经颅直流电刺激治疗轻中度老年抑郁症的临床观察

doi:10.3969/j.issn.1006-7795.2019.06.024

摘要/Abstract

摘要： 目的探讨经颅直流电刺激（transcranial direct current stimulation，tDCS）治疗轻中度老年抑郁症的临床疗效。方法选取2018年1月至2018年12月首都医科大学附属北京友谊医院康复医学科就诊的轻中度老年抑郁症患者40例，按随机数字表法分为观察组和对照组（各20例）。观察组采用tDCS，对照组采用相同的刺激部位和时间的伪刺激。分别于治疗前和治疗4周后采用24项版汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD）、老年抑郁量表（Geriatric Depression Scale，GDS）、蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）评价两组患者抑郁及认知功能改善情况。结果两组患者治疗前后HAMD、GDS变化的组间差异有统计学意义，观察组明显优于对照组（P<0.05），MoCA评分差异无统计学意义（P>0.05）。结论 tDCS可显著改善轻中度老年抑郁症患者的抑郁症状，值得临床推广。

关键词: 老年, 经颅直流电刺激, 轻中度抑郁症

Abstract: Objective To investigate the clinical efficacy of transcranial direct current stimulation (tDCS) in the treatment of mild to moderate senile depression.Methods From January 2018 to December 2018, forty patients with mild to moderate senile depression were selected from the Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University. They were randomly divided into observation group and control group (20 cases each). The observation group was treated with tDCS and the control group was treated with pseudo-stimulation of the same stimulation site and time. The 24-item Hamilton Depression Scale (HAMD), the Geriatric Depression Scale (GDS) and Montreal Cognitive Assessment Scale (MoCA) were used to evaluate the depression and cognitive improvement of the two groups before and after treatment.Results There was significant difference in the changes of HAMD and GDS between the two groups before and after treatment. The level of observation group was significantly better than that of the control group (P<0.05), and there was no significant difference in MOCA score (P> 0.05).Conclusion tDCS can significantly improve the depressive symptoms of patients with mild to moderate senile depression, which is worthy of clinical promotion.

Key words: old people, transcranial direct current stimulation, mild to moderate depression

中图分类号:

王建平, 桂沛君, 谢瑛. 经颅直流电刺激治疗轻中度老年抑郁症的临床观察[J]. 首都医科大学学报, 2019, 40(6): 948-952.

Wang Jianping, Gui Peijun, Xie Ying. Clinical observation of transcranial direct current stimulation in the treatment of mild to moderate senile depression[J]. Journal of Capital Medical University, 2019, 40(6): 948-952.

参考文献

[1] 童林泉, 陈丽. 中国25年老年人抑郁研究的内容分析[J]. 中国老年学杂志, 2016,36(11):2780-2781.
[2] 池玉兰. 老年抑郁症发生的相关因素[J]. 临床心身疾病杂志, 2016,22(S1):384-385.
[3] 朱明预, 余凤琼, 张骏, 等. 经颅直流电刺激的研究进展[J]. 中国神经精神疾病杂志, 2017,43(6):382-384.
[4] Cooper J E. On the publication of the diagnostic and statistical manual of mental disorders:fourth edition (DSM-IV)[J]. Br J Psychiatry, 1995,166(1):4-8.
[5] Kojima G. Quick and simple FRAIL scale predicts incident activities of daily living (ADL) and instrumental ADL (IADL) disabilities:a systematic review and meta-analysis[J]. J Am Med Dir Assoc, 2018,19(12):1063-1068.
[6] 张嫣然, 袁勇贵. 经颅直流电刺激在抑郁症治疗中的应用[J]. 实用医院临床杂志, 2015,12(6):12-15.
[7] 邹军辉, 符彬, 宋田琦, 等. 老年抑郁症患者的预后特点及相关影响因素调查分析[J]. 现代实用医学, 2018,30(8):1034-1036.
[8] Giri M, Chen T, Yu W, et al. Prevalence and correlates of cognitive impairment and depression among elderly people in the world's fastest growing city, Chongqing, People's Republic of China[J]. Clin Interv Aging, 2016,11:1091-1098.
[9] Zhang Q E, Ling S, Li P, et al. The association between urinary Alzheimer-associated neuronal thread protein and cognitive impairment in late-life depression:a controlled pilot study[J]. Int J Biol Sci, 2018,14(11):1497-1502.
[10] 赵铁梅, 陈静,徐海涛.老年抑郁症常用治疗药物研究进展[J].解放军医药杂志,2018,30(8):113-116.
[11] 张春媛, 侯明桥.抑郁症治疗研究进展[J].中国煤炭工业医学杂志,2016,19(8):1253-1255.
[12] 姚瑶, 高原. 老年抑郁症病因及发病机制研究新进展[J]. 中华老年病研究电子杂志, 2018,5(2):45-49.
[13] 孙晓艳, 李怡雪, 余灿清, 等. 中文版抑郁量表信效度研究的系统综述[J]. 中华流行病学杂志, 2017,38(1):110-116.
[14] Berryhill M E, Martin D. Cognitive effects of transcranial direct current stimulation in healthy and clinical populations:an overview[J]. J ECT, 2018,34(3):e25-e35.
[15] Brunoni A R, Sampaio-Junior B, Moffa A H, et al. The escitalopram versus electric current therapy for treating depression clinical study (ELECT-TDCS):rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial[J]. Sao Paulo Med J, 2015,133(3):252-263.
[16] Valiengo L C, Goulart A C, de Oliveira J F, et al. Transcranial direct current stimulation for the treatment of post-stroke depression:results from a randomised, sham-controlled, double-blinded trial[J]. J Neurol Neurosurg Psychiatry, 2017,88(2):170-175.
[17] Kurzeck A K, Kirsch B, Weidinger E, et al. Transcranial direct current stimulation (tDCS) for depression during pregnancy:scientific evidence and what Is being said in the media-a systematic review[J]. Brain Sci, 2018,8(8).pii:E155.
[18] Sampaio-Junior B, Tortella G, Borrione L, et al. Efficacy and safety of transcranial direct current stimulation as an add-on treatment for bipolar depression:a randomized clinical trial[J]. JAMA Psychiatry, 2018,75(2):158-166.
[19] Csifcsák G, Boayue N M, Puonti O, et al. Effects of transcranial direct current stimulation for treating depression:a modeling study[J]. J Affect Disord, 2018,234:164-173.
[20] Baumert A, Buchholz N, Zinkernagel A, et al. Causal underpinnings of working memory and Stroop interference control:testing the effects of anodal and cathodal tDCS over the left DLPFC[J]. Cogn Affect Behav Neurosci, 2019,[Epub aheacl of print].
[21] Dubreuil-Vall L, Chau P, Ruffini G, et al. tDCS to the left DLPFC modulates cognitive and physiological correlates of executive function in a state-dependent manner[J]. Brain Stimul, 2019,26(6):1456-1463.
[22] Froc D J, Racine R J. Interactions between LTP-and LTD-inducing stimulation in the sensorimotor cortex of the awake freely moving rat[J]. J Neurophysiol, 2005,93(1):548-556.
[23] Polania R, Paulus W, Nitsche M A. Modulating cortico-striatal and thalamo-cortical functional connectivity with transcranial direct current stimulation[J]. Hum Brain Mapp, 2012,33(10):2499-2508.
[24] Tully L M. Testing causal relationships between emotion processing circuitry and behavior using noninvasive brain stimulation[J]. Biol Psychiatry Cogn Neurosci Neuroimaging, 2018,3(4):305-307.
[25] 曲斯伟, 宋为群.经颅直流电刺激在卒中后认知功能障碍康复中的研究进展[J].中国脑血管病杂志,2016,13(4):219-224.