Disclaimer:The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.Background:Alzheimer s disease (AD) is a progressive neurodegenerative disease leading to cognitive decline and eventually death. Degradation of cortical neuroplasticity is thought to be a major catalyst of AD-related cognitive decline. Repetitive transcranial magnetic stimulation (rTMS), which uses pulsed magnetism to stimulate neurons, increases cortical plasticity and induces long-lasting neuroplastic changes. Patients have benefited from rTMS to treat AD, especially when done in conjunction with cognitive training exercises. This case report presents a 31-year-old male who tested positive for an autosomal dominant mutation implicated in early-onset AD. rTMS and cognitive training were employed to assist in the delay of early-onset AD manifestation in two cycles.Methods:Prior to each treatment cycle, the patient completed questionnaires and interviews designed to test his cognitive functioning; his spouse was interviewed to provide a third-party assessment of his functioning. Following pre-treatment data collection, 30 daily rTMS/cognitive training sessions were completed in the first cycle and 35 daily rTMS/cognitive training sessions were completed in the second cycle. The bilateral dorsolateral prefrontal cortices each received 1,000 pulses (10 Hz, 110% SMT). Tolerability and side effect data were collected after each treatment. Immediately following rTMS, the patient played cognitive training games at our Brain Fitness Center. All pre-treatment assessments were repeated after completion of the 30 sessions in the first cycle and the 35 sessions in the second cycle for comparison of pre- to post-treatment cognitive functionality.Results:Pre-treatment testing indicated the patient was asymptomatic before each cycle. The patient completed 30 daily rTMS sessions in the first cycle and 35 daily rTMS sessions in the second cycle. Tolerability/side effect data showed he tolerated treatment well and experienced only minor pain. The patient also completed 30 cognitive training sessions in the first cycle and 35 cognitive training sessions in the second cycle and showed moderate improvement across all cognitive domains. Post-treatment assessments indicated no change in functioning except to note the patient s improved sleep. A third treatment cycle is scheduled to begin in February 2020.Conclusions:This case report supports rTMS paired with cognitive training to be a safe and tolerable treatment for early-onset AD. However, more treatment cycles must be completed before conclusions about its efficacy can be determined.

中文翻译：

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136 重复经颅磁刺激作为预防早发性阿尔茨海默病的保护措施：病例报告

免责声明：本摘要中表达的观点是作者的观点，不反映陆军/海军/空军部、国防部或美国政府的官方政策。背景：阿尔茨海默病 (AD) 是一种渐进性的疾病神经退行性疾病导致认知能力下降并最终死亡。皮质神经可塑性的退化被认为是 AD 相关认知衰退的主要催化剂。重复经颅磁刺激 (rTMS) 使用脉冲磁力刺激神经元，增加皮质可塑性并诱导持久的神经可塑性变化。患者已从 rTMS 治疗 AD 中受益，尤其是在与认知训练练习结合使用时。本病例报告介绍了一名 31 岁男性，他检测出与早发性 AD 有关的常染色体显性突变呈阳性。采用 rTMS 和认知训练来帮助延迟两个周期的早发性 AD 表现。方法：在每个治疗周期之前，患者完成旨在测试其认知功能的问卷和访谈；他的配偶接受了面谈，以提供第三方对其运作的评估。治疗前数据收集后，第一个周期完成了 30 次每日 rTMS/认知训练，第二个周期完成了 35 次每日 rTMS/认知训练。双侧背外侧前额叶皮质分别接收 1,000 个脉冲（10 Hz，110% SMT）。每次治疗后收集耐受性和副作用数据。在 rTMS 之后，患者立即在我们的大脑健身中心玩认知训练游戏。在完成第一个周期的 30 个疗程和第二个周期的 35 个疗程后重复所有的治疗前评估，以比较治疗前和治疗后的认知功能。结果：治疗前测试表明患者在每次治疗前都没有症状循环。患者在第一个周期中完成了 30 次每日 rTMS 会话，在第二个周期中完成了 35 次每日 rTMS 会话。耐受性/副作用数据显示他很好地耐受治疗并且仅经历轻微疼痛。患者还在第一个周期完成了 30 次认知训练，在第二个周期完成了 35 次认知训练，并且在所有认知领域都表现出适度的改善。治疗后评估表明功能没有变化，只是注意到患者的睡眠有所改善。第三个治疗周期计划于 2020 年 2 月开始。结论：该病例报告支持 rTMS 与认知训练相结合，是一种安全且可耐受的早发性 AD 治疗方法。然而，在确定其疗效的结论之前，必须完成更多的治疗周期。