Verbesserung der kognitiven Leistungsfähigkeit von Patienten mit Schizophrenie durch transkranielle Gleichstromstimulation

Zusammenfassung

Kognitive Störungen sind ein Kernaspekt der Schizophrenie und beeinflussen das Langzeitergebnis der Behandlung, die Mortalität und die Lebensqualität der Patienten. Medikamentöse Behandlungsversuche erbrachten wenig zufriedenstellende Resultate, wohingegen das Training kognitiver Leistungen durchaus wirksam sein kann. Eine noch unzureichende Effektstärke und Generalisierbarkeit der Trainingserfolge sowie der hoher Zeitaufwand limitieren den generellen klinischen Einsatz. In einem innovativen Ansatz soll untersucht werden, ob eine Augmentation des kognitiven Trainings mit transkranieller Gleichstromstimulation (tDCS) den Effekt des Trainings und damit die klinische Anwendbarkeit verbessern kann. Mit der tDCS steht ein nebenwirkungsarmes Verfahren zur Verfügung, mit welchem der Aktivitätszustand des Gehirns polaritätsabhängig moduliert werden kann. Hierbei wird über zwei Elektroden schwacher Gleichstrom appliziert, welcher zur Veränderung des Ruhemembranpotenzials kortikaler Neurone führt und es ermöglicht dadurch die Erregbarkeit neuronaler Netzwerke gezielt zu modulieren. Die Kombination von Training und tDCS kann synergistisch zur Unterstützung adaptiver neuroplastischer Prozesse eingesetzt werden und möglicherweise die Effektivität eines kognitiven Trainings bei Patienten mit Schizophrenie verbessern. Dies könnte dazu beitragen die Erholung von Beeinträchtigungen kognitiver Funktionen bei an Schizophrenie erkrankten Menschen wirkungsvoll zu unterstützen und ihre Lebensqualität zu steigern.

Summary

Cognitive deficits are a core aspect of schizophrenia and significantly influence long-term outcome, mortality and quality of life of patients. So far, pharmacological treatment approaches yielded unsatisfactory results, whereas the training of cognitive abilities can be effective. However, size and generalization of training effects are in need for improvement and the high time expenditure is limiting a broad clinical use. To enhance effectiveness and foster clinical applicability, augmentation of cognitive training with transcranial direct current stimulation (tDCS) is currently investigated. Transcranial direct current stimulation is a safe and well tolerated procedure to modulate brain activity in a polarity specific manner. For this purpose, a weak current is applied to the scalp via rubber electrodes which transiently changes the resting membrane potential and consequently the excitability of cortical neurons. Therefore, tDCS allows for a targeted modulation of brainnetwork activity. As a next step, the combination of cognitive training and tDCS might synergistically induce adaptive neuroplastic processes and potentially increase the effectiveness of cognitive training paradigms. In patients with schizophrenia, this novel approach could contribute to the recovery of cognitive functions and improve quality of life.

Schlüsselwörter

Schizophrenie - Kognitive Störung - transkranielle Gleichstromstimulation

Keywords

Schizophrenia - cognitive deficits - transcranial direct current stimulation

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