Alzheimer hastalığı'nda transkranyal manyetik stimülasyon uygulaması ile fiziksel aktivite eğitiminin etkinliğinin karşılaştırılması
Comparison effects of transcranial magnetic stimulation and physical activity training on alzheimer's disease
Yazar: MİRAY BUDAK
Danışman: PROF. DR. LÜTFÜ HANOĞLU
İstanbul Medipol Üniversitesi / Sağlık Bilimleri Enstitüsü / Fizyoterapi ve Rehabilitasyon Ana Bilim Dalı
Derece: Doktora, 2017
Konu: Fizyoterapi ve Rehabilitasyon = Physiotherapy and Rehabilitation ; Geriatri = Geriatrics ; Nöroloji = Neurology
Dizin: Alzheimer hastalığı = Alzheimer disease ; Biliş = Cognition ; Biliş bozuklukları = Cognition disorders ; Egzersiz = Exercise ; Egzersiz tedavisi = Exercise therapy ; Fizik tedavi = Physical therapy ; Fiziksel aktivite = Physical activity ; Teşhis testleri = Diagnostic tests ; Transkraniyal manyetik uyarı = Transcranial magnetic stimulation

Özet:
Alzheimer Hastalığı (AH) kognitif fonksiyonlarda kademeli bir gerileme ile ilişkili nörodejeneratif bir hastalıktır. Transkranyal Manyetik Stimülasyon (TMS) ve fiziksel aktivite (FA) eğitimi farmakolojik tedaviye ilaveten kullanılabilecek alternatif tedavi yöntemlerindendir. Çalışmamızda farmakolojik tedaviye ilaveten uygulanan iki tedavi yönteminin AH' deki etkisinin araştırılması amaçlandı. AH tanılı 60 yaş ve üzeri 27 hasta çalışmaya dahil edildi ve 3 gruba ayrıldı. TMS grubuna (n=10) bilateral Dorsolateral Prefrontal Korteks' e 2 hafta boyunca, haftada birbirini takip eden 5 gün, 20 Hz frekanslı tekrarlı TMS (rTMS) tedavisi uygulandı. FA grubuna (n=9) 2 hafta boyunca, haftada birbirini takip eden 5 gün, günde 50 dakika orta yoğunluklu aerobik egzersiz içeren fiziksel aktivite verildi. Kontrol grubuna (n=8) ise yalnızca farmakolojik tedavi uygulandı. Bireylerin tedavi öncesi ve sonrasında nöropsikiyatrik ve davranışsal durum, biliş, depresyon, denge, ağrı, fonksiyonel mobilite, fiziksel uygunluk, fiziksel aktivite seviyesi, günlük yaşam aktivitesi, yaşam kalitesi, demans düzeyi ve beyindeki fonksiyonel değişiklikleri değerlendirildi. TMS grubunda dikkat, yürütücü işlev, davranışsal durum, fiziksel aktivite seviyesi ve yaşam kalitesinde, FA grubunda denge ve fonksiyonel mobilitede, kontrol grubunda bellek ve davranışsal durumda istatistiksel olarak anlamlı fark bulundu (p<0,05). FA' nın beyindeki fonksiyonel değişikliklerde bellek performansını etkilediği, rTMS tedavisinin ise Olağan Durum (DMN), Yürütücü Kontrol (ECN) ve Dorsal Dikkat Ağı (DAN) üzerinde etkili olduğu bulundu. Bulgularımız, AH' de alternatif gibi görünen terapötik yöntemlerin aslında kognitif ve davranışsal profilinin farklı alanları üzerinde etkili olduğunu göstermektedir. Sonuç olarak bu bulgular, farmakolojik tedaviye ilaveten uygulanan yüksek frekanslı rTMS tedavisi ve FA eğitimini içeren "multimodal" terapötik yaklaşımın, hastalığa karşı en etkin tedavi olasılığını oluşturabileceği düşünülmektedir.

Abstract:
Alzheimer's Disease (AD) is a neurodegenerative disease associated with a gradual regression in cognitive function. Transcranial Magnetic Stimulation (TMS) and physical activity (PA) training are alternative treatments that can be used in addition to pharmacological treatment. In our study, it was aimed to investigate the effect of the two treatment modalities in addition to pharmacological treatment in AD. Twenty-seven patients aged 60 years and over with AD were included in the study and separated to 3 groups. In TMS group (n=10) 20 Hz repeated TMS (rTMS) treatment was applied to the bilateral Dorsolateral Prefrontal Cortex for consecutive 5 days a week for 2 weeks. In PA group (n=9) received moderate intensity of aerobic exercise for 50 min session, 5 consecutive days a week for 2 weeks. In control group (n=8) only pharmacological treatment was applied. Individuals were evaluated for neuropsychiatric and behavioral status, cognition, depression, balance, pain, functional mobility, physical fitness, physical activity level, daily life activity, quality of life, dementia level and functional changes before and after treatment. Statistically significant difference was found on attention, executive function, behavioral status, level of physical activity and quality of life in the TMS group; on balance and functional mobility in the PA group; on memory and behavioral status in the control group (p<0,05). We found that physical activity affected memory performance in functional changes in the brain and rTMS treatment was effective on Default Mode Network (DMN), Executive Control Network (ECN), and Dorsal Attention Network (DAN). In conclusion, our study has shown that high frequency rTMS treatment and physical activity training including moderate intensity aerobic exercise are effective alternative treatment in addition to pharmacological treatment methods in AD. In AD, detailed studies are needed to understand better the destruction of cognitive functions and functional changes in the brain. Our findings show that therapeutic methods that appear to be alternative in AD are in fact influenced by different areas of the cognitive and behavioral profile. In conclusion, these findings suggest that the "multimodal" therapeutic approach, including high frequency rTMS therapy and FA education, in addition to pharmacological treatment, may produce the most effective treatment against the disease.