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Huang J, Liang M, Jiang D, Qin B, Zhang W. Enhanced Parkinson's gait, reduced fall risk, and improved cognitive function through multimodal rehabilitation combined with rivastigmine treatment. Am J Transl Res 2024; 16:2379-2388. [PMID: 39006262 PMCID: PMC11236654 DOI: 10.62347/paxi7650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/09/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE This study aimed to examine the effects of combined rehabilitation and rivastigmine treatment on patients with Parkinson's disease (PD). METHODS Gait parameters were assessed using the Gibbon Gait Analyzer in fifteen patients. Baseline gait data and cognitive assessments were collected. Each patient underwent external counterpulsation therapy, transcranial magnetic stimulation therapy, and exercise therapy for one hour per day, five days a week for three weeks. Post-intervention, gait and cognitive data were re-evaluated. Alongside their standard PD medications, all participants were administered rivastigmine throughout the study period. RESULTS The intervention significantly enhanced motor function in the single-task test, evidenced by marked improvements in gait metrics such as stride width and walking speed, and a substantial reduction in fall risk. Cognitive function, assessed by mini-mental state examination and Montreal cognitive assessment, showed an improvement trend after the three-week intervention. Improvements in dual-task walking function were observed, although these changes did not reach statistical significance. CONCLUSION Multimodal exercise training combined with rivastigmine treatment significantly improves certain gait parameters in the single-task test, enhances balance, and reduces the risk of falling in patients with PD. Cognitive function also demonstrated improvement.
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Affiliation(s)
- Jinshan Huang
- Neurology Department, Jiangbin Hospital of Guangxi Zhuang Autonomous RegionNanning 530021, Guangxi, China
| | - Mei Liang
- Neurology Department, Jiangbin Hospital of Guangxi Zhuang Autonomous RegionNanning 530021, Guangxi, China
| | - Dongdong Jiang
- Neurology Department, Jiangbin Hospital of Guangxi Zhuang Autonomous RegionNanning 530021, Guangxi, China
| | - Bin Qin
- Medical and Neurology Department, Jiangbin Hospital of Guangxi Zhuang Autonomous RegionNanning 530021, Guangxi, China
| | - Wei Zhang
- Neurology Department, Jiangbin Hospital of Guangxi Zhuang Autonomous RegionNanning 530021, Guangxi, China
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Yin BW, Yang L. Comparative Efficacy of Augmenting Escitalopram with Modified Electroconvulsive Therapy or High-Frequency Repetitive Transcranial Magnetic Stimulation on Depressive Symptoms, Quality of Life, and Cognitive Function in Treatment-Resistant Depression. TOHOKU J EXP MED 2024; 262:191-199. [PMID: 38171724 DOI: 10.1620/tjem.2023.j103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Treatment-resistant depression (TRD) poses significant therapeutic challenges despite available interventions. Escitalopram (ESC) is a highly selective antidepressant. This study aimed to compare ESC alone and ESC combined with modified electroconvulsive therapy (MECT) or high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in TRD patients. Ninety participants were randomized into ESC alone, ESC + MECT, and ESC + HF-rTMS groups. Notable differences were observed in Hamilton Depression Rating Scale (HDRS-17) scores at 12 weeks among ESC (14.37), ESC + MECT (10.27), and ESC + HF-rTMS (10.77) groups (P = 0.006). In terms of overall quality of life (QoL) evaluated using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) at 12 weeks, the ESC, ESC + MECT, and ESC + HF-rTMS groups scored 2, 3, and 3.5, respectively. ESC + MECT/HF-rTMS groups showed reduced depressive symptoms compared to the ESC group, accompanied by higher overall QoL scores and increased satisfaction with health. Patients receiving ESC + MECT demonstrated no significant alterations in short-term memory and orientation, as measured by the Montreal Cognitive Assessment (MoCA), before and after treatment. Moreover, a decline in language was observed compared to baseline (12 weeks: median 2, IQR 2-3; baseline: median 1, IQR 1-3; P = 0.022). The positive impact of ESC with HF-rTMS on cognitive function was evidenced by improvements in all domines MoCA.Combining ESC with MECT or HF-rTMS exhibited enhanced effectiveness in alleviating depressive symptoms and enhancing QoL compared to ESC monotherapy. Specifically, the ESC + HF-rTMS combination displayed potential as a comprehensive treatment strategy for TRD, addressing both emotional and cognitive aspects.
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Affiliation(s)
- Bo-Wen Yin
- Department of Psychiatry, Wenzhou Seventh People's Hospital
| | - Liu Yang
- Department of Psychiatry, Wenzhou Seventh People's Hospital
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Pagali SR, Kumar R, LeMahieu AM, Basso MR, Boeve BF, Croarkin PE, Geske JR, Hassett LC, Huston J, Kung S, Lundstrom BN, Petersen RC, St Louis EK, Welker KM, Worrell GA, Pascual-Leone A, Lapid MI. Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer's disease, Alzheimer's disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis. Int Psychogeriatr 2024:1-49. [PMID: 38329083 PMCID: PMC11306417 DOI: 10.1017/s1041610224000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment. DESIGN Systematic review, Meta-Analysis. SETTING We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023. PARTICIPANTS AND INTERVENTIONS RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included. MEASUREMENT Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423). RESULTS The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer's Disease Assessment Scale-Cognitive Subscale (SMD = -0.96 [-1.32, -0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity. CONCLUSION The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.
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Affiliation(s)
- Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MI, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MI, USA
| | - Rakesh Kumar
- Department of Psychiatry and Psychology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MI, USA
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MI, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | | | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MI, USA
| | | | - John Huston
- Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MI, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | | | | | | | - Kirk M Welker
- Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MI, USA
| | | | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna, Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA
- Department of Neurology, Harvard Medical School, Cambridge, MA, USA
| | - Maria I Lapid
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MI, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
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Yu K, Wang L, Lv S, Ye X, Liu L, Zheng X, Jin R, Zhou D, Zhang Y, Min G, Wu S. Using functional near-infrared spectroscopy to study effects of virtual reality intervention for adolescents with depression in a clinical setting in China: study protocol for a prospective, randomised, controlled trial. BMJ Open 2023; 13:e074129. [PMID: 38101854 PMCID: PMC10729192 DOI: 10.1136/bmjopen-2023-074129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Adolescent depression has been shown to be associated with many devastating psychosocial outcomes. However, there are many barriers that may prevent depressed individuals from receiving specialised treatment. Virtual reality (VR) technology has shown promise as one avenue for overcoming these challenges. This study first aims to evaluate the effectiveness of VR intervention on adolescent depression symptoms, and second, to determine the intervention's underlying mechanism of effect using functional near-infrared spectroscopy (fNIRS). METHODS AND ANALYSIS This is a single-centre, prospective, randomised controlled clinical trial. Sixty-six eligible adolescents aged 12-18 years with a diagnosis of depression will be randomised in a 1:1 ratio to either the VR treatment group or the conventional treatment group. All patients for both groups will receive usual treatment during a 4-week intervention period. In addition, patients randomised to VR treatment group (n=33) will complete three 20 min VR sessions including attention, executive function and relaxation training per week. Moreover, 33 healthy adolescents will be recruited as the general population. Primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, executive function, treatment emergent symptoms, haemoglobin changes measured by fNIRS) will be collected at preintervention, immediately postintervention and at 4 weeks follow-up. The data assessor and analyst will be blinded to group membership. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Lishui Second People's Hospital. Written informed consent will be obtained for all participants. Results will be disseminated through peer-reviewed journals, national or international conference presentations, media outlets, the internet and various community activities. TRIAL REGISTRATION NUMBER ChiCTR2300067747.
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Affiliation(s)
- Kunqiang Yu
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Zhejiang Clinical Medical Research Centre for Psychiatric and Psychological Disorders, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
| | - Lijun Wang
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Shiqiao Lv
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Xiaofang Ye
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Linhui Liu
- Psychological Counselling Center, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Xiuxiu Zheng
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
- Psychological Counselling Center, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Ruomei Jin
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
| | - Dongsheng Zhou
- Department of Mental Rehabilitation, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Yan Zhang
- Psychological Counselling Center, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Guoqing Min
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
| | - Shaochang Wu
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Zhejiang Clinical Medical Research Centre for Psychiatric and Psychological Disorders, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
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Chen J, Li Y, Wang S, Li W, Liu Y, Jin L, Li Z, Zhu J, Wang F, Liu W, Xue J, Shi H, Wang W, Jin C, Li Q. Methadone maintenance treatment alters couplings of default mode and salience networks in individuals with heroin use disorder: A longitudinal self-controlled resting-state fMRI study. Front Psychiatry 2023; 14:1132407. [PMID: 37139328 PMCID: PMC10149709 DOI: 10.3389/fpsyt.2023.1132407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Methadone maintenance treatment (MMT) is a common treatment for heroin use disorder (HUD). Although individuals with HUD have been reported to show impaired coupling among the salience network (SN), executive control network (ECN), and default mode network (DMN), the effects of MMT on the coupling among three large-scale networks in individuals with HUD remains unclear. Methods Thirty-seven individuals with HUD undergoing MMT and 57 healthy controls were recruited. The longitudinal one-year follow-up study aimed to evaluate the effects of methadone on anxiety, depression, withdrawal symptoms and craving and number of relapse, and brain function (SN, DMN and bilateral ECN) in relation to heroin dependence. The changes in psychological characteristics and the coupling among large-scale networks after 1 year of MMT were analyzed. The associations between the changes in coupling among large-scale networks and psychological characteristics and the methadone dose were also examined. Results After 1 year of MMT, individuals with HUD showed a reduction in the withdrawal symptom score. The number of relapses was negatively correlated with the methadone dose over 1 year. The functional connectivity between the medial prefrontal cortex (mPFC) and the left middle temporal gyrus (MTG; both key nodes of the DMN) was increased, and the connectivities between the mPFC and the anterior insular and middle frontal gyrus (key nodes of the SN) were also increased. The mPFC-left MTG connectivity was negatively correlated with the withdrawal symptom score. Conclusion Long-term MMT enhanced the connectivity within the DMN which might be related to reduced withdrawal symptoms, and that between the DMN and SN which might be related to increase in salience values of heroin cues in individuals with HUD. Long-term MMT may be a double-edged sword in treatment for HUD.
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Affiliation(s)
- Jiajie Chen
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yongbin Li
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Shu Wang
- Biomedical Engineering, School of Life Science and Technology, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yan Liu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Long Jin
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhe Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Liu
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Jiuhua Xue
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Hong Shi
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- Wei Wang,
| | - Chenwang Jin
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Chenwang Jin,
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- *Correspondence: Qiang Li,
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