The uncertain outcome of prefrontal tDCS

The role of neuronal variability in cognitive modulation via prefrontal direct current stimulation

This scientific commentary refers to ‘Direct current stimulation modulates prefrontal cell activity and behaviour without inducing seizure-like firing’ by Fehring et al. (https://doi.org/10.1093/brain/awae273).

Home-based, Remotely Supervised, 6-Week tDCS in Patients With Both MCI and Depression: A Randomized Double-Blind Placebo-Controlled Trial

As depressive symptom is considered a prodrome, a risk factor for progression from mild cognitive impairment (MCI) to dementia, improving depressive symptoms should be considered a clinical priority in patients with MCI undergoing transcranial direct current stimulation (tDCS) intervention. We aimed to comprehensively evaluate the efficacy of the home-based and remotely monitored tDCS in patients with both MCI and depression, by integrating cognitive, psychological, and electrophysiological indicators. In a 6-week, randomized, double blind, and sham-controlled study, 37 community-dwelling patients were randomly assigned to either an active or a sham stimulation group, and received 30 home-based sessions of 2 mA tDCS for 30 min with the anode located over the left and cathode over the right dorsolateral prefrontal cortex. We measured depressive symptoms, neurocognitive function, and resting-state electroencephalography. In terms of effects of both depressive symptoms and cognitive functions, active tDCS was not significantly different from sham tDCS. However, compared to sham stimulation, active tDCS decreased and increased the activation of delta and beta frequencies, respectively. Moreover, the increase in beta activity was correlated with the cognitive enhancement only in the active group. It was not possible to reach a definitive conclusion regarding the efficacy of tDCS on depression and cognition in patients with both MCI and depression. Nevertheless, the relationship between the changes of electrophysiology and cognitive performance suggests potential neuroplasticity enhancement implicated in cognitive processes by tDCS.

The relationship between frontal alpha asymmetry and behavioral and brain activity indices of reactive inhibitory control

Reactive inhibitory control plays an important role in phenotype of different diseases/different phases of a disease. One candidate electrophysiological marker of inhibitory control is frontal alpha asymmetry (FAA). FAA reflects the relative difference in contralateral frontal brain activity. However, the relationship between FAA and potential behavioral/brain activity indices of reactive inhibitory control is not yet clear. We assessed the relationship between resting-state FAA and indicators of reactive inhibitory control. Additionally, we investigated the effect of modulation of FAA via transcranial direct current stimulation (tDCS). We implemented a randomized sham-controlled design with 65 healthy humans (Mage = 23.93, SDage = 6.08; 46 female). Before and after 2-mA anodal tDCS of the right frontal site (with the cathode at the contralateral site) for 20 min, we collected EEG data and reactive inhibitory performance in neutral and food-reward conditions, using the stop signal task (SST). There was no support for the effect of tDCS on FAA or any indices of reactive inhibitory control. Our correlation analysis revealed an association between inhibitory brain activity in the food-reward condition and (pre-tDCS) asymmetry. Higher right relative to left frontal brain activity was correlated with reduced early-onset inhibitory activity and, in contrast, linked with higher late-onset inhibitory control in the food-reward condition. Similarly, event-related potential analyses showed reduced early-onset and enhanced late-onset inhibitory brain activity over time, particularly in the food-reward condition. These results suggest that there can be a dissociation regarding the lateralization of frontal brain activity and early- and late-onset inhibitory brain activity.NEW & NOTEWORTHY This research reveals dissociation between baseline frontal alpha asymmetry and the timing of reactive inhibitory brain activities in food-reward contexts. Whereas inhibitory control performance decreases over time in a stop signal task, electrophysiological indices show reduced early- and heightened late-onset inhibitory brain activity, especially in the reward condition. Additionally, greater right frontal activity correlates with reduced early-onset and increased late-onset inhibitory brain activity.

Modulation of pain perception through transcranial alternating current stimulation and its nonlinear relationship with the simulated electric field magnitude

BACKGROUND

Oscillatory activities observed in multiple regions are closely associated with the experience of pain. Specifically, oscillatory activities within the theta- and beta-frequency bands, observed in the left dorsolateral prefrontal cortex (DLPFC), have been implicated in pain perception among healthy individuals and those with chronic pain. However, their physiological significance remains unclear.

METHODS

We explored the modulation of pain perception in healthy individuals by theta- and beta-band transcranial alternating current stimulation (tACS) over the left DLPFC and examined the relationship between the modulation effect and magnitude of the electric field elicited by tACS in the left DLPFC using computational simulation.

RESULTS

Our findings revealed that both theta- and beta-tACS increased the heat pain threshold during and after stimulation. Notably, the simulated electric field magnitude in the left DLPFC exhibited an inverted U-shaped relationship with the pain modulation effect for theta-tACS.

CONCLUSIONS

Our study findings suggested that there would be an optimal electric field strength to produce a high analgesic effect for theta-tACS.

SIGNIFICANCE

The application of theta- and beta-tACS interventions targeting the left DLPFC might facilitate the treatment of chronic pain. Furthermore, the attainment of effective pain modulation via theta-tACS over the DLPFC warrants the use of optimal stimulus intensity.

Influence of noninvasive brain stimulation on connectivity and local activation: a combined tDCS and fMRI study

The effect of transcranial direct current stimulation (tDCS) on neurobiological mechanisms underlying executive function in the human brain remains elusive. This study aims at examining the effect of anodal and cathodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) in comparison with sham stimulation on resting-state connectivity as well as functional activation and working memory performance. We hypothesized perturbed fronto-parietal resting-state connectivity during stimulation and altered working memory performance combined with modified functional working memory-related activation. We applied tDCS with 1 mA for 21 min over the DLPFC inside an fMRI scanner. During stimulation, resting-state fMRI was acquired and task-dependent fMRI during working memory task performance was acquired directly after stimulation. N = 36 healthy subjects were studied in a within-subject design with three different experimental conditions (anodal, cathodal and sham) in a double-blind design. Seed-based functional connectivity analyses and dynamic causal modeling were conducted for the resting-state fMRI data. We found a significant stimulation by region interaction in the seed-based ROI-to-ROI resting-state connectivity, but no effect on effective connectivity. We also did not find an effect of stimulation on task-dependent signal alterations in working memory activation in our regions of interest and no effect on working memory performance parameters. We found effects on measures of seed-based resting-state connectivity, while measures of effective connectivity and task-based connectivity did not show any stimulation effect. We could not replicate previous findings of tDCS stimulation effects on behavioral outcomes. We critically discuss possible methodological limitations and implications for future studies.

Neurobiological Effects of Transcranial Direct Current Stimulation over the Inferior Frontal Gyrus: A Systematic Review on Cognitive Enhancement in Healthy and Neurological Adults

The neurobiological effects of transcranial direct current stimulation (tDCS) have still not been unequivocally clarified. Some studies have suggested that the application of tDCS over the inferior frontal gyrus (IFG) enhances different aspects of cognition in healthy and neurological individuals, exerting neural changes over the target area and its neural surroundings. In this systematic review, randomized sham-controlled trials in healthy and neurological adults were selected through a database search to explore whether tDCS over the IFG combined with cognitive training modulates functional connectivity or neural changes. Twenty studies were finally included, among which twelve measured tDCS effects through functional magnetic resonance (fMRI), two through functional near-infrared spectroscopy (fNIRS), and six through electroencephalography (EEG). Due to the high heterogeneity observed across studies, data were qualitatively described and compared to assess reliability. Overall, studies that combined fMRI and tDCS showed widespread changes in functional connectivity at both local and distant brain regions. The findings also suggested that tDCS may also modulate electrophysiological changes underlying the targeted area. However, these outcomes were not always accompanied by corresponding significant behavioral results. This work raises the question concerning the general efficacy of tDCS, the implications of which extend to the steadily increasing tDCS literature.

Interactions between tDCS treatment and COMT Val158Met in poststroke cognitive impairment

OBJECTIVE

This study aimed to explore the effect of catechol-O-methyltransferase (COMT) Val158Met and brain-derived neurotrophic factor (BDNF) Val66Met to post-stroke cognitive impairment (PSCI) and the interaction with transcranial direct current stimulation (tDCS).

METHODS

Seventy-six patients with PSCI were randomly assigned to Group (1) (n = 38) to receive anodal tDCS of left dorsolateral prefrontal cortex or Group (2) (n = 38) to receive sham stimulation. The intensity of the tDCS was 2 mA, and the stimulations were applied over the left DLPFC for 10 sessions. The Montreal Cognitive Assessment (MoCA) and backward digit span test (BDST) were assessed before, immediately after, and one month after stimulation.

RESULTS

After stimulation, patients in the tDCS group showed better improvement in both MoCA and BDST than those in the sham group. The results of GLMs also supported the main effects of tDCS on general cognitive function and working memory. Then we found that COMT genotype may have a main effect on the improvement of MoCA and BDST, and there may be an interaction between COMT genotype and tDCS in enhancing BDST. In contrast, BDNF genotype showed no significant main or interaction effects on any scales.

CONCLUSIONS

These findings demonstrate that tDCS can improve cognition after stroke. Gene polymorphisms of COMT can affect the efficacy of tDCS on PSCI, but BDNF may not.

SIGNIFICANCE

This study found that COMT Val158Met has an interaction on the efficacy of prefrontal tDCS in cognitive function, which provides reference for future tDCS research and clinical application.

Transcranial Alternating Current Stimulation to Modulate Alpha Activity: A Systematic Review

BACKGROUND

Transcranial alternating current stimulation (tACS) has been one of numerous investigation methods used for their potential to modulate brain oscillations; however, such investigations have given contradictory results and a lack of standardization.

OBJECTIVES

In this systematic review, we aimed to assess the potential of tACS to modulate alpha spectral power. The secondary outcome was the identification of tACS methodologic key parameters, adverse effects, and sensations.

MATERIALS AND METHODS

Studies in healthy adults who were receiving active and sham tACS intervention or any differential condition were included. The main outcome assessed was the increase/decrease of alpha spectral power through either electroencephalography or magnetoencephalography. Secondary outcomes were methodologic parameters, sensation reporting, and adverse effects. Risks of bias and the study quality were assessed with the Cochrane assessment tool.

RESULTS

We obtained 1429 references, and 20 met the selection criteria. A statistically significant alpha-power increase was observed in nine studies using continuous tACS stimulation and two using intermittent tACS stimulation set at a frequency within the alpha range. A statistically significant alpha-power increase was observed in three more studies using a stimulation frequency outside the alpha range. Heterogeneity among stimulation parameters was recognized. Reported adverse effects were mild. The implementation of double blind was identified as challenging using tACS, in part owing to electrical artifacts generated by stimulation on the recorded signal.

CONCLUSIONS

Most assessed studies reported that tACS has the potential to modulate brain alpha power. The optimization of this noninvasive brain stimulation method is of interest mostly for its potential clinical applications with neurological conditions associated with perturbations in alpha brain activity. However, more research efforts are needed to standardize optimal parameters to achieve lasting modulation effects, develop methodologic alternatives to reduce experimental bias, and improve the quality of studies using tACS to modulate brain activity.

Impact of electrode selection on modeling tDCS in the aging brain

Background

Person-specific computational models can estimate transcranial direct current stimulation (tDCS) current dose delivered to the brain and predict treatment response. Artificially created electrode models derived from virtual 10-20 EEG measurements are typically included in these models as current injection and removal sites. The present study directly compares current flow models generated via artificially placed electrodes ("artificial" electrode models) against those generated using real electrodes acquired from structural MRI scans ("real" electrode models) of older adults.

Methods

A total of 16 individualized head models were derived from cognitively healthy older adults (mean age = 71.8 years) who participated in an in-scanner tDCS study with an F3-F4 montage. Visible tDCS electrodes captured within the MRI scans were segmented to create the "real" electrode model. In contrast, the "artificial" electrodes were generated in ROAST. Percentage differences in current density were computed in selected regions of interest (ROIs) as examples of stimulation targets within an F3-F4 montage.

Main results

We found significant inverse correlations (p < 0.001) between median current density values and brain atrophy in both electrode pipelines with slightly larger correlations found in the artificial pipeline. The percent difference (PD) of the electrode distances between the two models predicted the median current density values computed in the ROIs, gray, and white matter, with significant correlation between electrode distance PDs and current density. The correlation between PD of the contact areas and the computed median current densities in the brain was found to be non-significant.

Conclusions

This study demonstrates potential discrepancies in generated current density models using real versus artificial electrode placement when applying tDCS to an older adult cohort. Our findings strongly suggest that future tDCS clinical work should consider closely monitoring and rigorously documenting electrode location during stimulation to model tDCS montages as closely as possible to actual placement. Detailed physical electrode location data may provide more precise information and thus produce more robust tDCS modeling results.

Synergistic effect of Tai Chi and transcranial direct current stimulation on memory function in patients with mild cognitive impairment: study protocol for a 2×2 factorial randomised controlled trial

INTRODUCTION

Interventions at the mild cognitive impairment (MCI) stage prevent or delay the progression of cognitive decline. In recent years, several studies have shown that physical exercise combined with transcranial direct current stimulation (tDCS) effectively delays the disease and promotes cognitive recovery in patients with MCI. This study aims to determine whether Tai Chi (TC) combined with tDCS can significantly improve memory in patients with MCI compared with TC or tDCS alone.

METHODS AND ANALYSIS

This clinical trial will use a 2×2 factorial design, enrolling 128 community-dwelling MCI patients, randomly categorised into four groups: TC, tDCS, TC combined with tDCS and the health education group. Outcome measures will include the Chinese Wechsler Memory Scale-Revised, Auditory Verbal Learning Test and Rey-Osterrieth Complex Figure Test. All assessments will be conducted at baseline and 3 months after the intervention. All analyses will use intention-to-treat or per-protocol methods.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of the Affiliated Rehabilitation Hospital of the Fujian University of Traditional Chinese Medicine (2022KY-002-01). The results of the study will be disseminated through peer-reviewed publications and at scientific conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2200059316.

HD-tDCS over the left DLPFC increases cued recall and subjective question familiarity rather than other aspects of memory and metamemory

When retrieving information from memory there is an interplay between memory and metamemory processes, and the prefrontal cortex has been implicated in both memory and metamemory. Previous work shown that High Definition transcranial Direct Current Stimulation (HD-tDCS) over the dorsolateral prefrontal cortex (DLPFC) can lead to improvements in memory and metamemory monitoring, but findings are mixed. Our original design targeted metamemory, but because the prefrontal cortex plays a role in both memory and metamemory, we tested for effects of HD-tDCS on multiple memory tasks (e.g., recall, cued recall, and recognition) and multiple aspects of metamemory (e.g., once-knew-it ratings, feeling-of-knowing ratings, metamemory accuracy, and metamemory control). There were HD-tDCS-related improvements in cued recall performance, but not other memory tasks. For metamemory, there were HD-tDCS-related increases in subjective once-knew-it ratings, but not other aspects of metamemory. These results highlight the need to consider the effects of HD-tDCS on memory and metamemory at different timepoints during retrieval, as well as specific conditions that show benefits from HD-tDCS.

Sex matters for the enhancement of cognitive training with transcranial direct current stimulation (tDCS)

BACKGROUND

Transcranial direct current stimulation (tDCS) can influence brain network activity and associated cognitive and behavioural functions. In addition to the extensive variety in stimulation parameters, numerous biological factors drive these effects, however these are yet poorly understood. Here, we investigate one of the major biological factors by focusing on sex-dependent effects of tDCS on a challenging cognitive control task (adaptive paced auditory serial addition task [PASAT]) in healthy humans.

METHODS

This sex-specific re-analysis was performed on data of 163 subjects who underwent a 2-week cognitive control training (6 sessions in total). Subjects received either verum (anodal/cathodal) or sham tDCS. Electrodes were placed over the left or right dorsolateral prefrontal cortex and the respective contralateral deltoid muscle. Cognitive control was measured as performance in the PASAT and was analysed in respect to stimulation conditions (sham, anodal, cathodal) and sex.

RESULTS

Regardless of stimulation condition, performance gains between the sexes were higher in females compared to males (p = 0.0038). Female's performance during anodal tDCS exceeded male's (p = 0.0070), yet no effects were found for cathodal or sham tDCS. Moreover, in females we found a superior effect for anodal tDCS over sham stimulation (fanodal: p = 0.0354; fcathodal: p = 0.6181), but no such effect in males (manodal: p = 0.6882; mcathodal: p = 0.4822).

CONCLUSIONS

This study highlights the relevance of biological sex for the effects of tDCS on cognitive training. Thus, an increased attention to biological sex is advisable in future brain stimulation research to highlight and in consequence better understand potentially underlying sex-specific mechanisms. Considering biological sex will further advance customisation and individualisation of tDCS interventions. Trial registration ClinicalTrials.gov, NCT04108663.

Noninvasive brain stimulation for cognitive rehabilitation following traumatic brain injury: A systematic review

Traumatic brain injury (TBI) can cause numerous cognitive deficits. These deficits are associated with disability and reduction in quality of life. Noninvasive brain stimulation (NIBS) provides excitatory or inhibitory stimuli to the cerebral cortex. This review aimed to examine the effectiveness of NIBS (i.e., rTMS and tDCS) on cognitive functions in patients with TBI. PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, and Web of Science were searched from inception to May 2021. The risk of bias in the randomized controlled trials was assessed using the Cochrane Collaboration's instrument. The Physiotherapy Evidence Database (PEDro) scale was applied to evaluate the risk of bias in the non-randomized controlled trials. Ten studies met our inclusion criteria. Six studies used repetitive Transcranial Magnetic Stimulation (rTMS), and four used transcranial Direct Current Stimulation (tDCS) as cognitive rehabilitation interventions. The results showed heterogenous evidence for the effects of rTMS and tDCS on cognitive function outcomes in individuals with TBI. The evidence for the effects of NIBS on cognition following TBI was limited. TDCS and rTMS are safe and well-tolerated interventions post-TBI. The optimal stimulation sites and stimulation parameters remain unknown. Combining NIBS with traditional rehabilitation interventions may contribute to greater enhancements in cognitive functions post-TBI.

Boosting affective control with bifrontal transcranial direct current stimulation (tDCS): a proof-of-concept study in healthy individuals

Affective control refers to the ability to regulate emotions and is considered a marker of mental health. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, holds promise to enhance affective control. In this between-subjects study in healthy individuals, we investigated the effects of bifrontal tDCS on core processes and higher-level markers of affective control. As such, we assessed direct tDCS effects on emotional interference during an affective control task and indirect effects on an instructed reappraisal task afterward. Results showed that the affective control task combined with active tDCS, compared to sham, resulted in enhanced cognitive emotion regulation. Specifically, participants in the active tDCS condition showed an increased propensity to use reappraisal and were more successful in doing so. Moreover, there was reduced vagally mediated heart rate variability indicative of attenuated emotion and self-regulation, in the sham, but not in the active condition. Surprisingly, there were no effects of tDCS on emotional interference during the affective control task, with Bayesian analyses showing extreme evidence against these effects. Nevertheless, there was a positive association between the emotional interference during the affective control task and participants' reappraisal success afterward for the active, but not the sham tDCS condition. The study offers valuable insights to guide future work on combined tDCS with affective control tasks or training on the ability to regulate emotions.

Management protocols of chronic Orofacial Pain: A Systematic Review

Objective

Chronic orofacial pain (CP) is a persistent and debilitating condition that affects the face, mouth, and jaw and can have a significant impact on an individual's quality of life by posing problems to eat, speak, and perform everyday activities. By the means of this narrative review, we aim to assess different types of management modalities that exist to combat chronic orofacial pain.

Design

Various databases were explored with MeSH keywords of chronic orofacial pain, orofacial pain, and interventions and treatment protocols for eligible articles. After an extensive literature search, it was ascertained that this review identified four major categories of treatment modalities for the management of chronic orofacial pain, namely pharmacological management, psychological management, lifestyle interventions-based management, and current stimulation-based management.

Results

Of the four categories discussed, although pharmacological intervention offered the most immediate relief-especially from orofacial pain that was of a sudden, stab-like in nature-psychological management demonstrated a remarkable ability to reduce/alleviate the more serious aspect of chronic orofacial pain and was deemed better in comparison to the rest. Lifestyle-based techniques and current stimulation-based management were of limited use since they tended to focus more on the causal and not the symptomatic aspect of orofacial pain.

Conclusions

Many patients with persistent orofacial discomfort can experience notable improvements in their symptoms and general well-being by all the treatment modalities evaluated.

Modulating Phonological Working Memory With Anodal High-Definition Transcranial Direct Current Stimulation to the Anterior Portion of the Supplementary Motor Area

BACKGROUND

Phonological working memory is key to vocabulary acquisition, spoken word recognition, real-time language processing, and reading. Transcranial direct current stimulation, when coupled with behavioral training, has been shown to facilitate speech motor output processes, a key component of nonword repetition, the primary task used to assess phonological working memory. In this study, we examined the efficacy of combining overt nonword repetition training with anodal high-definition transcranial direct current stimulation (HD tDCS) to the presupplementary motor area (preSMA) to enhance nonword repetition.

OBJECTIVE

This study investigated whether 20 min of active or sham anodal HD tDCS targeting preSMA concurrently with a nonword repetition task differentially impacted nonword repetition ability.

METHOD

Twenty-eight neurotypical college-age adults (18-25 years; 19 females, eight males, one nonbinary) completed a 20-min nonword repetition training task where they received either active or sham 1-mA anodal HD tDCS to the preSMA while overtly repeating a list of four-, five-, six-, and seven-syllable English-like nonwords presented in a random order. Whole nonword accuracy and error patterns (phoneme and syllable) were measured prior to and following training.

RESULTS

Following training, both groups showed a decrease in nonword repetition accuracy. The drop in performance was significantly greater for the active stimulation group compared to the sham stimulation group at the four-syllable nonword length.

DISCUSSION

The findings suggest that targeting the speech motor component of nonword repetition through overt training and HD tDCS to the preSMA does not enhance phonological working memory ability.

Effect of non-invasive brain stimulation on conscious disorder in patients after brain injury: a network meta-analysis

OBJECTIVE

To systematically evaluate the rehabilitation effect of non-invasive brain stimulation (NIBS) on disorder of consciousness (DOC) after brain injury and compare the effects of different NIBSs.

METHODS

Randomized controlled trials (RCTs) on the effect of NIBS on DOC after brain injury were retrieved from the PubMed, Cochrane Library, Web of Science, CNKI, VIP, Wanfang Data, and CBM databases from inception to October 2022. The risk of bias and quality of the trials were assessed following the Cochrane Handbook of Systematic Reviews and the physiotherapy evidence database Jadad Scale. Statistical analysis was conducted with RevMan 5.4 and R Studio. This study was registered on PROSPERO (No. CRD42022371334).

RESULTS

A total of 28 articles were included involving 1118 patients. Meta-analysis showed that NIBS combined with routine rehabilitation had the highest effect than the routine rehabilitation and the sham NIBS combined with routine rehabilitation. The cumulative probability ranking results showed that the rTMS was best. The order of network meta-analysis with GCS (Glasgow Coma Scale) as the outcome index is rTMS combined with routine rehabilitation > tDCS combined with routine rehabilitation > routine rehabilitation > NIBS sham stimulation combined with routine rehabilitation. The order of network meta-analysis with CRS-R (Coma Recovery Scale-Revised) as the outcome index is rTMS combined with routine rehabilitation > tDCS combined with routine rehabilitation > NIBS sham stimulation combined with routine rehabilitation > routine rehabilitation. For patients with different conditions of DOC, the subgroup analysis results showed that rTMS improved the effect of patients with severe DOC better than those with unclear conditions of DOC, but the overall results of the two groups were not significantly different. On the contrary, the effect of tDCS on patients with DOC whose condition was not clear was better than that on patients with severe DOC, and the effect on patients with severe DOC was not significant (P > 0.05). In terms of safety, only 9 articles mentioned ADRs in the included literature, including 8 articles without ADRs, and 1 article with ADRs.

CONCLUSION

Based on the research results of various indicators, NIBS can improve DOC after brain injury, and the rTMS is the best. Limited by the number and the quality of literature, the above conclusions need more high-quality research to verify.

No Polarity-specific Modulation of Prefrontal-to-M1 Interhemispheric Inhibition by Transcranial Direct Current Stimulation Over the Lateral Prefrontal Cortex

The lateral prefrontal cortex (PFC) plays a variety of crucial roles in higher-order cognitive functions. Previous works have attempted to modulate lateral PFC function by applying non-invasive transcranial direct current stimulation (tDCS) and demonstrated positive effects on performance of tasks involving cognitive processes. The neurophysiological underpinning of the stimulation effects, however, remain poorly understood. Here, we explored the neurophysiological after-effects of tDCS over the lateral PFC by assessing changes in the magnitude of interhemispheric inhibition from the lateral PFC to the contralateral primary motor cortex (PFC-M1 IHI). Using a dual-site transcranial magnetic stimulation paradigm, we assessed PFC-M1 IHI before and after the application of tDCS over the right lateral PFC. We conducted a double-blinded, crossover, and counterbalanced design where 15 healthy volunteers participated in three sessions during which they received either anodal, cathodal, and sham tDCS. In order to determine whether PFC-M1 IHI could be modulated at all, we completed the same assessment on a separate group of 15 participants as they performed visuo-motor reaction tasks that likely engage the lateral PFC. The results showed that tDCS over the right lateral PFC did not modulate the magnitude of PFC-M1 IHI, whereas connectivity changed when Go/NoGo decisions were implemented in reactions during the motor tasks. Although PFC-M1 IHI is sensitive enough to be modulated by behavioral manipulations, tDCS over the lateral PFC does not have substantial modulatory effects on PFC to M1 functional connectivity, or at least not to the degree that can be detected with this measure.

Inconsistencies in mapping current distribution in transcranial direct current stimulation

INTRODUCTION

tDCS is a non-invasive neuromodulation technique that has been widely studied both as a therapy for neuropsychiatric diseases and for cognitive enhancement. However, recent meta-analyses have reported significant inconsistencies amongst tDCS studies. Enhancing empirical understanding of current flow in the brain may help elucidate some of these inconsistencies.

METHODS

We investigated tDCS-induced current distribution by injecting a low frequency current waveform in a phantom and in vivo. MR phase images were collected during the stimulation and a time-series analysis was used to reconstruct the magnetic field. A current distribution map was derived from the field map using Ampere's law.

RESULTS

The current distribution map in the phantom showed a clear path of current flow between the two electrodes, with more than 75% of the injected current accounted for. However, in brain, the results did evidence a current path between the two target electrodes but only some portion ( 25%) of injected current reached the cortex demonstrating that a significant fraction of the current is bypassing the brain and traveling from one electrode to the other external to the brain, probably due to conductivity differences in brain tissue types. Substantial inter-subject and intra-subject (across consecutive scans) variability in current distribution maps were also observed in human but not in phantom scans.

DISCUSSIONS

An in-vivo current mapping technique proposed in this study demonstrated that much of the injected current in tDCS was not accounted for in human brain and deviated to the edge of the brain. These findings would have ramifications in the use of tDCS as a neuromodulator and may help explain some of the inconsistencies reported in other studies.

Home-based transcranial direct current stimulation in mild neurocognitive disorder due to possible Alzheimer's disease. A randomised, single-blind, controlled-placebo study

Introduction

Mild neurocognitive disorder (mNCD), a pre-dementia stage close to Mild Cognitive Impairment, shows a progressive and constant decline in the memory domain. Of the non-pharmacological therapeutic interventions that may help to decelerate the neurodegenerative progress, transcranial direct current stimulation (tDCS) shows beneficial effects on the learning curve, immediate recall, immediate verbal memory and executive functions. The purpose of this research was to study the effect of tDCS on general cognition, immediate and delayed memory and executive functions by comparing an active group with a placebo group of mNCD patients.

Methods

Participants were 33 mNCD due to possible AD, randomly assigned to two groups: 17 active tDCS and 16 placebo tDCS. Ten sessions of tDCS were conducted over the left dorsolateral prefrontal cortex. Several neuropsychological scales were administered to assess the primary outcome measures of general cognitive function, immediate and delayed memory and learning ability, whereas the secondary outcome measures included executive function tests. All participants were evaluated at baseline and at the end of the intervention. Mixed ANOVAs were performed.

Results

Significant effects were obtained on general cognitive function, immediate and delayed memory and learning ability, with increases in scores in the active tDCS group. However, there were no significant effects on executive function performance.

Conclusion

The present study demonstrated the effectiveness of tDCS in an active tDCS group, compared to a placebo group, in improving general cognition and immediate and delayed memory, as previous studies found. Taken together, our data suggest that tDCS is a simple, painless, reproducible and easy technique that is useful for treating cognitive alterations found in neurodegenerative diseases.

tDCS over the left prefrontal Cortex improves mental flexibility and inhibition in geriatric inpatients with symptoms of depression or anxiety: A pilot randomized controlled trial

BACKGROUND

Patients with depression and/or anxiety are commonly seen in inpatient geriatric settings. Both disorders are associated with an increased risk of cognitive impairments, notably in executive functioning. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, involves the administration of a low-dose electrical current to induce neuromodulation, which ultimately may act on downstream cognitive processing.

OBJECTIVE

The purpose of this study was to determine the effects of tDCS on executive functioning in geriatric inpatients with symptoms of depression and/or anxiety.

DESIGN

Pilot Randomized Controlled Trial.

SETTING

Specialized geriatric wards in a tertiary rehabilitation hospital.

METHODS

Thirty older-aged adults were recruited, of which twenty completed ten-to-fifteen sessions of 1.5 mA anodal or sham tDCS over the left dorsolateral prefrontal cortex. Cognitive assessments were administered at baseline and following the tDCS protocol; analyses examined the effects of tDCS on cognitive performance between groups (anodal or sham tDCS).

RESULTS

tDCS was found to increase inhibitory processing and cognitive flexibility in the anodal tDCS group, with significant changes on the Stroop test and Trail Making Test-Part B. No significant changes were observed on measures of attention or working memory.

DISCUSSION

These results provide preliminary evidence that tDCS-induced neuromodulation may selectively improve cognitive processing in older adults with symptoms of depression and/or anxiety.

CLINICAL TRIALS REGISTRATION

www.clinicaltrials.gov, NCT04558177.

Quantitative description of the relationship between the enhancement of distraction-suppression and brain local state alteration after transcranial direct current stimulation

Anodal transcranial direct current stimulation (tDCS) over the left dorsal lateral prefrontal cortex (lDLPFC) can improve distraction suppression ability, possibly by distantly regulating the connection properties of several large-scale brain networks and local brain state changes. However, little is known about the local state alteration that tDCS can induce in distant but task-related regions and the relationship between performance enhancement and local state alteration in potentially related regions, resulting in inefficient and uncertain tDCS regulation. We aimed to examine the alteration of brain local state before and after tDCS and its relationship with performance enhancement. With the within-subject design, the participants received anodal (1.5 mA) and sham tDCS at F3 (lDLPFC) for 20 min. The visual search task and resting-state functional magnetic resonance imaging (rsfMRI) were performed before and after stimulation. Anodal tDCS significantly enhanced distraction suppression. The amplitude of low-frequency fluctuation (ALFF) in the left parietal region significantly decreased, the decrement significantly positively correlated with performance enhancement after anodal tDCS. As well, the regional homogeneity (ReHo) in the left precuneus significantly increased, and the increasement significantly positively correlated with performance enhancement. Anodal tDCS over the lDLPFC can distantly modulate the local state of the brain and improve the distraction suppression ability. These two aspects are closely related and provide a direct and efficient approach to enhancing performance.

Preconditioning prefrontal connectivity using transcranial direct current stimulation and transcranial magnetic stimulation

Transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) have been shown to modulate functional connectivity. Their specific effects seem to be dependent on the pre-existing neuronal state. We aimed to precondition frontal networks using tDCS and subsequently stimulate the left dorsolateral prefrontal cortex (lDLPFC) using TMS. Thirty healthy participants underwent excitatory, inhibitory, or sham tDCS for 10 min, as well as an excitatory intermittent theta-burst (iTBS) protocol (600 pulses, 190 s, 20 × 2-s trains), applied over the lDLPFC at 90% of the individual resting motor threshold. Functional connectivity was measured in three task-free resting state fMRI sessions, immediately before and after tDCS, as well as after iTBS. Testing the whole design did not yield any significant results. Analysis of the connectivity between the stimulation site and all other brain voxels, contrasting only the interaction effect between the experimental groups (excitatory vs. inhibitory) and the repeated measure (post-tDCS vs. post-TMS), revealed significantly affected voxels bilaterally in the anterior cingulate and paracingulate gyri, the caudate nuclei, the insula and operculum cortices, as well as the Heschl’s gyrus. Post-hoc ROI-to-ROI analyses between the significant clusters and the striatum showed post-tDCS, temporo-parietal-to-striatal and temporo-parietal-to-fronto-cingulate differences between the anodal and cathodal tDCSgroup, as well as post-TMS, striatal-to-temporo-parietal differences between the anodal and cathodal groups and frontostriatal and interhemispheric temporo-parietal cathodal-sham group differences. Excitatory iTBS to a tDCS-inhibited lDLPFC thus yielded more robust functional connectivity to various areas as compared to excitatory iTBS to a tDCS-enhanced DLPFC. Even considering reduced statistical power due to low subject numbers, results demonstrate complex, whole-brain stimulation effects. They are possibly facilitated by cortical homeostatic control mechanisms and show the feasibility of using tDCS to modulate subsequent TMS effects. This proof-of-principle study might stimulate further research into the principle of preconditioning that might be useful in the development of protocols using DLPFC as a stimulation site for the treatment of depression.

Effective Transcranial Direct Current Stimulation Parameters for the Modulation of Eating Behavior: A Systematic Literature Review and Meta-Analysis

OBJECTIVE

This study aimed to consider the effect of differing transcranial direct current stimulation (tDCS) parameters on eating-related measures and how issues with experimental design (e.g., inadequate blinding) or parameters variation may drive equivocal effects.

METHODS

Literature searches were conducted across MEDLINE, PsycINFO, Scopus, and Science Direct. Studies using conventional sham-controlled tDCS to modify eating-related measures in adult human participants were included. A total of 1135 articles were identified and screened by two independent authors. Study quality was assessed using the Risk of Bias tool. Random-effects meta-analyses were performed, with subgroup analyses to determine differences between parameter sets.

RESULTS

We identified 28 eligible studies; 7 showed low risk of bias, with the remaining studies showing bias arising from issues implementing or reporting blinding protocols. Large variation in applied parameters was found, including montage, current intensity and density, participant and researcher blinding, and the use of online or offline tasks. The application of differing parameters seemed to alter the effects of tDCS on eating-related measures, particularly for current density ( g = -0.25 to 0.31), and when comparing single-session ( g = -0.08 to 0.01) versus multisession protocols ( g = -0.34 to -0.29). Some parameters result in null effects.

CONCLUSIONS

The absence of tDCS-mediated change in eating-related measures may be driven by variation in applied parameters. Consistent application of parameters that seem to be effective for modulating eating behavior is important for identifying the potential impact of tDCS. Using the findings of this review, we propose a series of parameters that researchers should apply in their work.

A systematic examination of the neural correlates of subjective time perception with fMRI and tDCS

The ability to keep track of time is one of the fundamental human behaviours that enhance survival in the wild. It is still an essential skill that enables an individual to function well in modern society. In the present study, we tested the attentional gate model, one of the most common conceptual frameworks in studies of subjective time perception. Its utility has been well established, but it has been criticised for its lack of neurophysiological support; few studies attempted to systematically identify its components and their neural correlates. Previous studies established that the dorsolateral prefrontal cortex (DLPFC) was associated with working memory tasks and a correlation between activity in the cerebellum and the timing of tasks. An fMRI study was conducted to confirm that these two cortical regions were activated during the execution of a new time discrimination task that considers individual variations in subjective time perception. Simulations were conducted to optimize the electrode placement in order to maximize the electric fields of tDCS perturbation to these two areas. According to the attentional gate model, hypotheses about tDCS perturbation to subjective time perception, attention and working memory were formulated and tested. Attention and working memory were measured by the attention network and N-back tasks. There are weak effects to the perceived subjective equivalent and the reaction time in the attention network task, but both are not statistically significant after correction for multiple comparisons. Exploration analyses show a link between attention and subjective time perception after tDCS perturbation. To conclude, the results do not support the attentional gate model, but show a linkage between attention and subjective time perception in terms of similar neural circuits and their relationships under certain circumstances.

Anodal Transcranial Direct Current Stimulation Does Not Affect Velocity Loss During a Typical Resistance Exercise Session

Purpose: This study investigated the effects of transcranial direct current stimulation (tDCS) on velocity loss in a typical resistance exercise session. Methods: Twelve recreationally resistance-trained males (age = 24.8 ± 3.0 years, body mass = 78.9 ± 13.6 kg, and height = 174.3 ± 7.3 cm) completed two experimental trials in a counterbalanced crossover design: anodal tDCS and sham conditions. The stimuli were applied over the left dorsolateral prefrontal cortex for 20 minutes, using a 2 mA current intensity in anodal tDCS and a 1-minute active stimulus in the sham condition. After stimulation, subjects performed three sets of the bench press at a 70% of 1 maximum repetition intensity and 1 min of inter-set rest. The velocity loss was calculated as the relative difference between the fastest repetition velocity (usually first) and the velocity of the last repetition of each set and averaged over all three sets. Results: The results found no interaction between conditions and sets (P = .122), and no effect for conditions (P = .323) or sets (P = .364) for the velocity loss in each set. Also, no differences were found between the average velocity loss of the three sets in the anodal tDCS (-25.0 ± 4.7%) and sham condition (-23.3 ± 6.4%; P = .323). Conclusion: Anodal tDCS does not affect movement velocity in a typical strength training protocol in recreationally trained subjects.

Examining the relationship between working memory consolidation and long-term consolidation

An emerging area of research is focused on the relationship between working memory and long-term memory and the likely overlap between these processes. Of particular interest is how some information first maintained in working memory is retained for longer periods and eventually preserved in long-term memory. The process of stabilizing transient memory representations for lasting retention is referred to as consolidation in both the working memory and long-term memory literature, although these have historically been viewed as independent constructs. The present review aims to investigate the relationship between working memory consolidation and long-term memory consolidation, which both have rich, but distinct, histories. This review provides an overview of the proposed models and neural mechanisms of both types of consolidation, as well as clinical findings related to consolidation and potential approaches for the manipulation of consolidation. Finally, two hypotheses are proposed to explain the relationship between working memory consolidation and long-term memory consolidation.

Perturbation of Right Dorsolateral Prefrontal Cortex Makes Power Holders Less Resistant to Tempting Bribes

Bribery is a common form of corruption that takes place when a briber suborns a power holder to achieve an advantageous outcome at the cost of moral transgression. Although bribery has been extensively investigated in the behavioral sciences, its underlying neurobiological basis remains poorly understood. Here, we employed transcranial direct-current stimulation (tDCS) in combination with a novel paradigm (N = 119 adults) to investigate whether disruption of right dorsolateral prefrontal cortex (rDLPFC) causally changed bribe-taking decisions of power holders. Perturbing rDLPFC via tDCS specifically made participants more willing to take bribes as the relative value of the offer increased. This tDCS-induced effect could not be explained by changes in other measures. Model-based analyses further revealed that such neural modulation alters the concern for generating profits for oneself via taking bribes and reshapes the concern for the distribution inequity between oneself and the briber, thereby influencing the subsequent decisions. These findings reveal a causal role of rDLPFC in modulating corrupt behavior.

Testing the Reproducibility of the Effects of Transcranial Direct Current Stimulation: Failure to Modulate Beauty Perception by Brain Stimulation

Transcranial direct current stimulation (tDCS) has been recognized as a promising tool for investigating the causal relationship between specific brain areas of interest and behavior. However, the reproducibility of previous tDCS studies is often questioned because of failures in replication. This study focused on the effects of tDCS on one cognitive domain: beauty perception. To date, the modulation of beauty perception by tDCS has been shown in two studies: Cattaneo et al. (2014) and Nakamura and Kawabata (2015). Here, we aimed at replicating their studies and investigating the effects of tDCS on beauty perception using the following parameters: (1) cathodal stimulation over the medial prefrontal cortex (mPFC) (Nakamura and Kawabata, 2015); (2) anodal stimulation over the left dorsolateral prefrontal cortex (lDLPFC) (Cattaneo et al., 2014). We also performed a more focal stimulation targeting the orbitofrontal cortex (OFC) to determine the optimal stimulation site for modulating beauty perception (3). Participants rated the subjectively-perceived beauty of the images before and after the tDCS administration. We divided images into four clusters according to the obtained scores in our preliminary study and examined changes in beauty ratings in each image cluster separately to exclude factors, such as stimuli attributions that may reduce tDCS effects. The results showed no strong effects of tDCS with the same parameters as in previous studies on beauty rating scores in any image cluster. Likewise, anodal stimulation over the OFC did not result in a change in rating scores. In contrast to previous studies, the current study did not corroborate the effects of tDCS on beauty perception. Our findings provide evidence regarding the recent reproducibility issue of tDCS effects and suggest the possible inflation of its effects on cognitive domains.

The Effects of a Single Transcranial Direct Current Stimulation Session on Impulsivity and Risk Among a Sample of Adult Recreational Cannabis Users

Individuals with substance use disorders exhibit risk-taking behaviors, potentially leading to negative consequences and difficulty maintaining recovery. Non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) have yielded mixed effects on risk-taking among healthy controls. Given the importance of risk-taking behaviors among substance-using samples, this study aimed to examine the effects of tDCS on risk-taking among a sample of adults using cannabis. Using a double-blind design, 27 cannabis users [M(SD) age = 32.48 (1.99), 41% female] were randomized, receiving one session of active or sham tDCS over the bilateral dorsolateral prefrontal cortex (dlPFC). Stimulation parameters closely followed prior studies with anodal right dlPFC and cathodal left dlPFC stimulation. Risk-taking-assessed via a modified Cambridge Gambling Task-was measured before and during tDCS. Delay and probability discounting tasks were assessed before and after stimulation. No significant effects of stimulation on risk-taking behavior were found. However, participants chose the less risky option ∼86% of the trials before stimulation which potentially contributed to ceiling effects. These results contradict one prior study showing increased risk-taking among cannabis users following tDCS. There was a significant increase in delay discounting of a $1000 delayed reward during stimulation for the sham group only, but no significant effects for probability discounting. The current study adds to conflicting and inconclusive literature on tDCS and cognition among substance-using samples. In conclusion, results suggest the ineffectiveness of single session dlPFC tDCS using an established stimulation protocol on risk-taking, although ceiling effects at baseline may have also prevented behavior change following tDCS.

Effects of tDCS on the attentional blink revisited: A statistical evaluation of a replication attempt

The attentional blink (AB) phenomenon reveals a bottleneck of human information processing: the second of two targets is often missed when they are presented in rapid succession among distractors. In our previous work, we showed that the size of the AB can be changed by applying transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (lDLPFC) (London & Slagter, Journal of Cognitive Neuroscience, 33, 756-68, 2021). Although AB size at the group level remained unchanged, the effects of anodal and cathodal tDCS were negatively correlated: if a given individual's AB size decreased from baseline during anodal tDCS, their AB size would increase during cathodal tDCS, and vice versa. Here, we attempted to replicate this finding. We found no group effects of tDCS, as in the original study, but we no longer found a significant negative correlation. We present a series of statistical measures of replication success, all of which confirm that both studies are not in agreement. First, the correlation here is significantly smaller than a conservative estimate of the original correlation. Second, the difference between the correlations is greater than expected due to sampling error, and our data are more consistent with a zero-effect than with the original estimate. Finally, the overall effect when combining both studies is small and not significant. Our findings thus indicate that the effects of lDPLFC-tDCS on the AB are less substantial than observed in our initial study. Although this should be quite a common scenario, null findings can be difficult to interpret and are still under-represented in the brain stimulation and cognitive neuroscience literatures. An important auxiliary goal of this paper is therefore to provide a tutorial for other researchers, to maximize the evidential value from null findings.

Influencing Human Behavior with Noninvasive Brain Stimulation: Direct Human Brain Manipulation Revisited

The use of tools to perturb brain activity can generate important insights into brain physiology and offer valuable therapeutic approaches for brain disorders. Furthermore, the potential of such tools to enhance normal behavior has become increasingly recognized, and this has led to the development of various noninvasive technologies that provides a broader access to the human brain. While providing a brief survey of brain manipulation procedures used in the past decades, this review aims at stimulating an informed discussion on the use of these new technologies to investigate the human. It highlights the importance to revisit the past use of this unique armamentarium and proceed to a detailed analysis of its present state, especially in regard to human behavioral regulation.

Sex difference in tDCS current mediated by changes in cortical anatomy: A study across young, middle and older adults

INTRODUCTION

The observed variability in the effects of transcranial direct current stimulation (tDCS) is influenced by the amount of current reaching the targeted region-of-interest (ROI). Age and sex might affect current density at target ROI due to their impact on cortical anatomy. The present tDCS simulation study investigates the effects of cortical anatomical parameters (volumes, dimension, and torque) on simulated tDCS current density in healthy young, middle-aged, and older males and females.

METHODOLOGY

Individualized head models from 240 subjects (120 males, 18-87 years of age) were used to identify the estimated current density (2 mA current intensity, 25 cm2 electrode) from two simulated tDCS montages (CP5_CZ and F3_FP2) targeting the inferior parietal lobule (IPL) and middle frontal gyrus (MFG), respectively. Cortical parameters including segmented brain volumes (cerebrospinal fluid [CSF], grey and white matter), cerebral-dimensions (length/width &length/height) and brain-torque (front and back shift, petalia, and bending) were measured using the magnetic resonance images (MRIs) from each subject. The present study estimated sex differences in current density at these target ROIs mediated by these cortical parameters within each age group.

RESULTS

For both tDCS montages, females in the older age group received higher current density than their male counterparts at the target ROIs. No sex differences were observed in the middle-aged group. Males in the younger age group had a higher current density than females, only for the parietal montage. Across all age groups, CSF, and grey matter volumes significantly predicted the current intensity estimated at the target sites. In the older age group only, brain-torque was a significant mediator of the sex difference.

CONCLUSIONS

Our findings demonstrate the presence of sex differences in the simulated tDCS current density, however this pattern differed across age groups and stimulation locations. Future studies should consider influence of age and sex on individual cortical anatomy and tailor tDCS stimulation parameters accordingly.

Is there a neuroscience-based, mechanistic rationale for transcranial direct current stimulation as an adjunct treatment for posttraumatic stress disorder?

It is well-known that there is considerable variation in the effectiveness of evidence-based treatments for psychiatric disorders, and a continued need to improve the real-world effectiveness of these treatments. In the last 20+ years the examination of noninvasive brain stimulation techniques for psychiatric treatment has increased dramatically. However, in order to test these techniques for effective therapeutic use, it is critical to understand (a) (what are) the key neural circuits to engage for specific disorders or clusters of symptoms, and (b) (how) can these circuits be reached effectively using neurostimulation? Here we focus on the research toward the application of transcranial direct current stimulation (tDCS) for posttraumatic stress disorder (PTSD). tDCS is a portable and inexpensive technique that lends itself well to be combined with, and thus potentially augment, exposure-based treatment for PTSD. In this review, we discuss the behavioral model of threat and safety learning and memory as it relates to PTSD, the underlying neurobiology of PTSD, as well as the current understandings of tDCS action, including its limitations and opportunities. Through this lens, we summarize the research on the application of tDCS to modulated threat and safety learning and memory to date, and propose new directions for its future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of Transcranial Direct Current Stimulation on Cognitive and Affective Outcomes Using Virtual Stimuli: A Systematic Review

Transcranial direct current stimulation (tDCS) is a noninvasive form of brain stimulation used to influence neural activity. While early tDCS studies primarily used static stimuli, there is growing interest in dynamic stimulus presentations using virtual environments (VEs). This review attempts to convey the state of the field. This is not a quantitative meta-analysis as there are not yet enough studies following consistent protocols and/or reporting adequate data. In addition to reviewing the state of the literature, this review includes an exploratory analysis of the available data. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, studies were culled from several databases. Results from this review reveal differences between online and offline stimulation. While offline stimulation did not influence affective and cognitive outcomes, online stimulation led to small changes in affect and cognition. Future studies should include randomized controlled trials with larger samples. Furthermore, greater care needs to be applied to full data reporting (e.g., means, standard deviations, and data for their nonsignificant findings) to improve our understanding of the combined effects of virtual stimuli with tDCS.

Anodal tDCS effects over the left dorsolateral prefrontal cortex (L-DLPFC) on the rating of facial expression: evidence for a gender-specific effect

The accurate recognition of others' facial expressions is a core skill for social interactions. The left Dorsolateral Prefrontal Cortex (L-DLPFC) represents a key node in the network for facial emotion recognition. However, its specific role is still under debate. As such, the aim of the current neuromodulation study was to assess the causal role of the L-DLPFC in humans' rating of facial expressions of emotions and implicit attitudes toward other races. In this sham-controlled single-blind between-subject experiment, we offline administered L-DLPFC transcranial direct current stimulation (tDCS) to 69 healthy participants who were divided into three groups of 23 (each receiving anodal 1 mA tDCS, anodal 2 mA tDCS, or Sham), before completing an "Emotion Rating task and two Implicit Association Tests (IATs). The former required the intensity rating of 192 faces (half black and half white) displaying happiness, sadness, anger, or fear. The IATs were designed to assess participants' automatic associations of positive or negative attributes with racial contents. Results on the Emotion Rating task showed participants' gender-specific effect of tDCS. Specifically, a gender bias, with only males showing a tendency to underestimate negative emotions was found in Sham, and absent in the tDCS groups. When considering the race of the stimuli, females but not males in Sham exhibited a racial bias, that is, the tendency to overestimate negative emotions of other-race faces. Again, the bias disappeared in the tDCS groups. Concerning the IATs, no significant effects emerged. We conclude that the L-DLPFC plays a critical role in humans' rating of facial expressions, and for variability in other-race emotional judgements. These results shed light on the neural bases of the human emotional system and its gender-related differences, and have potential implications for interventional settings.

Online Left-Hemispheric In-Phase Frontoparietal Theta tACS for the Treatment of Negative Symptoms of Schizophrenia

Negative symptoms represent an unmet need for schizophrenia treatment. The effect of theta frequency transcranial alternating current stimulation (theta-tACS) applied during working memory (WM) tasks on negative symptoms has not been demonstrated as of yet. We conducted a randomized, double-blind, sham-controlled trial of 36 stabilized schizophrenia patients, randomized to receive either twice daily, 6 Hz 2 mA, 20 min sessions of in-phase frontoparietal tACS or sham for five consecutive weekdays. Participants were concurrently engaged in WM tasks during stimulation. The primary outcome measure was the change over time in the Positive and Negative Syndrome Scale (PANSS) negative subscale score measured from baseline through to the 1-month follow-up. Secondary outcome measures were other symptom clusters, neurocognitive performance, and relevant outcomes. The intention-to-treat analysis demonstrated greater reductions in PANSS negative subscale scores at the end of stimulation in the active (−13.84%) than the sham (−3.78%) condition, with a large effect size (Cohen’s d = 0.96, p = 0.006). The positive effect endured for at least one month. Theta-tACS also showed efficacies for cognitive symptoms, WM capacity, and psychosocial functions. Online theta-tACS offers a novel approach to modulate frontoparietal networks to treat negative symptoms of schizophrenia. The promising results require large-scale replication studies in patients with predominantly negative symptoms.

Non-invasive neurostimulation modulates processing of spatial frequency information in rapid perception of faces

This study used high-frequency transcranial random noise stimulation (tRNS) to examine how low and high spatial frequency filtered faces are processed. Response times were measured in a task where healthy young adults categorised spatially filtered hybrid faces, presented at foveal and peripheral blocks, while sham and high-frequency random noise was applied to a lateral occipito-temporal location on their scalp. Both the Frequentist and Bayesian approaches show that in contrast to sham, active stimulation significantly reduced response times to peripherally presented low spatial frequency information. This finding points to a possible plasticity in targeted regions induced by non-invasive neuromodulation of spatial frequency information in rapid perception of faces.

Transcranial Magnetic and Direct Current Stimulation in the Treatment of Depression: Basic Mechanisms and Challenges of Two Commonly Used Brain Stimulation Methods in Interventional Psychiatry

Noninvasive neuromodulation, including repetitive trans-cranial magnetic stimulation (rTMS) and direct current stimulation (tDCS), provides researchers and health care professionals with the ability to gain unique insights into brain functions and treat several neurological and psychiatric conditions. Undeniably, the number of published research and clinical papers on this topic is increasing exponentially. In parallel, several methodological and scientific caveats have emerged in the transcranial stimulation field; these include less robust and reliable effects as well as contradictory clinical findings. These inconsistencies are maybe due to the fact that research exploring the relationship between the methodological aspects and clinical efficacy of rTMS and tDCS is far from conclusive. Hence, additional work is needed to understand the mechanisms underlying the effects of magnetic stimulation and low-intensity transcranial electrical stimulation (TES) in order to optimize dosing, methodological designs, and safety aspects.

Cognitive outcomes after tDCS in schizophrenia patients with prominent negative symptoms: Results from the placebo-controlled STARTS trial

Cognitive deficits and negative symptoms in schizophrenia are associated with poor functional outcomes and limited in terms of treatment. The Schizophrenia Treatment With Electric Transcranial Stimulation (STARTS) trial has shown efficacy of transcranial direct current stimulation (tDCS) for improving negative symptoms. In this secondary analysis, we investigate its effects on cognitive performance. In STARTS, a double-blinded, sham-controlled, randomized clinical trial, patients were treated with twice-daily, 20-min, 2-mA fronto-temporal tDCS over 5 days or sham-tDCS. In 90 patients, we evaluated the cognitive performance up to 12 weeks post-treatment. We found that active-tDCS showed no beneficial effects over sham-tDCS in any of the tests. Based on a 5-factor cognitive model, improvements of executive functions and delayed memory were observed in favor of sham-tDCS. Overall, the applied active-tDCS protocol, primarily designed to improve negative symptoms, did not promote cognitive improvement. We discuss possible protocol modification potentially required to increase tDCS effects on cognition. ClinicalTrials.gov identifier: NCT02535676.

Transcranial Direct Current Stimulation above the Medial Prefrontal Cortex Facilitates Decision-Making following Periods of Low Outcome Controllability

Recent studies suggest that choice behavior in reinforcement learning tasks is shaped by the level of outcome controllability. In particular, Pavlovian bias (PB) seems to be enhanced under low levels of control, manifesting in approach tendencies toward rewards and response inhibition when facing potential losses. The medial prefrontal cortex (mPFC) has been implicated both in evaluating outcome controllability and in the recruitment of cognitive control (CC) to suppress maladaptive PB during reinforcement learning. The current study tested whether high-definition transcranial direct current stimulation (HD-tDCS) above the mPFC of healthy humans can influence PB, and counteract the previously documented, deleterious behavioral effects of low outcome controllability on decision-making. In a preregistered, between-group, double-blind study (N = 103 adults, both sexes), we tested the interaction between controllability and HD-tDCS on parameters of choice behavior in a Go/NoGo task. Relative to sham stimulation, HD-tDCS resulted in more robust performance improvement following reduced control, an effect that was more pronounced in appetitive trials. In addition, we found evidence for weaker PB when HD-tDCS was administered during low controllability over outcomes. Computational modeling revealed that parameter estimates of learning rate and choice randomness were modulated by controllability, HD-tDCS and their interaction. Overall, these results highlight the potential of our HD-tDCS protocol for interfering with choice arbitration under low levels of control, resulting in more adaptive behavior.

tACS as a promising therapeutic option for improving cognitive function in mild cognitive impairment: A direct comparison between tACS and tDCS

Neuromodulation has gained attention as a potential non-pharmacological intervention for mild cognitive impairment (MCI). However, no studies have directly compared the effects of transcranial alternating current stimulation (tACS) with transcranial direct current stimulation (tDCS) on MCI patients. We aimed to identify the more promising and efficient therapeutic option between tACS and tDCS for cognitive enhancement in MCI patients. We compared the effects of gamma-tACS with tDCS on cognitive function and electroencephalography (EEG) in MCI patients. In this sham-controlled, double-blinded, repeated-measures study with the order of the stimulation counterbalanced across patients (n = 20), both gamma-tACS (40 H z) and tDCS were administered at the same intensity (2 mA) in the dorsolateral prefrontal cortex for 30 min. Cognitive tests (Stroop and Trail-Making-Test [TMT]) and EEG were performed before and after single-session stimulation. Gamma-tACS improved the Stroop-color in comparison with tDCS (p = .044) and sham (p = .010) and enhanced the TMT-B in comparison with sham (p = .021). However, tDCS was not significantly different from sham in changes of any cognitive test scores. In EEG analysis, gamma-tACS increased beta activity in comparison with sham and tDCS, whereas tDCS decreased delta and theta activity in comparison with sham. Gamma-tACS also increased beta 2 source activity in the anterior cingulate, compared to sham. The cognitive benefits of tACS in MCI patients appeared superior to those of tDCS. tACS facilitated cognitive function by increasing beta activity, while tDCS delayed the progression of MCI symptoms by decreasing slow-frequency activity. Thus, tACS could be used as a new therapeutic option for MCI.

Transcranial Direct Current Stimulation Reduces the Negative Impact of Mental Fatigue on Swimming Performance

The issue of using transcranial direct current stimulation (tDCS) to improve sport performance has recently been a topic of interest for researchers. The purpose of this study was to examine the effect of tDCS over left dorsolateral prefrontal cortex (DLPFC) on mental fatigue and physical performance in professional swimmers. Fifteen professional swimmers were randomly assigned in a single-blinded, randomized, counterbalanced order to sham, anodal and cathodal stimulation conditions. Mental fatigue was induced by using a 60-min modified Stroop color-word task. Subjective ratings of mental fatigue were measured before and after the stroop task. The results showed that only anodal tDCS of the left DLPFC reduces adverse effects of mental fatigue in 50-meter swimming performance, whereas cathodal stimulation had no significant effect.

High-Definition Transcranial Direct Current Stimulation Improves Delayed Memory in Alzheimer's Disease Patients: A Pilot Study Using Computational Modeling to Optimize Electrode Position

BACKGROUND

The optimal stimulation parameters when using transcranial direct current stimulation (tDCS) to improve memory performance in patients with Alzheimer's disease (AD) are lacking. In healthy individuals, inter-individual differences in brain anatomy significantly influence current distribution during tDCS, an effect that might be aggravated by variations in cortical atrophy in AD patients.

OBJECTIVE

To measure the effect of individualized HD-tDCS in AD patients.

METHODS

Nineteen AD patients were randomly assigned to receive active or sham high-definition tDCS (HD-tDCS). Computational modeling of the HD-tDCS-induced electric field in each patient's brain was analyzed based on magnetic resonance imaging (MRI) scans. The chosen montage provided the highest net anodal electric field in the left dorsolateral prefrontal cortex (DLPFC). An accelerated HD-tDCS design was conducted (2 mA for 3×20 min) on two separate days. Pre- and post-intervention cognitive tests and T1 and T2-weighted MRI and diffusion tensor imaging data at baseline were analyzed.

RESULTS

Different montages were optimal for individual patients. The active HD-tDCS group improved significantly in delayed memory and MMSE performance compared to the sham group. Five participants in the active group had higher scores on delayed memory post HD-tDCS, four remained stable and one declined. The active HD-tDCS group had a significant positive correlation between fractional anisotropy in the anterior thalamic radiation and delayed memory score.

CONCLUSION

HD-tDCS significantly improved delayed memory in AD. Our study can be regarded as a proof-of-concept attempt to increase tDCS efficacy. The present findings should be confirmed in larger samples.

Magnetic-resonance-based measurement of electromagnetic fields and conductivity in vivo using single current administration-A machine learning approach

Diffusion tensor magnetic resonance electrical impedance tomography (DT-MREIT) is a newly developed technique that combines MR-based measurements of magnetic flux density with diffusion tensor MRI (DT-MRI) data to reconstruct electrical conductivity tensor distributions. DT-MREIT techniques normally require injection of two independent current patterns for unique reconstruction of conductivity characteristics. In this paper, we demonstrate an algorithm that can be used to reconstruct the position dependent scale factor relating conductivity and diffusion tensors, using flux density data measured from only one current injection. We demonstrate how these images can also be used to reconstruct electric field and current density distributions. Reconstructions were performed using a mimetic algorithm and simulations of magnetic flux density from complementary electrode montages, combined with a small-scale machine learning approach. In a biological tissue phantom, we found that the method reduced relative errors between single-current and two-current DT-MREIT results to around 10%. For in vivo human experimental data the error was about 15%. These results suggest that incorporation of machine learning may make it easier to recover electrical conductivity tensors and electric field images during neuromodulation therapy without the need for multiple current administrations.

Transcranial direct current stimulation as an adjunct to cognitive training for older adults with mild cognitive impairment: A randomized controlled trial

BACKGROUND

Cognitive training (CT) for individuals with mild cognitive impairment (MCI) may not be optimal for enhancing cognitive functioning. Coupling CT with transcranial direct current stimulation (tDCS) may maximize the strength of transmission across synaptic circuits in pathways that are stimulated by CT. The synergistic effects arising from this combination could be superior to those with administration of CT alone.

OBJECTIVES

To investigate whether the receiving tDCS combined with CT is superior to CT alone on domain-specific and task-specific cognitive outcomes in older adults with MCI.

METHODS

This double-blind, sham-controlled randomized trial included 67 older adults with MCI assigned to 3 groups: 1) tDCS combined with CT (tDCS+CT), 2) sham tDCS combined with CT (sham tDCS+CT) and 3) CT alone. Nine sessions of computerized CT were administered to the 3 groups for 3 weeks. In addition, tDCS and sham tDCS was delivered to the left dorsolateral prefrontal cortex to the tDCS+CT and sham tDCS+CT groups, respectively, simultaneously with CT. Standardized cognitive assessments were performed at baseline, post-intervention, and at 6-week follow-up. Participants' performance in the CT tasks was rated every session.

RESULTS

The 3 groups showed improvements in global cognition and everyday memory (P<0.017) after the intervention and at follow-up, with larger effect sizes in the tDCS+CT than other groups (d>0.94) but with no significant differences between groups. Regarding CT outcomes, the groups showed significant differences in favour of the tDCS+CT group in decreasing the completion and reaction times of working memory and attention activities (P<0.017).

CONCLUSIONS

tDCS combined with CT was not superior to sham tDCS with CT and CT alone in its effects on domain-specific cognitive outcomes, but it did provide comparatively larger effect sizes and improve the processing speed of task-specific outcomes. CLINICALTRIALS.GOV: NCT03441152.