大腦預設模式網路活性之一致性及 振動性在早期阿茲海默症與輕度知 能障礙患者的不同: 以腦波研究 王毓禛1 蕭富榮2
台北市立聯合醫院神經科1及教研部2 Altered Oscillation and
Synchronization of Default-Mode Network Activity in Mild
Alzheimer’s Disease Compared to Mild Cognitive Impairment: An Electrophysiological Study
Yuh-Jen Wang1, Fu-Jung Hsiao2
1 Department of Neurology and 2Department of Education and Research,Taipei City Hospital, Taipei, Taiwan
Objective To examine whether electroencephalography (EEG) is as useful as functional magnetic resonance imaging (fMRI) in investigating brain default mode network (DMN) activity and differentiating early stage AD from
mild cognitive impairment (MCI).
Background Some researchers have suggested that the DMN plays an important role in the pathological
mechanisms of Alzheimer’s disease (AD).
However, fMRI is not available in every institution. Instead, EEG is more accessible.
Methods EEG was recorded from 21 mild AD and 21 mild cognitive impairment (MCI) patients during an eyes closed, resting-state condition. The spectral power and functional
connectivity of the DMN were estimated using a minimum norm estimate (MNE) combined with fast Fourier transform and imagery coherence analysis.
Results Our results indicated that source-based EEG maps of resting-state activity show alterations of cortical spectral power in mild AD when compared to MCI. These alterations are characteristic of attenuated alpha or beta activities in the DMN, as are enhanced delta or theta activities in the medial temporal, inferior parietal, posterior cingulate cortex and precuneus. With regard to altered synchronization in AD, altered functional interconnections were observed as specific connectivity patterns of connection hubs in the precuneus, posterior cingulate cortex, anterior cingulate cortex and medial temporal regions. Moreover, posterior theta and alpha power and altered connectivity in
the medial temporal lobe correlated significantly with scores obtained on the Mini-Mental State Examination (MMSE).
Conclusion EEG is a useful tool for investigating the DMN in the brain and differentiating early stage AD and MCI patients. This is a promising finding;
however, further large-scale studies are needed.
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以穿顱直流電刺激右背外側前額葉 皮質調節空間工作記憶的干擾作用 吳怡真1 張期富2 曾祥非2 阮啟弘2 白明奇3 林宙晴3
1國立成功大學附設醫院斗六分院神經科
2國立中央大學認知神經科學研究所
3國立成功大學附設醫院神經部
Modulating the Interference Effect on Spatial Working Memory by Applying
Transcranial Direct Current Stimulation over the Right Dorsolateral Prefrontal Cortex
Yi-Jen Wu1, Chi-Fu Chang2, Philip Tseng2, Chi-Hung Juan2, Ming-Chyi Pai3,Chou-Ching Lin3
1 Division of Neurology, National Cheng Kung University Hospital, Dou-Liou Branch
2 Institute of Cognitive Neuroscience, National Central University
3 Department of Neurology, National Cheng Kung University Hospital
Objective Spatial working memory (SWM) is the ability to temporarily store and manipulate spatial
information. It has limited capacity and is quite vulnerable to interference.
Dorsolateral prefrontal cortex (DLPFC) is one of the brain regions in the SWM network but its role in SWM is still
under investigation. This study
investigated the role of the right DLPFC in processing the interference effect on SWM.
Methods Eleven healthy young adults were enrolled. Transcranial direct current stimulation (tDCS) noninvasively provides polarity-specific electric stimulation to the targeted brain region.
Anodal tDCS (1.5mA) was applied on the right DLPFC for 15 minutes before participants performed a forward- and backward-recall computerized Corsi Block Tapping task (CBT), both with and without a concurrent motor interference task (the modified Luria manual
sequencing task). The response accuracy for the memorized span and reaction time were recorded.
Results With tDCS, participants’
reaction time improved in all four conditions (forward, backward, forward with interference, and backward with interference). Although there was a consistent decline of memory span in the motor interference conditions, tDCS significantly improved participants’
SWM span (sham group: 5.1, tDCS group: 5.7, p<0.05) in the
“backward-recall with motor
interference” condition, which was the most difficult condition.
Conclusion This study demonstrated that the motor interference degraded SWM performance. Right DLPFC anodal
tDCS shortened the reaction time of SWM performance and improved SWM capacity in high-difficulty conditions with concurrent interference.
These results suggest the right DLPFC plays a crucial role dealing with the interference effect for spatial working memory.
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引發多發性神經病變及認知功能失 調病例報告
林圻域 蔡松彥
彰化基督教醫院 雲林分院 神經內科 Polyneuropathy and possible cognitive dysfunction induced by exposure to ethylene oxide Ethylene oxide
Background Ethylene oxide is a well-known neurotoxin which cause polyneuropathy. The involvement of central nervous system is also reported in the past. In this case report, the patient suffered from antonomic dysfunction, including abdominal fullness and impotence as first symptoms after exposure to Ethylene oxide for 4 years.
Case Report A 47 y/o married man visited our outpatient department due to progressive bilateral calf cramp and acroparesthesia for more than one month. He has been a sterilizer worker exposed to ethylene oxide for 4 years.
Initially, he experienced abdominal fullness, poor appetite and impotence in the first week of June and followed by bilateral calf cramp, which got
worse in the night. One month later, he suffered from acroparesthesia and poor attention also. There were no fever and other autonomic dysfunctions including nausea, vomiting, diarrhea, urinary or bowel movement dysfunction.
Neurological examination revealed intact of cranial nerve, full strength of limbs muscle power, decreased deep tendon reflexes, distal sensory impairment, predominantly lower limbs, including all modalities which are pinprick, light tough, vibration and joint position sense, and positive Romberg’s test. The brain CT and cervical/lumbosacral MRI did not show abnormal findings. The NCV study found polyneuropathy. The ABEP study revealed bilateral brain stem dysfunctions. He was diagnosed as toxic polyneuropathy caused by ethylene oxide.
After using personal protective mask during working, his symptoms including bilateral calf cramp, acroparesthesia and impotence were improved.
Conclusion Neuropsychologic impairment and Peripheral neuropathy after long term exposture to EtO has beed documented in past series report. This patient has autonomic dysfunction, including abdominal fullness, nausea, vomiting and impotence. In addition, we also complete evaluated Eto toxic damage to nerve system, including anatomic and functional study. We also known that CNS and PNS involvement has reversible effect, but autonomic effect has uncertain damage in the past
case report and this case.
105
足底振動改變單腳站立時的姿勢控 制
林聖皇 錢振愷 李筱媛 黃信祺 郭藍遠 楊 志鴻
財團法人佛教慈濟綜合醫院神經內科 慈濟大學醫學院物理治療學系 高雄醫學大學醫學院運動醫學系 Foot Plantar Vibration Changes Postural Control With One-Leg Standing
Sheng-Huang Lin, Chen-Kai Chien, Hsiao-Yuan Lee, Sin-Chi Huang, Lan-Yuen Guo, Chich-Haung Yang
Department of Neurology, Buddhist Tzu Chi General Hospital; Department of Physical Therapy, College of Medicine, Tzu-Chi University; Faculty of Sports Medicine, College of Medicine, Kaohsiung Medical University
Abstract Postural control is critical in human upright activities (e.g. standing, walking and running), which is an integral output of musculoskeletal, motor and sensory nervous system.
Notably, somatosensory input of plantar area is an essential role in postural control and compromised in patients with polyneuropathy. The purpose of this study was to examine whether plantar vibration may alter postural control in people with plantar desensitization after ice immersion. A single-leg upright posture over a forceplate was selected to examine the capability of postural control under 3 conditions (pre-intervention, plantar desensitization, and with vibration).
The preliminary results have shown that significant reduced postural control in both eyes open and eyes
close conditions were found in people with plantar desensitization (after ice immersion), which indicating increased area, root mean square and mean velocity of center of pressure (COP) (p < 0.05).
Meanwhile, plantar vibration intervention did not improve the
parameters (Area, RMS and MV) of COP.
The findings confirm the role of plantar sensory input is a key role to mediate the postural control. In contrast, plantar vibration over the calcaneus provides adverse effect on the postural control in a single-leg upright standing posture.