Zusammenfassung
Transkranielle Gleichstromstimulation (tDCS) ist mittlerweile ein gängiges Verfahren in den Neurowissenschaften, mit dem sich kognitive Funktionen modulieren lassen. Aktuelle Studien legen nahe, dass über die Modulation neuronaler Aktivität und Konnektivität eine Verbesserung der behavioralen Leistung erzielt werden kann. Demnach stellt die tDCS auch im klinischen Kontext ein vielversprechendes Verfahren zur Restitution beeinträchtigter Funktionen des Gedächtnisses infolge der Alzheimer-Krankheit oder der Aphasie nach einem Schlaganfall dar. Jedoch gibt es bisher nur wenige Befunde aus randomisierten, placebokontrollierten klinischen Studien. Die Ergebnisse der tDCS-induzierten Leistungsverbesserung bei Patienten mit (Prä-)Demenz deuten darauf hin, dass eine mit einem Gedächtnistraining kombinierte Stimulation zu Verbesserungen führen könnte. Die frühe Intervention bereits im Stadium der leichten kognitiven Beeinträchtigung könnte dabei entscheidend sein, bedarf aber weiterer Studien. Bei Patienten mit schlaganfallbedingter Aphasie zeigten sich unterschiedliche Erfolge links- oder rechtshemisphärischer tDCS je nach Polarität und Schwere der Symptomatik. Patienten mit leichter Aphasie könnten hierbei besonders von der Stimulation der sprachdominanten Hirnhälfte profitieren, während bei schwerer Aphasie ein Ausweichen auf rechtshemisphärische homologe Areale Erfolg versprechend ist. Auch hier könnte die Applikation der tDCS bereits im subakuten Stadium besonders vielversprechend sein. Insgesamt eröffnet die tDCS also die Möglichkeit der Funktionsrestitution bei neurologischen Patienten. Ob die Stimulation in der Praxis eingesetzt werden kann, um weiteren Funktionsverlust bei neurodegenerativen Prozessen zu verhindern, und ob die in experimentellen Studien gezeigten Verbesserungen auch langfristig die Alltagsaktivitäten verbessern, muss in künftigen Studien geklärt werden.
Abstract
Transcranial direct current stimulation (tDCS) has been successfully used in neuroscientific research to modulate cognitive functions. Recent studies suggested that improvement of behavioral performance is associated with tDCS-induced modulation of neuronal activity and connectivity. Thus, tDCS may also represent a promising tool for reconstitution of cognitive functions in the context of memory decline related to Alzheimer’s disease or aphasia following stroke; however, evidence from randomized sham-controlled clinical trials is still scarce. Initial results of tDCS-induced behavioral improvement in patients with Alzheimer’s dementia and its precursors indicated that an intense memory training combined with tDCS may be effective. Early interventions in the stage of mild cognitive impairment could be crucial but further evidence is needed to substantiate this. In patients with aphasia following stroke tDCS was applied to the left and right hemispheres, with varying results depending on the severity of the symptoms and polarity of the stimulation. Patients with mild aphasia can benefit from tDCS of the language dominant hemisphere while in patients with severe aphasia tDCS of right hemispheric homologous brain language areas may be particularly relevant. Moreover, recent studies suggested that an intervention in the subacute phase of aphasia could be most promising. In summary, tDCS could provide the exciting possibility to reconstitute cognitive functions in patients with neurological disorders. Future studies have to elucidate whether tDCS can be used in the clinical routine to prevent further cognitive decline in neurodegenerative diseases and whether beneficial effects from experimental studies translate into long-term improvement in activities of daily life.
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D. Antonenko und A. Flöel geben an, dass kein Interessenkonflikt besteht.
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Antonenko, D., Flöel, A. Nichtinvasive Stimulationsverfahren in der Neurologie. Nervenarzt 87, 838–845 (2016). https://doi.org/10.1007/s00115-016-0115-z
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DOI: https://doi.org/10.1007/s00115-016-0115-z