tDCS通过注意力-听觉平衡补偿促进PD言语障碍恢复的作用及脑机制

Speech disorder (SD) is one of the major dysfunctions of Parkinson’s disease (PD). At present, however, there is little advantageous intervention on PD-associated SD. In the previous studies, we have already demonstrated that attention could positively heighten the motor speech processing modulated by auditory feedback, via the functional link of balance compensation between attention and central auditory system. Our pilot study found that tDCS could change the amount of some neurotransmitter by activating inferior parietal lobe (IPL). Additionally, we also found an enhancement of attention and an improvement of motor speech after tDCS targeting IPL, within a short period. In accord, we speculate that tDCS may promote the recovery of PD-associated SD by means of the balance compensation of auditory attention, resulting from activation of inferior parietal lobe. Furthermore, the neural mechanism underlying tDCS-derived recovery of PD-associated SD may lie in neuroplastic repairs of the neural networks and key cortical areas belonging to modulation of motor speech, by virtue of amount changes of some neurotransmitter. Therefore, we plan to carry out the present study using rehabilitation evaluations, electrophysiological test, as well as neural imaging, in order to explore the rehabilitation effect and detailed neural mechanism underlying tDCS-induced balance compensation of auditory attention for the recovery of PD-associated SD, in a multi-dimension manner including macroscopic, mesoscopic and micorcosmic levels. Our present study intends to illuminate the detailed therapeutic advantage and neural mechanism underlying tDCS-derived neuroplastic repairs for PD-associated SD, in a novel insight. Moreover, we also aim to provide some new theoretical evidence on tDCS-associated translational medical application to PD-associated SD.

言语障碍（SD）是帕金森病（PD）主要功能障碍之一，目前尚无有效干预手段。我们前期研究发现，注意力可通过平衡补偿增强听觉反馈对言语运动的控制；并在预实验中观察到，tDCS激活下顶叶（IPL）可改变脑内多种神经递质含量，可在短期内增强PD患者注意力水平，改善言语运动功能。据此，我们推测，tDCS激活IPL可通过注意力-听觉平衡补偿促进SD恢复，其机制在于调节神经递质代谢而促进言语运动调控神经网络和关键脑区的可塑性修复。本项目拟采用康复评定、电生理及MRI成像等方法，从宏观-介观-微观层面，多维度探索tDCS通过注意力-听觉平衡补偿促进SD恢复的康复效应及其作用机制。本研究不但揭示tDCS促进PD言语障碍恢复新的作用机理，也为tDCS在PD言语障碍干预领域的临床转化奠定理论基础。

言语障碍（SD）是帕金森病（PD）主要功能障碍之一，目前尚无有效干预手段。本项目拟采用康复评定和MRI成像等方法，多维度探索tDCS通过注意力-听觉平衡补偿促进SD恢复的康复效应及其作用机制。通过本项目的系统研究，我们有以下发现：（1）在tDCS干预前后，空白对照组的注意力水平无明显变化，阳性刺激组和阴性刺激组的注意力水平稍增高，但二者之间的差异无统计学意义，而双侧刺激组的注意力水平明显增高，并高于其余三个组；（2）通过大样本量病例-对照证明，意力和记忆下降是PD患者发生言语障碍的独立危险因素；（3）在tDCS干预前后，空白对照组的言语运动功能无明显变化，阳性刺激组和阴性刺激组的言语运动功能稍增高，但二者之间的差异无统计学意义，而双侧刺激组的言语运动功能明显增高，并高于其余三个组；（4）PD患者言语运动能力的改变与注意力水平的改变呈正相关；（5）三种模式tDCS干预均能促进相关脑区和神经网络的重塑；（6）系统回顾无创神经调控技术在PD运动障碍康复治疗中的应用进展；（7）系统评价无创神经调控技术对PD步态异常和认知障碍的干预疗效。本项目不但揭示tDCS促进PD言语障碍恢复新的作用机理，也为tDCS在PD言语障碍干预领域的临床转化奠定理论基础。