Otępienie (inaczej demencja) jest zespołem objawów występującym w chorobach neurodegeneracyjnych, czyli prowadzących do stopniowej utraty zdolności poznawczych, zmian osobowości i zaburzeń zachowania. Jest to proces postępujący w czasie, charakteryzujący się (zwykle) podstępnym początkiem i zmierzający ku całkowitej zależności pacjenta od osób trzecich. Jednym z najpowszechniejszych rodzajów demencji jest otępienie w przebiegu choroby Alzheimera. Wśród pierwszych objawów zauważa się m.in.:
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– obniżenie nastroju i wycofanie.
Niestety dotychczas brak skutecznej metody leczenia wpływającej nie tylko na objawy, lecz przede wszystkim przyczynę schorzenia. Spowolnieniu przebiegu choroby i wydłużeniu bieżącego poziomu samodzielności chorego sprzyjają metody niefarmakologiczne. Wśród nich można wymienić: trening funkcji poznawczych, terapię zajęciową, terapię reminiscencyjną, zajęcia arteterapeutyczne, ruchowe czy muzyczne. Każda forma aktywności stymuluje mózg, tymczasowo poprawia ogólny stan chorego i odgrywa kluczową rolę w przedłużeniu sprawności.
EEG Biofeedback (Neurofeedback) to nieinwazyjna metoda terapeutyczna, bazująca na sprzężeniu zwrotnym, umożliwiająca modelowanie aktywności ludzkiego mózgu w oparciu o zapis generowanych fal elektrycznych. Wstępne badania wskazują, że treningi neurofeedback mogą być skuteczne w poprawie funkcjonowania poznawczego, leczeniu objawów afektywnych oraz wspieraniu plastyczności mózgu. Trening neurofeedback prowadzi do ogólnej poprawy pamięci, uwagi i hamowania reakcji, ponieważ łączy trening poznawczy z warunkowaniem instrumentalnym określonej funkcji. Badania wskazują również na poprawę pamięci roboczej, czyli zdolności dokonywania operacji umysłowych i bieżącego przetwarzania informacji. Ze względu na powyższe może on stanowić atrakcyjne uzupełnienie terapii psychologicznej i farmakoterapii.
Wśród uzasadnień stosowania treningów neurofeedback w populacji osób starszych bądź cierpiących na zespoły otępienne wymienić można teorię kompensacji zachodzącej w starzejącym się mózgu. Podczas wykonywania zadań umysłowych u osób starszych obserwuje się większą aktywację kory przedczołowej, podczas gdy te w młodych grupach angażują głównie okolice potyliczne. Oznacza to, że starzejący się mózg kompensuje trudności w realizacji zadań intelektualnych poprzez uruchomienie procesów kontrolowanych. Trening EEG Biofeedback odpowiednio zaprojektowany dla okolic przedczołowych może więc stymulować oraz podtrzymywać zdolność korzystania ze strategii wewnętrznych, a w konsekwencji realizowania czynności obejmujących pozostałe funkcje poznawcze. Hamowanie rytmu Beta2 może również pozytywnie wpłynąć na regulację napięcia emocjonalnego oraz pobudzenia psychoruchowego u chorych we wczesnym etapie choroby.
U osób starszych zauważa się ponadto spadek aktywności w paśmie alfa (8-12 Hz) i beta (13-21 Hz) odpowiedzialnych m.in. za pamięć i koncentrację uwagi, a także wzrost aktywności fal wolnych delta (1-4 Hz) i theta (4-8 Hz). Prawdopodobnym jest więc, że odpowiednio zaplanowany protokół pozwoli na stymulację dostosowaną do zmian zachodzących wraz z wiekiem.
Pogorszeniu funkcji poznawczych często towarzyszą zaburzenia emocjonalne, m.in. depresja czy objawy lękowe. Odpowiednio dobranymi protokołami treningowymi jesteśmy w stanie celować w obszary i sieci mózgu odpowiedzialne za przetwarzanie emocji, co otwiera możliwość na wspomaganie leczenia zaburzeń nastroju u pacjentów z demencją.
Nowe technologie umożliwiają więc inną, nowocześniejszą rehabilitację, która koncentruje się nie tylko na celach i problemach, ale również na mechanizmach autoregulacyjnych jako zasobach pacjenta. Zwiększona liczba wytwarzanych potencjałów czynnościowych powoduje tworzenie się nowych połączeń synaptycznych. Uwzględniając te pozytywne doniesienia, należy podkreślić, że nie zawsze oferowane pacjentom usługi neurorehabilitacyjne przynoszą oczekiwane efekty. Metody komputerowe (takie jak Neurofeedback) mimo, że nie są leczeniem i nie mogą odwrócić choroby neurozwyrodnieniowej, pozwalają zmaksymalizować działanie zdrowych części mózgu, pomagają złagodzić objawy i opóźnić postęp degradacji poznawczej, szczególnie we wczesnych etapach zespołu otępiennego bądź w fazie łagodnych zaburzeń poznawczych. W ich doborze należy zawsze uwzględniać możliwości pacjenta i tak określać formy oddziaływań, aby wywoływały one spodziewany skutek. Niezbędnym kryterium kwalifikacyjnym do podjęcia terapii jest stan poznawczy umożliwiający w pełni aktywny i świadomy udział w treningu.
Źródła
Trambaiolli, L., R. (2021). Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment. W: Frontiers in Aging Neuroscience
Kilian, J., Wiśniowska-Szurlej, A., Kopańska, M., Ćwirlej-Sozańska, A. (2020). The use of neurofeedback method in cognitive function training in the elderly – a systematic literature review.
Markiewicz, R. (2017). Zastosowanie EEG Biofeedback/Neurofeedback w rehabilitacji psychiatrycznej. W: Psychiatria Polska, 51(6)
Luijmes, R., E. The Effectiveness of Neurofeedback on Cognitive Functioning in Patients with Alzheimers Disease
Berman, M., H., Frederick, J. (Efficacy of neurofeedback for executive and memory function in dementia)
https://ichgcp.net/pl/clinical-trials-registry/NCT01168466
https://www.frontiersin.org/articles/10.3389/fnagi.2021.682683/full
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