease and mild cognitive impairment: a component network meta-analysis. J Neurol Neurosurg Psychiatry. 2021;92(2):195-203. doi: 10.1136/jnnp-2020-323870. Epub 2020 Oct 28.

Begemann MJ, Brand BA, Ćurčić-Blake B, Aleman A, Sommer IE. Efficacy of non-invasive brain stimulation on cognitive functioning in brain disorders: a meta-analysis. Psychol Med. 2020;50(15):2465-86. doi: 10.1017/S0033291720003670. Epub 2020 Oct 19.

Lu H, Chan SSM, Chan WC, Lin C, Cheng CPW, Linda Chiu Wa L. Randomized controlled trial of TDCS on cognition in 201 seniors with mild neurocognitive disorder. Ann Clin Transl Neurol. 2019;6(10):1938-48. doi: 10.002/acn3.50823. Epub 2019 Sep 17.

Bragina OA, Lara DA, Nemoto EM, Shuttleworth CW, Semyachkina-Glushkovskaya OV, Bragin DE. Increases in Microvascular Perfusion and Tissue Oxygenation via Vasodilatation After Anodal Transcranial Direct Current Stimulation in the Healthy and Traumatized Mouse Brain. Advances in experimental medicine and biology. 2018;1072:27-31.(doi):10.1007/978-3-319-91287-5_5.

Liu CS, Herrmann N, Gallagher D, Rajji TK, Kiss A, Vieira D, et al. A Pilot Study Comparing Effects of Bifrontal Versus Bitemporal Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Mild Alzheimer Disease. J ECT. 2020;36(3):211-5. doi: 10.1097/YCT.0000000000000639.

Chhatbar PY, Chen R, Deardorff R, Dellenbach B, Kautz SA, George MS, et al. Safety and tolerability of transcranial direct current stimulation to stroke patients - A phase I current escalation study. Brain stimulation. 2017;10(3):553-9.

L. G. Efecto placebo en la medicina contemporánea. Revista Cubana de Neurología y Neurocirugía. 2020;Oct-Dic.

Holczer A, Németh VL, Vékony T, Vécsei L, Klivényi P, Must A. Non-invasive Brain Stimulation in Alzheimer's Disease and Mild Cognitive Impairment-A State-of-the-Art Review on Methodological Characteristics and Stimulation Parameters. Front Hum Neurosci. 2020;14:179.(doi):10.3389/fnhum.2020.00179. eCollection 2020.





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