Abstract
Deep brain stimulation (DBS) is a neurosurgical technique that regulates neuron activity by using internal pulse generators to electrodes in specific target areas of the brain. As a blind treatment, DBS is widely used in the field of mental and neurological diseases, although its mechanism of action is still unclear. In the past 10 years, DBS has shown a certain positive effect in animal models and patients with Alzheimer's disease (AD), but there are also different results that may be related to the stimulation parameters of DBS. Based on this, determining the optimal stimulation parameters for DBS in AD and understanding its mechanism of action are essential to promote the clinical application of DBS in AD. This review aims to explore the therapeutic effect of DBS in AD, and to analyze its stimulation parameters and potential mechanism of action. The keywords “Deep brain stimulation” and “Alzheimer's Disease” were used for systematic searches in the literature databases of Web of Science and PubMed (from 1900 to September 29, 2020). All human clinical studies and animal studies were reported in English, including individual case studies and long-term follow-up studies, were included. These studies described the therapeutic effects of DBS in AD. The results included 16 human clinical studies and 14 animal studies, of which 28 studies clearly demonstrated the positive effect of DBS in AD. We analyzed the current stimulation parameters of DBS in AD from stimulation target, stimulation frequency, stimulation start time, stimulation duration, unilateral/bilateral treatment and current intensity, etc., and we also discussed its potential mechanism of action from multiple aspects, including regulating related neural networks, promoting nerve oscillation, reducing β-amyloid and tau levels, reducing neuroinflammation, regulating the cholinergic system, inducing the synthesis of nerve growth factor.
Highlights
Alzheimer’s disease (AD) is the most common type of dementia in the elderly
In the literature databases of Web of Science and PubMed, human clinical studies and animal studies on DBS in AD were systematically searched using the following terms, individually and combined in multiple search strategies: “Deep brain stimulation,” “DBS,” “Alzheimer’s disease,” and “AD.” Literature inclusion criteria: the main purpose was to study the therapeutic effects of DBS in AD, including human clinical research and animal research; the language of the article was English only; individual case studies and long-term follow-up studies were not excluded; and duplicate studies were excluded
The following data were extracted from human clinical studies: (1) study design; (2) basic information on the participants, including number, sex, average age, average Alzheimer’s disease assessment scale-cognitive section (ADAS-Cog), average Mini-Mental State Examination (MMSE), and additional medications; (3) DBS data, including the DBS protocol and brain target; (4) follow-up; (5) main results, including the main outcome measures and conclusion; and (6) adverse events
Summary
Alzheimer’s disease (AD) is the most common type of dementia in the elderly. Its clinical manifestations are progressive cognitive decline and memory loss (Querfurth and LaFerla, 2010; Patterson, 2018). There are currently no viable medications to slow or reverse the progression of AD (Ihl et al, 2011; Arai et al, 2016, 2018; Cummings et al, 2020). A series of physical therapy methods, including electrical stimulation and magnetic stimulation, are gradually being applied in the field of neurological diseases (Li et al, 2015; Temel and Jahanshahi, 2015; Zhou et al, 2018; Holczer et al, 2020)
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