Alzheimer hastalığı'nda transkranyal manyetik stimülasyon uygulaması ile fiziksel aktivite eğitiminin etkinliğinin karşılaştırılması

Alzheimer Hastalıg?ı (AH) kognitif fonksiyonlarda kademeli bir gerileme ile ilis?kili no?rodejeneratif bir hastalıktır. Transkranyal Manyetik Stimu?lasyon (TMS) ve fiziksel aktivite (FA) eg?itimi farmakolojik tedaviye ilaveten kullanılabilecek alternatif tedavi yo?ntemlerindendir. C?alıs?mamızda farmakolojik tedaviye ilaveten uygulanan iki tedavi yo?nteminin AH' deki etkisinin aras?tırılması amac?landı. AH tanılı 60 yas? ve u?zeri 27 hasta c?alıs?maya dahil edildi ve 3 gruba ayrıldı. TMS grubuna (n=10) bilateral Dorsolateral Prefrontal Korteks' e 2 hafta boyunca, haftada birbirini takip eden 5 gu?n, 20 Hz frekanslı tekrarlı TMS (rTMS) tedavisi uygulandı. FA grubuna (n=9) 2 hafta boyunca, haftada birbirini takip eden 5 gu?n, gu?nde 50 dakika orta yog?unluklu aerobik egzersiz ic?eren fiziksel aktivite verildi. Kontrol grubuna (n=8) ise yalnızca farmakolojik tedavi uygulandı. Bireylerin tedavi o?ncesi ve sonrasında no?ropsikiyatrik ve davranıs?sal durum, bilis?, depresyon, denge, ag?rı, fonksiyonel mobilite, fiziksel uygunluk, fiziksel aktivite seviyesi, gu?nlu?k yas?am aktivitesi, yas?am kalitesi, demans du?zeyi ve beyindeki fonksiyonel deg?is?iklikleri deg?erlendirildi. TMS grubunda dikkat, yu?ru?tu?cu? is?lev, davranıs?sal durum, fiziksel aktivite seviyesi ve yas?am kalitesinde, FA grubunda denge ve fonksiyonel mobilitede, kontrol grubunda bellek ve davranıs?sal durumda istatistiksel olarak anlamlı fark bulundu (p<0,05). FA' nın beyindeki fonksiyonel deg?is?ikliklerde bellek performansını etkiledig?i, rTMS tedavisinin ise Olag?an Durum (DMN), Yu?ru?tu?cu? Kontrol (ECN) ve Dorsal Dikkat Ag?ı (DAN) u?zerinde etkili oldug?u bulundu. Bulgularımız, AH' de alternatif gibi go?ru?nen terapo?tik yo?ntemlerin aslında kognitif ve davranıs?sal profilinin farklı alanları u?zerinde etkili oldug?unu go?stermektedir. Sonuc? olarak bu bulgular, farmakolojik tedaviye ilaveten uygulanan yu?ksek frekanslı rTMS tedavisi ve FA eg?itimini ic?eren "multimodal" terapo?tik yaklas?ımın, hastalıg?a kars?ı en etkin tedavi olasılıg?ını olus?turabileceg?i du?s?u?nu?lmektedir.

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.