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Martins ARS, Fregni F, Simis M, Almeida J. Neuromodulation as a cognitive enhancement strategy in healthy older adults: promises and pitfalls. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 24:158-185. [DOI: 10.1080/13825585.2016.1176986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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152
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Kedzior KK, Gierke L, Gellersen HM, Berlim MT. Cognitive functioning and deep transcranial magnetic stimulation (DTMS) in major psychiatric disorders: A systematic review. J Psychiatr Res 2016; 75:107-15. [PMID: 26828370 DOI: 10.1016/j.jpsychires.2015.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
Deep transcranial magnetic stimulation (DTMS) is a non-invasive brain stimulation method mostly utilised in the treatment of major depression. The aim of the current study was to systematically review the literature on the cognitive effects of DTMS applied with the H-coil system in major psychiatric disorders. Following a literature search in PsycInfo and PubMed (any time to December 2015), 13 out of 32 studies on DTMS and cognitive functioning were included in the current review. Three studies included 38 healthy participants, eight studies included 158 unipolar or bipolar depression patients and two studies included 45 schizophrenia patients. Low-frequency DTMS (1-3 sessions) had little effect on cognitive functioning in healthy participants. The most consistent cognitive and clinical improvements were reported in the short-term (after 20 daily sessions of high-frequency DTMS with H1-coil) in studies with major depression patients. There was also a trend towards a short-term cognitive and clinical improvement in studies with schizophrenia patients. High-frequency DTMS might improve cognitive functioning and alleviate clinical symptoms in the short-term, particularly in major depression. However, this conclusion is based on data from mostly uncontrolled, open-label studies with patients receiving concurrent antidepressants or antipsychotics. Randomised, sham-controlled trials are needed to investigate the magnitude of the cognitive outcomes of DTMS in the short-term and beyond the daily stimulation phase in major psychiatric disorders.
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Affiliation(s)
| | - Lioba Gierke
- Institute of Psychology and Transfer, University of Bremen, Bremen, Germany
| | | | - Marcelo T Berlim
- Department of Psychiatry, McGill University, and Neuromodulation Research Clinic, Douglas Institute, Montreal, Canada
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153
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Lan MJ, Chhetry BT, Liston C, Mann JJ, Dubin M. Transcranial Magnetic Stimulation of Left Dorsolateral Prefrontal Cortex Induces Brain Morphological Changes in Regions Associated with a Treatment Resistant Major Depressive Episode: An Exploratory Analysis. Brain Stimul 2016; 9:577-83. [PMID: 27017072 DOI: 10.1016/j.brs.2016.02.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (TMS) is an FDA-approved antidepressant treatment but little is known of its mechanism of action. Specifically, downstream effects of TMS remain to be elucidated. OBJECTIVE/HYPOTHESIS This study aims to identify brain structural changes from TMS treatment of a treatment resistant depressive episode through an exploratory analysis. METHODS Twenty-seven subjects in a DSM-IV current major depressive episode and on a stable medication regimen had a 3T magnetic resonance T1 structural scan before and after five weeks of standard TMS treatment to the left dorsolateral prefrontal cortex. Twenty-seven healthy volunteer (HVs) subjects had the same brain MRI acquisition. Voxel-based morphometry was performed using high dimensional non-linear diffusomorphic anatomical registration (DARTEL). RESULTS Six clusters of gray matter volume (GMV) that were lower in pre-treatment MRIs of depressed subjects than in HVs. GMV in four of these regions increased in MDD after TMS treatment by 3.5-11.2%. The four brain regions that changed with treatment were centered in the left anterior cingulate cortex, the left insula, the left superior temporal gyrus and the right angular gyrus. Increases in the anterior cingulate GMV with TMS correlated with improvement in depression severity. CONCLUSIONS To our knowledge, this is the first study of brain structural changes during TMS treatment of depression. The affected brain areas are involved in cognitive appraisal, decision-making and subjective experience of emotion. These effects may have potential relevance for the antidepressant action of TMS.
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Affiliation(s)
- Martin J Lan
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, USA.
| | - Binod Thapa Chhetry
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, USA
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medical College, USA; Fell Family Brain and Mind Research Institute, Weill Cornell Medical College, USA
| | - J John Mann
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, USA
| | - Marc Dubin
- Department of Psychiatry, Weill Cornell Medical College, USA; Fell Family Brain and Mind Research Institute, Weill Cornell Medical College, USA
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154
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Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex enhances working memory. Exp Brain Res 2016; 234:1807-1818. [DOI: 10.1007/s00221-016-4580-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/30/2016] [Indexed: 11/26/2022]
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155
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Neuromodulation of Attentional Control in Major Depression: A Pilot DeepTMS Study. Neural Plast 2015; 2016:5760141. [PMID: 26823985 PMCID: PMC4707329 DOI: 10.1155/2016/5760141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/06/2015] [Accepted: 09/20/2015] [Indexed: 01/29/2023] Open
Abstract
While Major Depressive Disorder (MDD) is primarily characterized by mood disturbances, impaired attentional control is increasingly identified as a critical feature of depression. Deep transcranial magnetic stimulation (deepTMS), a noninvasive neuromodulatory technique, can modulate neural activity and induce neuroplasticity changes in brain regions recruited by attentional processes. This study examined whether acute and long-term high-frequency repetitive deepTMS to the dorsolateral prefrontal cortex (DLPFC) can attenuate attentional deficits associated with MDD. Twenty-one MDD patients and 26 matched control subjects (CS) were administered the Beck Depression Inventory and the Sustained Attention to Response Task (SART) at baseline. MDD patients were readministered the SART and depressive assessments following a single session (n = 21) and after 4 weeks (n = 13) of high-frequency (20 Hz) repetitive deepTMS applied to the DLPFC. To control for the practice effect, CS (n = 26) were readministered the SART a further two times. The MDD group exhibited deficits in sustained attention and cognitive inhibition. Both acute and long-term high-frequency repetitive frontal deepTMS ameliorated sustained attention deficits in the MDD group. Improvement after acute deepTMS was related to attentional recovery after long-term deepTMS. Longer-term improvement in sustained attention was not related to antidepressant effects of deepTMS treatment.
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RETRACTED ARTICLE: Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive Impairment in Stroke Patients: A Meta-Analysis. Mol Neurobiol 2015. [DOI: 10.1007/s12035-014-8895-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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157
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Jansen JM, van Wingen G, van den Brink W, Goudriaan AE. Resting state connectivity in alcohol dependent patients and the effect of repetitive transcranial magnetic stimulation. Eur Neuropsychopharmacol 2015; 25:2230-9. [PMID: 26481907 DOI: 10.1016/j.euroneuro.2015.09.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/13/2015] [Accepted: 09/28/2015] [Indexed: 01/15/2023]
Abstract
Alcohol dependence is thought to result from an overactive neural motivation system and a deficient cognitive control system, and rebalancing these systems may mitigate excessive alcohol use. This study examines the differences in functional connectivity of the fronto-parietal cognitive control network (FPn) and the motivational network (striatum and orbitofrontal cortex) between alcohol dependent patients (ADPs) and healthy controls (HCs), and the effect of repetitive transcranial magnetic stimulation (rTMS) on these networks. This randomized controlled trial included 38 ADPs and 37 HCs, matched on age, gender and education. Participants were randomly assigned to sham or right dorsolateral prefrontal cortex (dlPFC) stimulation with rTMS. A 3T resting state functional Magnetic Resonance Imaging (fMRI) scan was acquired before and after active or sham 10Hz rTMS. Group differences of within and between network connectivity and the effect of rTMS on network connectivity was assessed using independent component analysis. Results showed higher connectivity within the left FPn (p=0.012) and the left fronto-striatal motivational network (p=0.03) in ADPs versus HCs, and a further increase in connectivity within the left FPn after active stimulation in ADPs. ADPs also showed higher connectivity between the left and the right FPns (p=0.025), and this higher connectivity was related to fewer alcohol related problems (r=0.30, p=0.06). The results show higher within and between network connectivity in ADPs and a further increase in fronto-parietal connectivity after right dlPFC rTMS in ADPs, suggesting that frontal rTMS may have a beneficial influence on cognitive control and may result in lower relapse rates.
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Affiliation(s)
- Jochem M Jansen
- Academic Medical Centre (AMC), Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, The Netherlands.
| | - Guido van Wingen
- Academic Medical Centre (AMC), Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.
| | - Wim van den Brink
- Academic Medical Centre (AMC), Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, The Netherlands.
| | - Anna E Goudriaan
- Academic Medical Centre (AMC), Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands.
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158
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Balconi M, Molteni E. Past and future of near-infrared spectroscopy in studies of emotion and social neuroscience. JOURNAL OF COGNITIVE PSYCHOLOGY 2015. [DOI: 10.1080/20445911.2015.1102919] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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159
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de Wit SJ, van der Werf YD, Mataix-Cols D, Trujillo JP, van Oppen P, Veltman DJ, van den Heuvel OA. Emotion regulation before and after transcranial magnetic stimulation in obsessive compulsive disorder. Psychol Med 2015; 45:3059-3073. [PMID: 26027740 DOI: 10.1017/s0033291715001026] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Impaired emotion regulation may underlie exaggerated emotional reactivity in patients with obsessive compulsive disorder (OCD), yet instructed emotion regulation has never been studied in the disorder. METHOD This study aimed to assess the neural correlates of emotion processing and regulation in 43 medication-free OCD patients and 38 matched healthy controls, and additionally test if these can be modulated by stimulatory (patients) and inhibitory (controls) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (dlPFC). Participants performed an emotion regulation task during functional magnetic resonance imaging before and after a single session of randomly assigned real or sham rTMS. Effect of group and rTMS were assessed on self-reported distress ratings and brain activity in frontal-limbic regions of interest. RESULTS Patients had higher distress ratings than controls during emotion provocation, but similar rates of distress reduction after voluntary emotion regulation. OCD patients compared with controls showed altered amygdala responsiveness during symptom provocation and diminished left dlPFC activity and frontal-amygdala connectivity during emotion regulation. Real v. sham dlPFC stimulation differentially modulated frontal-amygdala connectivity during emotion regulation in OCD patients. CONCLUSIONS We propose that the increased emotional reactivity in OCD may be due to a deficit in emotion regulation caused by a failure of cognitive control exerted by the dorsal frontal cortex. Modulatory rTMS over the left dlPFC may influence automatic emotion regulation capabilities by influencing frontal-limbic connectivity.
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Affiliation(s)
- S J de Wit
- Department of Psychiatry,VU University Medical Center,Amsterdam,The Netherlands
| | | | - D Mataix-Cols
- Department of Clinical Neuroscience,Centre for Psychiatric Research and Education,Karolinska Institutet,Stockholm,Sweden
| | - J P Trujillo
- Department of Psychiatry,VU University Medical Center,Amsterdam,The Netherlands
| | - P van Oppen
- Department of Psychiatry,VU University Medical Center,Amsterdam,The Netherlands
| | - D J Veltman
- Department of Psychiatry,VU University Medical Center,Amsterdam,The Netherlands
| | - O A van den Heuvel
- Department of Psychiatry,VU University Medical Center,Amsterdam,The Netherlands
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160
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Non-invasive Human Brain Stimulation in Cognitive Neuroscience: A Primer. Neuron 2015; 87:932-45. [DOI: 10.1016/j.neuron.2015.07.032] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/07/2015] [Accepted: 07/16/2015] [Indexed: 11/21/2022]
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161
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Maranhão MF, Estella NM, Cury MEG, Amigo VL, Picasso CM, Berberian A, Campbell I, Schmidt U, Claudino AM. The effects of repetitive transcranial magnetic stimulation in obese females with binge eating disorder: a protocol for a double-blinded, randomized, sham-controlled trial. BMC Psychiatry 2015; 15:194. [PMID: 26265452 PMCID: PMC4533762 DOI: 10.1186/s12888-015-0569-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 07/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Binge eating disorder is a new category in DSM-5 and highly associated with higher body mass index. The neural mechanisms that underlie binge eating are of great interest in order to improve treatment interventions. Brain mechanisms underlying drug and food craving are suggested to be similar: for example, both are reported to be associated with increased neural activity in the orbitofrontal and anterior cingulate cortex, and a diminished regulatory influence from lateral prefrontal circuits. Several studies have begun to assess the potential benefits of brain stimulation in reducing craving and addictive behaviors. Data from a study of a one-off session of transcranial magnetic stimulation in healthy women identified as strong cravers and of individuals with bulimic-type eating disorders, reported a reduction in food craving and binge eating episodes. This provides support for a more extensive investigation of the potential therapeutic benefits of transcranial magnetic stimulation. Lastly, brain imaging studies and a dimensional approach, will improve understanding of the neural correlates of the disorders and of the mode of action of transcranial magnetic stimulation. METHODS/DESIGN Sixty eligible obese females, with binge eating disorder, will be randomly allocated to receive 20 sessions of transcranial magnetic stimulation intervention (n = 30) or the sham transcranial magnetic stimulation intervention (n = 30) scattered 3 days/week. Thirty eligible controls will complete the baseline assessment. The primary outcome (number of binge eating episodes) will be assed at each treatment sessions, and 8 weeks after intervention completion (follow-up). It is hypothesized that mean weekly binge-eating episodes will be reduced in the intervention group, compared to the sham group, and that the effect will be maintained at follow-up. DISCUSSION Despite the severity associated with Binge Eating Disorder, there are limited treatment options. This study is an important step in the development of more effective treatments. Importantly, the study is the first to investigating binge eating disorder using a dimensional approach, by looking at the different aspects of the disorder, such as behavioral factors, biological factors, brain circuits and chemistry. TRIAL REGISTRATION Clinical Trials NCT02180984 . Registered in July 2014.
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Affiliation(s)
- Mara Fernandes Maranhão
- Eating Disorder Unit, Psychiatry Department, Universidade Federal de São Paulo (UNIFESP), R. Borges Lagoa, 570, 7th floor, CEP 04038-020, São Paulo, SP, Brazil.
| | - Nara Mendes Estella
- Eating Disorder Unit, Psychiatry Department, Universidade Federal de São Paulo (UNIFESP), R. Borges Lagoa, 570, 7th floor, CEP 04038-020, São Paulo, SP, Brazil.
| | - Maria Elisa Gisbert Cury
- Eating Disorder Unit, Psychiatry Department, Universidade Federal de São Paulo (UNIFESP), R. Borges Lagoa, 570, 7th floor, CEP 04038-020, São Paulo, SP, Brazil.
| | - Veruska Lastoria Amigo
- Eating Disorder Unit, Psychiatry Department, Universidade Federal de São Paulo (UNIFESP), R. Borges Lagoa, 570, 7th floor, CEP 04038-020, São Paulo, SP, Brazil.
| | - Clarissa Mollinero Picasso
- Eating Disorder Unit, Psychiatry Department, Universidade Federal de São Paulo (UNIFESP), R. Borges Lagoa, 570, 7th floor, CEP 04038-020, São Paulo, SP, Brazil.
| | - Arthur Berberian
- Laboratory Integrative Neuroscience (LiNC), Psychiatric Department, Universidade Federal de São Paulo (UNIFESP), R. Pedro de Toledo, 669, 3rd floor, CEP 04039-032, São Paulo, SP, Brazil.
| | - Iain Campbell
- Section of Eating Disorder, Institute of Psychiatry, King's College London, Denmark Hill, SE5 8AF, London, UK.
| | - Ulrike Schmidt
- Section of Eating Disorder, Institute of Psychiatry, King's College London, Denmark Hill, SE5 8AF, London, UK.
| | - Angélica Medeiros Claudino
- Eating Disorder Unit, Psychiatry Department, Universidade Federal de São Paulo (UNIFESP), R. Borges Lagoa, 570, 7th floor, CEP 04038-020, São Paulo, SP, Brazil.
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162
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Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study. Behav Neurol 2015; 2015:287843. [PMID: 26160997 PMCID: PMC4487699 DOI: 10.1155/2015/287843] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/05/2015] [Accepted: 04/01/2015] [Indexed: 11/19/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersen's MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction (p = 0.05), favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration.
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163
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Dysfunctional prefrontal gamma-band oscillations reflect working memory and other cognitive deficits in schizophrenia. Biol Psychiatry 2015; 77:1010-9. [PMID: 25847179 DOI: 10.1016/j.biopsych.2015.02.034] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/22/2015] [Accepted: 02/24/2015] [Indexed: 12/30/2022]
Abstract
Impairments in working memory (WM) and other cognitive functions are cardinal neuropsychological symptoms in schizophrenia (ScZ). The prefrontal cortex (PFC) is important for mediating and executing these functions. Functional neuroimaging and molecular studies have consistently shown PFC abnormalities in ScZ. In addition, recent studies have suggested that impairments in oscillatory activity, especially in the gamma band (approximately 30-80 Hz), reflect disturbed cortical information processing in this patient group. Here we review evidence that dysfunctional gamma-band responses (GBR) in the PFC could be a factor contributing to WM and other cognitive deficits in ScZ. We provide an overview of noninvasive electrophysiological studies reporting frontal GBR abnormalities in ScZ patients during WM and other cognitive tasks. In agreement with the often-reported hypofrontality in functional neuroimaging studies, the majority of reviewed studies revealed reduced amplitudes or reduced phase locking of GBR over frontal areas in this patient group. Clinical implications derived from these findings and possibilities to foster future studies on GBR abnormalities in ScZ patients, are discussed. Since oscillatory activity in the gamma band has previously been linked to a variety of neurotransmitters, such as the gamma-aminobutyric acid-ergic system, the study of prefrontal GBR could also have implications for pharmacologic approaches in the treatment of WM and other cognitive deficits in ScZ.
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164
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Rutherford G, Lithgow B, Moussavi Z. Short and Long-term Effects of rTMS Treatment on Alzheimer's Disease at Different Stages: A Pilot Study. J Exp Neurosci 2015; 9:43-51. [PMID: 26064066 PMCID: PMC4457230 DOI: 10.4137/jen.s24004] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/06/2015] [Accepted: 04/10/2015] [Indexed: 12/03/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) uses a magnetic coil to induce an electric field in brain tissue. As a pilot study, we investigated the effect of rTMS treatment on 10 volunteers with Alzheimer’s disease (AD) in a two-stage study. The first stage consisted of a double-blind crossover study with real and sham treatments. Each treatment block consisted of 13 sessions over 4 weeks. During each session, 2000 TMS pulses at 90%–100% of resting motor threshold were applied to dorsolateral prefrontal cortex bilaterally, and the patients were kept cognitively active by object/action naming during the treatment. The second stage was an open-label study, in which the same treatments were performed in 2-week blocks (10 sessions) approximately every 3 months as follow-up treatments on six of the volunteers, who completed the first stage of the study. Primary outcome measures were the Montreal Cognitive Assessment (MOCA) and the Alzheimer’s Disease Assessment Scale-cognitive subscale. The secondary outcome measures were the Revised Memory and Behavior Checklist as well as our team’s custom-designed cognitive assessments. The results showed a noticeably stronger improvement on all assessments during the real treatment as compared to the sham treatment. The changes in MOCA scores as well as our designed cognitive assessment were found to be statistically significant, with particularly strong results in the six volunteers who were in the early stages of the disease. The long-term trends observed in the second stage of the study also showed generally less decline than would be expected for their condition. It appears that rTMS can be an effective tool for improving the cognitive abilities of patients with early to moderate stages of AD. However, the positive effects of rTMS may persist for only up to a few weeks. Specific skills being practiced during rTMS treatment may retain their improvement for longer periods.
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Affiliation(s)
- Grant Rutherford
- Biomedical Engineering Program, University of Manitoba, Winnipeg, Canada
| | - Brian Lithgow
- Biomedical Engineering Program, University of Manitoba, Winnipeg, Canada. ; Monash-Alfred Psychiatry Research Center, Melbourne, Australia
| | - Zahra Moussavi
- Biomedical Engineering Program and Psychiatry Department, University of Manitoba, Winnipeg, Canada
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165
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166
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Keshavan MS, Mehta UM, Padmanabhan JL, Shah JL. Dysplasticity, metaplasticity, and schizophrenia: Implications for risk, illness, and novel interventions. Dev Psychopathol 2015; 27:615-35. [PMID: 25997775 PMCID: PMC6283269 DOI: 10.1017/s095457941500019x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this paper, we review the history of the concept of neuroplasticity as it relates to the understanding of neuropsychiatric disorders, using schizophrenia as a case in point. We briefly review the myriad meanings of the term neuroplasticity, and its neuroscientific basis. We then review the evidence for aberrant neuroplasticity and metaplasticity associated with schizophrenia as well as the risk for developing this illness, and discuss the implications of such understanding for prevention and therapeutic interventions. We argue that the failure and/or altered timing of plasticity of critical brain circuits might underlie cognitive and deficit symptoms, and may also lead to aberrant plastic reorganization in other circuits, leading to affective dysregulation and eventually psychosis. This "dysplastic" model of schizophrenia can suggest testable etiology and treatment-relevant questions for the future.
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Affiliation(s)
- Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jaya L. Padmanabhan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Jai L. Shah
- Douglas Hospital Research Center and Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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167
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Hsu WY, Ku Y, Zanto TP, Gazzaley A. Effects of noninvasive brain stimulation on cognitive function in healthy aging and Alzheimer's disease: a systematic review and meta-analysis. Neurobiol Aging 2015; 36:2348-59. [PMID: 26022770 DOI: 10.1016/j.neurobiolaging.2015.04.016] [Citation(s) in RCA: 240] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 01/23/2023]
Abstract
The study aimed to evaluate the effects of noninvasive brain stimulation on cognitive function in healthy older adults and patients with Alzheimer's disease. A comprehensive literature search was performed on noninvasive stimulation studies published from January 1990 to November 2014 in Pubmed and Web of Science. Fourteen articles with a total of 331 participants were identified as studies with healthy older adults, and the mean effect size and 95% confidence interval were estimated. A significant effect size of 0.42 was found for the cognitive outcome. Further subgroup analyses demonstrated more prominent effects for studies delivering the stimulation before the execution of the task and studies applying multiple sessions of stimulation. To assess the effects of stimulation on Alzheimer's disease patients, 11 studies with a total of 200 patients were included in the analysis. A significant effect size of 1.35 was found for the cognitive outcomes. Subgroup analyses indicated more pronounced effects for studies applying the stimulation during the execution of the task compared with studies delivering the stimulation before the execution of the task. Noninvasive brain stimulation has a positive effect on cognitive function in physiological and pathological aging.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Yixuan Ku
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, Institue of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Theodore P Zanto
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Gazzaley
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Physiology and Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
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168
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Effet de la stimulation magnétique transcrânienne répétitive (rTMS) sur une tâche de N-back avec leurre : étude randomisée en double insu. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ContexteLa stimulation magnétique transcrânienne répétitive (SMTr) appliquée sur le cortex préfrontal dorso-latéral (CPFDL) a prouvé son efficacité dans le traitement de la dépression résistante [1]. En plus d’une amélioration sur la symptomatologie, des études rapportent des effets positifs sur le fonctionnement cognitif [2], dont la mémoire de travail. Cependant, cet effet ne semble pas être retrouvé chez des sujets sains [3] lors d’une tâche de N-back sans leurre. L’objectif de notre étude est donc d’évaluer l’impact de la SMTr sur le CPFDL, région plus sensible à une tâche de N-back avec leurre [4].MéthodesUne étude randomisée en double insu a été menée chez 30 participants sains. Une stimulation de type iTBS (intermittent theta burst stimulation) a été effectuée pendant 5 jours à raison de 2 séances/jour appliquée au niveau du CPFDL gauche ciblé par neuro-navigation sur les coordonnées MNI (X, Y, Z = –50,30,36). Nous avons observé l’impact de la SMTr sur le comportement des participants durant la tâche de N-back. Pour cela, les participants ont effectué cette tâche, composée de blocs de 0-back, 3-back et 3-back contenant des leurres, lors de deux sessions d’IRMf (une avant et une après la semaine de stimulation active ou placebo). La performance, le temps de réaction ainsi que les données d’imageries ont été recueillis.RésultatsLes 2 groupes ne montrent pas de différence au niveau de l’âge ou du genre. Au niveau comportemental, les premières analyses sur la performance ainsi que sur le temps de réaction ne montrent pas d’effet d’interaction Groupe (actif/placebo) * Temps (avant/après SMTr). Au niveau des données de neuro-imagerie, une analyse d’interaction Groupe * Temps en prenant en compte la condition leurre nous permettra de mieux comprendre l’impact de la SMTr sur la mémoire de travail impliquant le CPFDL.
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Dinur-Klein L, Dannon P, Hadar A, Rosenberg O, Roth Y, Kotler M, Zangen A. Smoking cessation induced by deep repetitive transcranial magnetic stimulation of the prefrontal and insular cortices: a prospective, randomized controlled trial. Biol Psychiatry 2014; 76:742-9. [PMID: 25038985 DOI: 10.1016/j.biopsych.2014.05.020] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tobacco smoking is the leading cause of preventable death in developed countries. Our previous studies in animal models and humans suggest that repeated activation of cue-induced craving networks followed by electromagnetic stimulation of the dorsal prefrontal cortex (PFC) can cause lasting reductions in drug craving and consumption. We hypothesized that disruption of these circuitries by deep transcranial magnetic stimulation (TMS) of the PFC and insula bilaterally can induce smoking cessation. METHODS Adults (N = 115) who smoke at least 20 cigarettes/day and failed previous treatments were recruited from the general population. Participants were randomized to receive 13 daily sessions of high-frequency, low-frequency or sham stimulation following, or without, presentation of smoking cues. Deep TMS was administered using an H-coil version targeting the lateral PFC and insula bilaterally. Cigarette consumption was evaluated during the treatment by measuring cotinine levels in urine samples and recording participants' self-reports as a primary outcome variable. Dependence and craving were assessed using standardized questionnaires. RESULTS High (but not low) frequency deep TMS treatment significantly reduced cigarette consumption and nicotine dependence. The combination of this treatment with exposure to smoking cues enhanced reduction in cigarette consumption leading to an abstinence rate of 44% at the end of the treatment and an estimated 33% 6 months following the treatment. CONCLUSIONS This study further implicates the lateral PFC and insula in nicotine addiction and suggests the use of deep high-frequency TMS of these regions following presentation of smoking cues as a promising treatment strategy.
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Affiliation(s)
- Limor Dinur-Klein
- Beer Yaakov Mental Health Center, Tel Aviv University, Israel; Department of Life Science, Ben-Gurion University, Beer-Sheva, Israel
| | - Pinhas Dannon
- Beer Yaakov Mental Health Center, Tel Aviv University, Israel
| | - Aviad Hadar
- Department of Life Science, Ben-Gurion University, Beer-Sheva, Israel
| | - Oded Rosenberg
- Beer Yaakov Mental Health Center, Tel Aviv University, Israel
| | - Yiftach Roth
- Department of Life Science, Ben-Gurion University, Beer-Sheva, Israel
| | - Moshe Kotler
- Beer Yaakov Mental Health Center, Tel Aviv University, Israel
| | - Abraham Zangen
- Department of Life Science, Ben-Gurion University, Beer-Sheva, Israel.
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170
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Kedzior KK, Reitz SK. Short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression- reanalysis of data from meta-analyses up to 2010. BMC Psychol 2014; 2:39. [PMID: 25685354 PMCID: PMC4317138 DOI: 10.1186/s40359-014-0039-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 09/23/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND According to a narrative review of 13 meta-analyses (published up to 2010), repetitive transcranial magnetic stimulation (rTMS) has a moderate, short-term antidepressant effect in the treatment of major depression. The aim of the current study was to reanalyse the data from these 13 meta-analyses with a uniform meta-analytical procedure and to investigate predictors of such an antidepressant response. METHODS A total of 40 double-blind, randomised, sham-controlled trials with parallel designs, utilising rTMS of the dorsolateral prefrontal cortex in the treatment of major depression, was included in the current meta-analysis. The studies were conducted in 15 countries on 1583 patients and published between 1997-2008. Depression severity was measured using the Hamilton Depression Rating Scale, Beck Depression Inventory, or Montgomery Åsberg Depression Rating Scale at baseline and after the last rTMS. A random-effects model with the inverse-variance weights was used to compute the overall mean weighted effect size, Cohen's d. RESULTS There was a significant and moderate reduction in depression scores from baseline to final, favouring rTMS over sham (overall d = -.54, 95% CI: -.68, -.41, N = 40 studies). Predictors of such a response were investigated in the largest group of studies (N = 32) with high-frequency (>1 Hz) left (HFL) rTMS. The antidepressant effect of HFL rTMS was present univariately in studies with patients receiving antidepressants (at stable doses or started concurrently with rTMS), with treatment-resistance, and with unipolar (or bipolar) depression without psychotic features. Univariate meta-regressions showed that depression scores were significantly lower after HFL rTMS in studies with higher proportion of female patients. There was little evidence for publication bias in the current analysis. CONCLUSIONS Daily rTMS (with any parameters) has a moderate, short-term antidepressant effect in studies published up to 2008. The clinical efficacy of HFL rTMS may be better in female patients not controlling for any other study parameters.
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Affiliation(s)
- Karina Karolina Kedzior
- Bremen International Graduate School of Social Sciences (BIGSSS), Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany
| | - Sarah Kim Reitz
- Bremen International Graduate School of Social Sciences (BIGSSS), Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany
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Repetitive transcranial magnetic stimulation (rTMS) influences spatial cognition and modulates hippocampal structural synaptic plasticity in aging mice. Exp Gerontol 2014; 58:256-68. [DOI: 10.1016/j.exger.2014.08.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/27/2014] [Accepted: 08/26/2014] [Indexed: 01/09/2023]
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Etkin A, Gyurak A, O'Hara R. A neurobiological approach to the cognitive deficits of psychiatric disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 24459409 PMCID: PMC3898680 DOI: 10.31887/dcns.2013.15.4/aetkin] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Deficits in brain networks that support cognitive regulatory functions are prevalent in many psychiatric disorders. Findings across neuropsychology and neuroimaging point to broad-based impairments that cross traditional diagnostic boundaries. These dysfunctions are largely separate from the classical symptoms of the disorders, and manifest in regulatory problems in both traditional cognitive and emotional domains. As such, they relate to the capacity of patients to engage effectively in their daily lives and activity, often persist even in the face of symptomatically effective treatment, and are poorly targeted by current treatments. Advances in cognitive neuroscience now allow us to ground an understanding of these cognitive regulatory deficits in the function and interaction of key brain networks. This emerging neurobiological understanding furthermore points to several promising routes for novel neuroscience-informed treatments targeted more specifically at improving cognitive function in a range of psychiatric disorders.
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Affiliation(s)
- Amit Etkin
- Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA
| | - Anett Gyurak
- Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA, Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Ruth O'Hara
- Departments of Psychiatry and Behavioral Sciences and Psychology, Stanford University, Stanford, California, USA
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Gorelick DA, Zangen A, George MS. Transcranial magnetic stimulation in the treatment of substance addiction. Ann N Y Acad Sci 2014; 1327:79-93. [PMID: 25069523 DOI: 10.1111/nyas.12479] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive method of brain stimulation used to treat a variety of neuropsychiatric disorders, but is still in the early stages of study as addiction treatment. We identified 19 human studies using repetitive TMS (rTMS) to manipulate drug craving or use, which exposed a total of 316 adults to active rTMS. Nine studies involved tobacco, six alcohol, three cocaine, and one methamphetamine. The majority of studies targeted high-frequency (5-20 Hz; expected to stimulate neuronal activity) rTMS pulses to the dorsolateral prefrontal cortex. Only five studies were controlled clinical trials: two of four nicotine trials found decreased cigarette smoking; the cocaine trial found decreased cocaine use. Many aspects of optimal treatment remain unknown, including rTMS parameters, duration of treatment, relationship to cue-induced craving, and concomitant treatment. The mechanisms of rTMS potential therapeutic action in treating addictions are poorly understood, but may involve increased dopamine and glutamate function in corticomesolimbic brain circuits and modulation of neural activity in brain circuits that mediate cognitive processes relevant to addiction, such as response inhibition, selective attention, and reactivity to drug-associated cues. rTMS treatment of addiction must be considered experimental at this time, but appears to have a promising future.
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Affiliation(s)
- David A Gorelick
- Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Wölwer W, Lowe A, Brinkmeyer J, Streit M, Habakuck M, Agelink MW, Mobascher A, Gaebel W, Cordes J. Repetitive Transcranial Magnetic Stimulation (rTMS) Improves Facial Affect Recognition in Schizophrenia. Brain Stimul 2014; 7:559-63. [DOI: 10.1016/j.brs.2014.04.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/30/2014] [Indexed: 12/24/2022] Open
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Nardone R, Tezzon F, Höller Y, Golaszewski S, Trinka E, Brigo F. Transcranial magnetic stimulation (TMS)/repetitive TMS in mild cognitive impairment and Alzheimer's disease. Acta Neurol Scand 2014; 129:351-66. [PMID: 24506061 DOI: 10.1111/ane.12223] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2014] [Indexed: 12/20/2022]
Abstract
Several Transcranial Magnetic Stimulation (TMS) techniques can be applied to noninvasively measure cortical excitability and brain plasticity in humans. TMS has been used to assess neuroplastic changes in Alzheimer's disease (AD), corroborating findings that cortical physiology is altered in AD due to the underlying neurodegenerative process. In fact, many TMS studies have provided physiological evidence of abnormalities in cortical excitability, connectivity, and plasticity in patients with AD. Moreover, the combination of TMS with other neurophysiological techniques, such as high-density electroencephalography (EEG), makes it possible to study local and network cortical plasticity directly. Interestingly, several TMS studies revealed abnormalities in patients with early AD and even with mild cognitive impairment (MCI), thus enabling early identification of subjects in whom the cholinergic degeneration has occurred. Furthermore, TMS can influence brain function if delivered repetitively; repetitive TMS (rTMS) is capable of modulating cortical excitability and inducing long-lasting neuroplastic changes. Preliminary findings have suggested that rTMS can enhance performances on several cognitive functions impaired in AD and MCI. However, further well-controlled studies with appropriate methodology in larger patient cohorts are needed to replicate and extend the initial findings. The purpose of this paper was to provide an updated and comprehensive systematic review of the studies that have employed TMS/rTMS in patients with MCI and AD.
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Affiliation(s)
- R. Nardone
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
| | - F. Tezzon
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
| | - Y. Höller
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
| | - S. Golaszewski
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
| | - E. Trinka
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
| | - F. Brigo
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; Section of Clinical Neurology; University of Verona; Verona Italy
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Deguil J, Ravasi L, Auffret A, Babiloni C, Bartres Faz D, Bragulat V, Cassé-Perrot C, Colavito V, Herrero Ezquerro MT, Lamberty Y, Lanteaume L, Pemberton D, Pifferi F, Richardson JC, Schenker E, Blin O, Tarragon E, Bordet R. Evaluation of symptomatic drug effects in Alzheimer's disease: strategies for prediction of efficacy in humans. DRUG DISCOVERY TODAY. TECHNOLOGIES 2014; 10:e329-42. [PMID: 24179995 DOI: 10.1016/j.ddtec.2013.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In chronic diseases such as Alzheimer's disease (AD), the arsenal of biomarkers available to determine the effectiveness of symptomatic treatment is very limited. Interpretation of the results provided in literature is cumbersome and it becomes difficult to predict their standardization to a larger patient population. Indeed, cognitive assessment alone does not appear to have sufficient predictive value of drug efficacy in early clinical development of AD treatment. In recent years, research has contributed to the emergence of new tools to assess brain activity relying on innovative technologies of imaging and electrophysiology. However, the relevance of the use of these newer markers in treatment response assessment is waiting for validation. This review shows how the early clinical assessment of symptomatic drugs could benefit from the inclusion of suitable pharmacodynamic markers. This review also emphasizes the importance of re-evaluating a step-by-step strategy in drug development.
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177
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Fan LY, Chiu MJ. Combotherapy and current concepts as well as future strategies for the treatment of Alzheimer's disease. Neuropsychiatr Dis Treat 2014; 10:439-51. [PMID: 24648738 PMCID: PMC3956689 DOI: 10.2147/ndt.s45143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
It has been estimated that 35.6 million people globally had dementia in 2010 and the prevalence of dementia has been predicted to double every 20 years. Thus, 115.4 million people may be living with dementia in 2050. Alzheimer's disease (AD) is the leading cause of dementia and is present in 60%-70% of people with dementia. Unfortunately, there are few approved drugs that can alleviate the cognitive or behavioral symptoms of AD dementia. Recent studies have revealed that pathophysiological changes related to AD occur decades before the appearance of clinical symptoms of dementia. This extended preclinical phase of AD provides a critical chance for disease-modifying agents to halt or delay the relentless process of AD. Although several trials targeting various pathological processes are ongoing, the examination of the combined use of different approaches to combat AD seems warranted. In this article, we will review current therapies, future strategies, and ongoing clinical trials for the treatment of AD with a special focus on combination therapies. Furthermore, preventive strategies for cognitively normal subjects in the presymptomatic stages of AD will also be addressed. In this review, we discuss current hypotheses of the disease process. In the decades since the approval of cholinesterase inhibitors, no new drug has ultimately demonstrated clear success in clinical trials. Given the difficulties that have been encountered in attempts to identify a single drug that can treat AD, we must pursue effective multi-target strategies, ie, combination therapies. The combination of cholinesterase inhibitors and memantine is considered well tolerated and safe, and this combination benefits patients with moderate-to-severe AD. In contrast, with the exception of adjuvant therapies of conventional drugs, combinations of different disease-modifying agents with different mechanisms may have promising synergic effects and benefit cognition, behavior, and daily living function.
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Affiliation(s)
- Ling-Yun Fan
- Department of Neurology, En Chu Kong Hospital, Taipei, Taiwan
- Department of Neurology, College of Medicine, Graduate Institute of Brain and Mind Sciences, Taipei, Taiwan
| | - Ming-Jang Chiu
- Department of Neurology, College of Medicine, Graduate Institute of Brain and Mind Sciences, Taipei, Taiwan
- Graduate Institute of Psychology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Biomedical Engineering and Bioinformatics, National Taiwan University Hospital, Taipei, Taiwan
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178
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Lett TA, Voineskos AN, Kennedy JL, Levine B, Daskalakis ZJ. Treating working memory deficits in schizophrenia: a review of the neurobiology. Biol Psychiatry 2014; 75:361-70. [PMID: 24011822 DOI: 10.1016/j.biopsych.2013.07.026] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 01/06/2023]
Abstract
Cognitive deficits are a core feature of schizophrenia. Among these deficits, working memory impairment is considered a central cognitive impairment in schizophrenia. The prefrontal cortex, a region critical for working memory performance, has been demonstrated as a critical liability region in schizophrenia. As yet, there are no standardized treatment options for working memory deficits in schizophrenia. In this review, we summarize the neuronal basis for working memory impairment in schizophrenia, including dysfunction in prefrontal signaling pathways (e.g., γ-aminobutyric acid transmission) and neural network synchrony (e.g., gamma/theta oscillations). We discuss therapeutic strategies for working memory dysfunction such as pharmacological agents, cognitive remediation therapy, and repetitive transcranial magnetic stimulation. Despite the drawbacks of current approaches, the advances in neurobiological and translational treatment strategies suggest that clinical application of these methods will occur in the near future.
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Affiliation(s)
- Tristram A Lett
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada; Department of Psychiatry, Toronto, Ontario, Canada
| | - James L Kennedy
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada; Department of Psychiatry, Toronto, Ontario, Canada
| | - Brian Levine
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Centre Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Toronto, Ontario, Canada; Department of Psychiatry, Toronto, Ontario, Canada.
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179
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Green MF, Harvey PD. Cognition in schizophrenia: Past, present, and future. SCHIZOPHRENIA RESEARCH-COGNITION 2014; 1:e1-e9. [PMID: 25254156 DOI: 10.1016/j.scog.2014.02.001] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Schizophrenia Research: Cognition will serve an important function - a place where interests converge and investigators can learn about the recent developments in this area. This new journal will provide rapid dissemination of information to people who will make good use of it. In this initial article, we comment globally on the study of cognition in schizophrenia: how we got here, where we are, and where we are going. The goal of this first article is to place the study of cognition in schizophrenia within a historical and scientific context. In a field as richly textured as ours it is impossible to hit all the important areas, and we hope the reader will forgive our omissions. Phrased in cognitive terms, our limited presentation of the past is a matter of selective memory, the present is a matter of selective attention, and the future is a matter of selective prospection. This broad introduction emphasizes that cognition in schizophrenia provides clues to pathophysiology, treatment, and outcome. In fact, the study of cognitive impairment in schizophrenia has become wholly intertwined with the study of schizophrenia itself.
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Affiliation(s)
- Michael F Green
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA ; Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA ; Bruce Carter VA Medical Center, Miami, FL, USA
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Guhn A, Dresler T, Andreatta M, Müller LD, Hahn T, Tupak SV, Polak T, Deckert J, Herrmann MJ. Medial prefrontal cortex stimulation modulates the processing of conditioned fear. Front Behav Neurosci 2014; 8:44. [PMID: 24600362 PMCID: PMC3927128 DOI: 10.3389/fnbeh.2014.00044] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/29/2014] [Indexed: 01/26/2023] Open
Abstract
The extinction of conditioned fear depends on an efficient interplay between the amygdala and the medial prefrontal cortex (mPFC). In rats, high-frequency electrical mPFC stimulation has been shown to improve extinction by means of a reduction of amygdala activity. However, so far it is unclear whether stimulation of homologues regions in humans might have similar beneficial effects. Healthy volunteers received one session of either active or sham repetitive transcranial magnetic stimulation (rTMS) covering the mPFC while undergoing a 2-day fear conditioning and extinction paradigm. Repetitive TMS was applied offline after fear acquisition in which one of two faces (CS+ but not CS-) was associated with an aversive scream (UCS). Immediate extinction learning (day 1) and extinction recall (day 2) were conducted without UCS delivery. Conditioned responses (CR) were assessed in a multimodal approach using fear-potentiated startle (FPS), skin conductance responses (SCR), functional near-infrared spectroscopy (fNIRS), and self-report scales. Consistent with the hypothesis of a modulated processing of conditioned fear after high-frequency rTMS, the active group showed a reduced CS+/CS- discrimination during extinction learning as evident in FPS as well as in SCR and arousal ratings. FPS responses to CS+ further showed a linear decrement throughout both extinction sessions. This study describes the first experimental approach of influencing conditioned fear by using rTMS and can thus be a basis for future studies investigating a complementation of mPFC stimulation to cognitive behavioral therapy (CBT).
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Affiliation(s)
- Anne Guhn
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University of TübingenTübingen, Germany
- LEAD Graduate School, University of TuebingenTuebingen, Germany
| | - Marta Andreatta
- Department of Psychology, University of WürzburgWürzburg, Germany
| | - Laura D. Müller
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Tim Hahn
- Department of Cognitive Psychology II, University of Frankfurt/MainFrankfurt, Germany
| | - Sara V. Tupak
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of WürzburgWürzburg, Germany
- Institute of Medical Psychology and Systems Neuroscience, University of MünsterMünster, Germany
| | - Thomas Polak
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Martin J. Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of WürzburgWürzburg, Germany
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Cognitive effects of repetitive transcranial magnetic stimulation in patients with neurodegenerative diseases - clinician's perspective. J Neurol Sci 2014; 339:15-25. [PMID: 24530170 DOI: 10.1016/j.jns.2014.01.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 12/23/2013] [Accepted: 01/27/2014] [Indexed: 02/06/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) represents a promising tool for studying and influencing cognition in people with neurodegenerative diseases. This procedure is noninvasive and painless, and it does not require the use of anesthesia or pharmacological substances. In this systematic critical review we report outcomes from research focused on behavioral cognitive effects induced by rTMS in patients with Alzheimer's disease (AD), Parkinson's disease (PD), and mild cognitive impairment (MCI) preceding AD. There are still major limitations to rTMS use, such as a poor understanding of its after-effects and inter-individual variability in their magnitude, discrepancies in stimulation protocols and study designs, varied selection of the specific stimulated areas and control procedures, and neuropsychological methods for assessment of after-effects; hence, the results of the present research can only be considered preliminary. The future directions are discussed.
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Brem AK, Fried PJ, Horvath JC, Robertson EM, Pascual-Leone A. Is neuroenhancement by noninvasive brain stimulation a net zero-sum proposition? Neuroimage 2014; 85 Pt 3:1058-68. [PMID: 23880500 PMCID: PMC4392930 DOI: 10.1016/j.neuroimage.2013.07.038] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/09/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022] Open
Abstract
In the past several years, the number of studies investigating enhancement of cognitive functions through noninvasive brain stimulation (NBS) has increased considerably. NBS techniques, such as transcranial magnetic stimulation and transcranial current stimulation, seem capable of enhancing cognitive functions in patients and in healthy humans, particularly when combined with other interventions, including pharmacologic, behavioral and cognitive therapies. The "net zero-sum model", based on the assumption that brain resources are subjected to the physical principle of conservation of energy, is one of the theoretical frameworks proposed to account for such enhancement of function and its potential cost. We argue that to guide future neuroenhancement studies, the net-zero sum concept is helpful, but only if its limits are tightly defined.
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Affiliation(s)
- Anna-Katharine Brem
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Laboratory of Cerebral Dynamics, Plasticity and Rehabilitation, Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Jared C. Horvath
- Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Edwin M. Robertson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Institut Guttman de Neurorehabilitació, Universitat Autonoma, Barcelona, Spain
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183
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Herholz SC, Herholz RS, Herholz K. Non-pharmacological interventions and neuroplasticity in early stage Alzheimer's disease. Expert Rev Neurother 2014; 13:1235-45. [DOI: 10.1586/14737175.2013.845086] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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184
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Vidal-Piñeiro D, Martin-Trias P, Arenaza-Urquijo EM, Sala-Llonch R, Clemente IC, Mena-Sánchez I, Bargalló N, Falcón C, Pascual-Leone Á, Bartrés-Faz D. Task-dependent activity and connectivity predict episodic memory network-based responses to brain stimulation in healthy aging. Brain Stimul 2014; 7:287-96. [PMID: 24485466 DOI: 10.1016/j.brs.2013.12.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 12/17/2013] [Accepted: 12/31/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) can affect episodic memory, one of the main cognitive hallmarks of aging, but the mechanisms of action remain unclear. OBJECTIVES To evaluate the behavioral and functional impact of excitatory TMS in a group of healthy elders. METHODS We applied a paradigm of repetitive TMS - intermittent theta-burst stimulation - over left inferior frontal gyrus in healthy elders (n = 24) and evaluated its impact on the performance of an episodic memory task with two levels of processing and the associated brain activity as captured by a pre and post fMRI scans. RESULTS In the post-TMS fMRI we found TMS-related activity increases in left prefrontal and cerebellum-occipital areas specifically during deep encoding but not during shallow encoding or at rest. Furthermore, we found a task-dependent change in connectivity during the encoding task between cerebellum-occipital areas and the TMS-targeted left inferior frontal region. This connectivity change correlated with the TMS effects over brain networks. CONCLUSIONS The results suggest that the aged brain responds to brain stimulation in a state-dependent manner as engaged by different tasks components and that TMS effect is related to inter-individual connectivity changes measures. These findings reveal fundamental insights into brain network dynamics in aging and the capacity to probe them with combined behavioral and stimulation approaches.
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Affiliation(s)
- Dídac Vidal-Piñeiro
- Department de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Barcelona, Spain
| | - Pablo Martin-Trias
- Department de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Barcelona, Spain
| | - Eider M Arenaza-Urquijo
- Department de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Barcelona, Spain
| | - Roser Sala-Llonch
- Department de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Barcelona, Spain
| | - Imma C Clemente
- Department de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Barcelona, Spain; Institute for Brain, Cognition and Behaviour (IR3C), Barcelona, Spain
| | - Isaias Mena-Sánchez
- Department de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Barcelona, Spain
| | - Núria Bargalló
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Secció de Neuroradiologia, Servei de Radiologia, Centre de Diagnòstic per la Imatge, Barcelona, Spain
| | - Carles Falcón
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER-BBN, Barcelona, Spain
| | - Álvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Institut Universitari de Neurorehabilitació Guttmann-UAB, Badalona, Spain
| | - David Bartrés-Faz
- Department de Psiquiatria i Psicobiologia Clinica, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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185
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Lindahl JR, Kaplan CT, Winget EM, Britton WB. A phenomenology of meditation-induced light experiences: traditional buddhist and neurobiological perspectives. Front Psychol 2014; 4:973. [PMID: 24427148 PMCID: PMC3879457 DOI: 10.3389/fpsyg.2013.00973] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022] Open
Abstract
The scientific study of Buddhist meditation has proceeded without much attention to Buddhist literature that details the range of psychological and physiological changes thought to occur during meditation. This paper presents reports of various meditation-induced light experiences derived from American Buddhist practitioners. The reports of light experiences are classified into two main types: discrete lightforms and patterned or diffuse lights. Similar phenomena are well documented in traditional Buddhist texts but are virtually undocumented in scientific literature on meditation. Within Buddhist traditions, these phenomena are attributed a range of interpretations. However, because it is insufficient and problematic to rely solely upon the textual sources as a means of investigating the cause or significance of these phenomena, these qualitative reports are also considered in relation to scientific research on light-related experiences in the context of sensory deprivation, perceptual isolation, and clinical disorders of the visual system. The typologies derived from these studies also rely upon reports of experiences and closely match typologies derived from the qualitative study of contemporary practitioners and typologies found in Buddhist literary traditions. Taken together, these studies also provide evidence in support of the hypothesis that certain meditative practices – especially those that deliberately decrease social, kinesthetic, and sensory stimulation and emphasize focused attention – have perceptual and cognitive outcomes similar to sensory deprivation. Given that sensory deprivation increases neuroplasticity, meditation may also have an enhanced neuroplastic potential beyond ordinary experience-dependent changes. By providing and contextualizing these reports of meditation-induced light experiences, scientists, clinicians, and meditators gain a more informed view of the range of experiences that can be elicited by contemplative practices.
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Affiliation(s)
- Jared R Lindahl
- Department of Religious Studies, Warren Wilson College Asheville, NC, USA
| | - Christopher T Kaplan
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University Providence, RI, USA
| | - Evan M Winget
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University Providence, RI, USA
| | - Willoughby B Britton
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University Providence, RI, USA
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186
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Thorsen AL, Johansson K, Løberg EM. Neurobiology of cognitive remediation therapy for schizophrenia: a systematic review. Front Psychiatry 2014; 5:103. [PMID: 25177300 PMCID: PMC4133649 DOI: 10.3389/fpsyt.2014.00103] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/01/2014] [Indexed: 12/13/2022] Open
Abstract
Cognitive impairment is an important aspect of schizophrenia, where cognitive remediation therapy (CRT) is a promising treatment for improving cognitive functioning. While neurobiological dysfunction in schizophrenia has been the target of much research, the neural substrate of cognitive remediation and recovery has not been thoroughly examined. The aim of the present article is to systematically review the evidence for neural changes after CRT for schizophrenia. The reviewed studies indicate that CRT affects several brain regions and circuits, including prefrontal, parietal, and limbic areas, both in terms of activity and structure. Changes in prefrontal areas are the most reported finding, fitting to previous evidence of dysfunction in this region. Two limitations of the current research are the few studies and the lack of knowledge on the mechanisms underlying neural and cognitive changes after treatment. Despite these limitations, the current evidence suggests that CRT is associated with both neurobiological and cognitive improvement. The evidence from these findings may shed light on both the neural substrate of cognitive impairment in schizophrenia, and how better treatment can be developed and applied.
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Affiliation(s)
| | - Kyrre Johansson
- Department of Psychosocial Science, University of Bergen , Bergen , Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital , Bergen , Norway ; Department of Biological and Medical Psychology, University of Bergen , Bergen , Norway
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187
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The Transcranial Magnetic Stimulation (TMS) Device and Foundational Techniques. TRANSCRANIAL MAGNETIC STIMULATION 2014. [DOI: 10.1007/978-1-4939-0879-0_1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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188
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Repetitive transcranial magnetic stimulation applications normalized prefrontal dysfunctions and cognitive-related metabolic profiling in aged mice. PLoS One 2013; 8:e81482. [PMID: 24278445 PMCID: PMC3838337 DOI: 10.1371/journal.pone.0081482] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/16/2013] [Indexed: 12/17/2022] Open
Abstract
Chronic high-frequency repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique that has recently received increasing interests as a therapeutic procedure for neurodegenerative diseases. To identify the metabolism mechanism underlying the improving effects of rTMS, we observed that high frequency (25Hz) rTMS for 14 days could reverse the decline of the performance of the passive avoidance task in aged mice. We further investigated the metabolite profiles in the prefrontal cortex (PFC) in those mice and found that rTMS could also reverse the metabolic abnormalities of gamma-aminobutyric acid, N-acetyl aspartic, and cholesterol levels to the degree similar to the young mice. These data suggested that the rTMS could ameliorate the age-related cognitive impairment and improving the metabolic profiles in PFC, and potentially can be used to improve cognitive decline in the elderly.
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189
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Luber B, McClintock SM, Lisanby SH. Applications of transcranial magnetic stimulation and magnetic seizure therapy in the study and treatment of disorders related to cerebral aging. DIALOGUES IN CLINICAL NEUROSCIENCE 2013. [PMID: 23576892 PMCID: PMC3622472 DOI: 10.31887/dcns.2013.15.1/bluber] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Transcranial magnetic stimulation (TMS) can be used to probe cortical function and treat neuropsychiatric illnesses. TMS has demonstrated neuroplastic effects akin to long-term potentiation and long-term depression, and therapeutic applications are in development for post-stroke recovery, Alzheimer's disease, and depression in seniors. Here, we discuss two new directions of TMS research relevant to cerebral aging and cognition. First, we introduce a paradigm for enhancing cognitive reserve, based on our research in sleep deprivation. Second, we discuss the use of magnetic seizure therapy (MST) to spare cognitive functions relative to conventional electroconvulsive therapy, and as a means of providing a more potent antidepressant treatment when subconvulsive TMS has shown modest efficacy in seniors. Whether in the enhancement of cognition as a treatment goal, or in the reduction of amnesia as a side effect, these approaches to the use of TMS and MST merit further exploration regarding their clinical potential.
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Affiliation(s)
- Bruce Luber
- Department of Psychiatry and Behavioral Sciences, Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
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190
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Sykes M, Makowiecki K, Rodger J. Long term delivery of pulsed magnetic fields does not alter visual discrimination learning or dendritic spine density in the mouse CA1 pyramidal or dentate gyrus neurons. F1000Res 2013; 2:180. [PMID: 24627788 PMCID: PMC3938248 DOI: 10.12688/f1000research.2-180.v2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2013] [Indexed: 01/22/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is thought to facilitate brain plasticity. However, few studies address anatomical changes following rTMS in relation to behaviour. We delivered 5 weeks of daily pulsed rTMS stimulation to adult ephrin-A2 (-/-) and wildtype (C57BI/6j) mice (n=10 per genotype) undergoing a visual learning task and analysed learning performance, as well as spine density, in the dentate gyrus molecular and CA1 pyramidal cell layers in Golgi-stained brain sections. We found that neither learning behaviour, nor hippocampal spine density was affected by long term rTMS. Our negative results highlight the lack of deleterious side effects in normal subjects and are consistent with previous studies suggesting that rTMS has a bigger effect on abnormal or injured brain substrates than on normal/control structures.
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Affiliation(s)
- Matthew Sykes
- Experimental and Regenerative Neurosciences, School of Animal Biology, University of Western Australia, Crawley, Australia
| | - Kalina Makowiecki
- Experimental and Regenerative Neurosciences, School of Animal Biology, University of Western Australia, Crawley, Australia
| | - Jennifer Rodger
- Experimental and Regenerative Neurosciences, School of Animal Biology, University of Western Australia, Crawley, Australia
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191
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Schaller G, Lenz B, Friedrich K, Dygon D, Richter-Schmidinger T, Sperling W, Kornhuber J. No evidence for effects of a high-frequency repetitive transcranial magnetic stimulation series on verbal and figural fluency and TAP task performance in healthy male volunteers. Neuropsychobiology 2013; 67:69-73. [PMID: 23295825 DOI: 10.1159/000343502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/14/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Study results on cognitive effects of repetitive transcranial magnetic stimulation (rTMS) in healthy people are inconsistent. Moreover, former trials performed exclusively single-session stimulations. This sham-controlled study analyzed the influence of 9 serial high-frequency rTMS on cognition. METHODS 44 young healthy male volunteers received active or sham rTMS. We evaluated verbal fluency tasks, the Ruff Figural Fluency Test and different Test for Attentional Performance tasks (alertness, go/no-go, divided attention, working memory, flexibility) prior to the first stimulation, immediately (within 5-30 min) after stimulation on day 5 and on day 10 (1 day after the last stimulation). RESULTS Overall, our statistical analyses revealed no significant cognitive effects of serial rTMS. CONCLUSION In this sham-controlled study design, 9 serial rTMS over the left dorsolateral prefrontal cortex (targeted by the 5-cm rule) did neither enhance nor impair the assessed cognitive functions in healthy male volunteers.
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Affiliation(s)
- Gerd Schaller
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
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192
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Potentiation of quantitative electroencephalograms following prefrontal repetitive transcranial magnetic stimulation in patients with major depression. Neurosci Res 2013; 77:70-7. [DOI: 10.1016/j.neures.2013.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 06/12/2013] [Accepted: 06/15/2013] [Indexed: 11/20/2022]
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193
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Effects of non-invasive neurostimulation on craving: a meta-analysis. Neurosci Biobehav Rev 2013; 37:2472-80. [PMID: 23916527 DOI: 10.1016/j.neubiorev.2013.07.009] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/10/2013] [Accepted: 07/14/2013] [Indexed: 01/03/2023]
Abstract
This meta-analysis was conducted to evaluate the available evidence regarding the effects of non-invasive neurostimulation of the dorsolateral prefrontal cortex (DLPFC), on craving in substance dependence and craving for high palatable food. Non-invasive neurostimulation techniques were restricted to repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS). A total of 17 eligible studies were identified. Random effects analysis revealed a pooled standardized effect size (Hedge's g) of 0.476 (CI: 0.316-0.636), indicating a medium effect size favouring active non-invasive neurostimulation over sham stimulation in the reduction of craving (z=5.832, p<0.001). No significant differences were found between rTMS and tDCS, between the various substances of abuse and between substances of abuse and food, or between left and right DLPFC stimulation. In conclusion, this meta-analysis provides the first clear evidence that non-invasive neurostimulation of the DLPFC decreases craving levels in substance dependence.
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194
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Berlim MT, Van den Eynde F, Daskalakis ZJ. Efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (rTMS) versus electroconvulsive therapy (ECT) for major depression: a systematic review and meta-analysis of randomized trials. Depress Anxiety 2013; 30:614-23. [PMID: 23349112 DOI: 10.1002/da.22060] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 12/18/2012] [Accepted: 12/22/2012] [Indexed: 01/30/2023] Open
Abstract
Clinical trials comparing the efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) for treating major depression (MD) have yielded conflicting results. As this may have been the result of limited statistical power, we have carried out this meta-analysis to examine this issue. We searched the literature for randomized trials on head-to-head comparisons between HF-rTMS and ECT from January 1995 through September 2012 using MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and SCOPUS. The main outcome measures were remission rates, pre-post changes in depression ratings, as well as overall dropout rates at study end. We used a random-effects model, Odds Ratios (OR), Number Needed to Treat (NNT), and Hedges' g effect sizes. Data were obtained from 7 randomized trials, totalling 294 subjects with MD. After an average of 15.2 HF-rTMS and 8.2 ECT sessions, 33.6% (38/113) and 52% (53/102) of subjects were classified as remitters (OR = 0.46; p = 0.04), respectively. The associated NNT for remission was 6 and favoured ECT. Also, reduction of depressive symptomatology was significantly more pronounced in the ECT group (Hedges' g = -0.93; p = 0.007). No differences on dropout rates for HF-rTMS and ECT groups were found. In conclusion, ECT seems to be more effective than HF-rTMS for treating MD, although they did not differ in terms of dropout rates. Nevertheless, future comparative trials with larger sample sizes and better matching at baseline, longer follow-ups and more intense stimulation protocols are warranted.
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Affiliation(s)
- Marcelo T Berlim
- Neuromodulation Research Clinic, Douglas Mental Health University Institute, Montréal, Québec H4H 1R3, Canada.
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195
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Application of high-frequency repetitive transcranial magnetic stimulation to the DLPFC alters human prefrontal-hippocampal functional interaction. J Neurosci 2013; 33:7050-6. [PMID: 23595762 DOI: 10.1523/jneurosci.3081-12.2013] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neural plasticity is crucial for understanding the experience-dependent reorganization of brain regulatory circuits and the pathophysiology of schizophrenia. An important circuit-level feature derived from functional magnetic resonance imaging (fMRI) is prefrontal-hippocampal seeded connectivity during working memory, the best established intermediate connectivity phenotype of schizophrenia risk to date. The phenotype is a promising marker for the effects of plasticity-enhancing interventions, such as high-frequency repetitive transcranial magnetic stimulation (rTMS), and can be studied in healthy volunteers in the absence of illness-related confounds, but the relationship to brain plasticity is unexplored. We recruited 39 healthy volunteers to investigate the effects of 5 Hz rTMS on prefrontal-hippocampal coupling during working memory and rest. In a randomized and sham-controlled experiment, neuronavigation-guided rTMS was applied to the right dorsolateral prefrontal cortex (DLPFC), and fMRI and functional connectivity analyses [seeded connectivity and psychophysiological interaction (PPI)] were used as readouts. Moreover, the test-retest reliability of working-memory related connectivity markers was evaluated. rTMS provoked a significant decrease in seeded functional connectivity of the right DLPFC and left hippocampus during working memory that proved to be relatively time-invariant and robust. PPI analyses provided evidence for a nominal effect of rTMS and poor test-retest reliability. No effects on n-back-related activation and DLPFC-hippocampus resting-state connectivity were observed. These data provide the first in vivo evidence for the effects of plasticity induction on human prefrontal-hippocampal network dynamics, offer insights into the biological mechanisms of a well established intermediate phenotype linked to schizophrenia, and underscores the importance of the choice of outcome measures in test-retest designs.
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196
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Kuo MF, Paulus W, Nitsche MA. Therapeutic effects of non-invasive brain stimulation with direct currents (tDCS) in neuropsychiatric diseases. Neuroimage 2013; 85 Pt 3:948-60. [PMID: 23747962 DOI: 10.1016/j.neuroimage.2013.05.117] [Citation(s) in RCA: 278] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/30/2013] [Accepted: 05/23/2013] [Indexed: 12/19/2022] Open
Abstract
Neuroplasticity, which is the dynamic structural and functional reorganization of central nervous system connectivity due to environmental and internal demands, is recognized as a major physiological basis for adaption of cognition, and behavior, and thus of utmost importance for normal brain function. Pathological alterations of plasticity are increasingly explored as pathophysiological foundation of diverse neurological and psychiatric diseases. Non-invasive brain stimulation techniques (NIBS), such as repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), are able to induce and modulate neuroplasticity in humans. Therefore, they have potential to alter pathological plasticity on the one hand, and foster physiological plasticity on the other, in neuropsychiatric diseases to reduce symptoms, and enhance rehabilitation. tDCS is an emerging NIBS tool, which induces glutamatergic plasticity via application of relatively weak currents through the scalp in humans. In the last years its efficacy to treat neuropsychiatric diseases has been explored increasingly. In this review, we will give an overview of pathological alterations of plasticity in neuropsychiatric diseases, gather clinical studies involving tDCS to ameliorate symptoms, and discuss future directions of application, with an emphasis on optimizing stimulation effects.
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Affiliation(s)
- Min-Fang Kuo
- University Medical Center, Clinic for Clinical Neurophysiology, Georg-August-University, Robert-Koch-Str. 40, 37099 Goettingen, Germany.
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197
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Ahn HM, Kim SE, Kim SH. The Effects of High-Frequency rTMS Over the Left Dorsolateral Prefrontal Cortex on Reward Responsiveness. Brain Stimul 2013; 6:310-4. [DOI: 10.1016/j.brs.2012.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 04/11/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022] Open
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198
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An Investigation of Medial Temporal Lobe Changes and Cognition Following Antidepressant Response: A Prospective rTMS Study. Brain Stimul 2013; 6:346-54. [DOI: 10.1016/j.brs.2012.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 06/22/2012] [Accepted: 06/22/2012] [Indexed: 11/18/2022] Open
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199
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Transcranial Magnetic and Electric Stimulation in Perception and Cognition Research. ACTA ACUST UNITED AC 2013. [DOI: 10.1201/b14174-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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200
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rTMS as a Treatment of Alzheimer's Disease with and without Comorbidity of Depression: A Review. NEUROSCIENCE JOURNAL 2013; 2013:679389. [PMID: 26317096 PMCID: PMC4437275 DOI: 10.1155/2013/679389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/15/2013] [Indexed: 11/17/2022]
Abstract
With an ever-increasing population of Alzheimer's disease (AD) patients worldwide, a noninvasive treatment for AD is needed. In this paper, the application of repetitive transcranial magnetic stimulus (rTMS) as a treatment for patients with probable AD is compared to the application of rTMS as a treatment for depression. Comorbidity of depression and dementia is discussed, as well as possible links between the two diseases. The possible confounding antidepressant effects of rTMS on cognitive improvements in AD patients are discussed.
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