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Chen Y, Hou X, Zhou H, Han R, Lv T, Yang Z, Zheng W, Bai F. Distinguishable neural circuit mechanisms associated with the clinical efficacy of rTMS in aMCI patients. Cereb Cortex 2024; 34:bhae310. [PMID: 39077918 DOI: 10.1093/cercor/bhae310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 07/31/2024] Open
Abstract
Repetitive transcranial magnetic stimulation is used in early-stage Alzheimer's disease to slow progression, but heterogeneity in response results in different treatment outcomes. The mechanisms underlying this heterogeneity are unclear. This study used resting-state neuroimaging to investigate the variability in episodic memory improvement from angular gyrus repetitive transcranial magnetic stimulation and tracked the neural circuits involved. Thirty-four amnestic mild cognitive impairment patients underwent angular gyrus repetitive transcranial magnetic stimulation (4 weeks, 20 Hz, 100% resting motor threshold) and were divided into high-response and low-response groups based on minimal clinically important differences in auditory verbal learning test scores. Baseline and pre/post-treatment neural circuit activities were compared. Results indicated that the orbital middle frontal gyrus in the orbitofrontal cortex network and the precuneus in the default mode network had higher local activity in the low-response group. After treatment, changes in local and remote connectivity within brain regions of the orbitofrontal cortex, default mode network, visual network, and sensorimotor network showed opposite trends and were related to treatment effects. This suggests that the activity states of brain regions within the orbitofrontal cortex and default mode network could serve as imaging markers for early cognitive compensation in amnestic mild cognitive impairment patients and predict the aftereffects of repetitive transcranial magnetic stimulation response.
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Affiliation(s)
- Ya Chen
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing 210000, China
| | - Xinle Hou
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China
| | - Huijuan Zhou
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing 210000, China
| | - RuiChen Han
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing 210000, China
| | - Tingyu Lv
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China
- Geriatric Medicine Center, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210023, China
| | - Zhiyuan Yang
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China
| | - Wenao Zheng
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China
| | - Feng Bai
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing 210000, China
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing 210000, China
- Geriatric Medicine Center, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210023, China
- Institute of Geriatric Medicine, Medical School of Nanjing University, Nanjing 210000, China
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Moussavi Z, Uehara M, Rutherford G, Lithgow B, Millikin C, Wang X, Saha C, Mansouri B, Omelan C, Fellows L, Fitzgerald PB, Koski L. Repetitive transcranial magnetic stimulation as a treatment for Alzheimer's disease: A randomized placebo-controlled double-blind clinical trial. Neurotherapeutics 2024; 21:e00331. [PMID: 38360452 PMCID: PMC10937236 DOI: 10.1016/j.neurot.2024.e00331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
We report results of a large multisite double-blind randomized trial investigating the short and long-term efficacy of repetitive transcranial magnetic stimulation (rTMS) applied to patients with Alzheimer's disease (AD) at mild to moderate stages, in doses of either 2 or 4 weeks of treatment (5 days/week), whilst compared with 4 weeks of sham rTMS. Randomization to treatment group was stratified based on age and severity. The objectives of this study were to: 1) investigate the efficacy of active rTMS versus sham, 2) investigate the effect of dose of treatment (2 or 4 weeks), and 3) investigate the length of benefits from treatment. The rTMS pulses (20 Hz, 30 pulses/train, 25 trains, 10-s intertrain interval) were applied serially to the left and right dorsolateral prefrontal cortex using neuro-navigation. We compared the primary outcome measure's (ADAS-Cog) score changes from pre- to post-treatment, with assessments at baseline and 4 more times up to 6 months post-treatment. Data of 135 patients were analyzed. The mean total ADAS-Cog score at baseline did not differ between the active and sham treatment groups, nor across the three study sites. The overall results show significant cognitive improvement after treatment up to two months post-treatment with either sham or active coils. The results show both short and long-term benefits of active rTMS treatment but also show similar benefits for sham coil treatment of mild/moderate AD. We discuss this finding in the context of the existing literature on rTMS therapy for AD, as well as evidence of the sham coil's potential to induce a low-level current in the brain. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02908815.
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Affiliation(s)
- Zahra Moussavi
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada; Riverview Health Center, Winnipeg, MB, Canada.
| | - Maria Uehara
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
| | - Grant Rutherford
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
| | - Brian Lithgow
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada; Riverview Health Center, Winnipeg, MB, Canada; Monash Alfred Psychiatry Research Center, Prahran, Victoria, Australia
| | - Colleen Millikin
- Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Xikui Wang
- Warren Centre for Actuarial Studies and Research, University of Manitoba, Winnipeg, MB Canada
| | - Chandan Saha
- Biomedical Engineering, University of Manitoba, Winnipeg, MB Canada
| | | | - Craig Omelan
- Psychiatry, University of Manitoba, Winnipeg, MB Canada
| | - Lesley Fellows
- Neurology & Neurosurgery, McGill University, Montreal, QC Canada
| | - Paul B Fitzgerald
- School of Medicine and Psychology, ANU College of Health and Medicine, Canberra, NSW Australia
| | - Lisa Koski
- Clinical Psychology, McGill University, Montreal, QC Canada
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Pagali SR, Kumar R, LeMahieu AM, Basso MR, Boeve BF, Croarkin PE, Geske JR, Hassett LC, Huston J, Kung S, Lundstrom BN, Petersen RC, St Louis EK, Welker KM, Worrell GA, Pascual-Leone A, Lapid MI. Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer's disease, Alzheimer's disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis. Int Psychogeriatr 2024:1-49. [PMID: 38329083 PMCID: PMC11306417 DOI: 10.1017/s1041610224000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment. DESIGN Systematic review, Meta-Analysis. SETTING We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023. PARTICIPANTS AND INTERVENTIONS RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included. MEASUREMENT Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423). RESULTS The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer's Disease Assessment Scale-Cognitive Subscale (SMD = -0.96 [-1.32, -0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity. CONCLUSION The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.
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Affiliation(s)
- Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MI, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MI, USA
| | - Rakesh Kumar
- Department of Psychiatry and Psychology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MI, USA
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MI, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | | | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MI, USA
| | | | - John Huston
- Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MI, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
| | | | | | | | - Kirk M Welker
- Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MI, USA
| | | | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna, Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA
- Department of Neurology, Harvard Medical School, Cambridge, MA, USA
| | - Maria I Lapid
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MI, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI, USA
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Lithgow BJ, Moussavi Z. Measuring anxiety disorder in bipolar disorder using EVestG: broad impact of medication groups. Front Neurol 2024; 14:1303287. [PMID: 38292032 PMCID: PMC10824993 DOI: 10.3389/fneur.2023.1303287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024] Open
Abstract
Objectives Anxiety disorder is present in approximately half of all bipolar disorder (BD) patients. There are neurologic bases for the comorbidity of balance (vestibular) disorders and anxiety. Our objective is to use electrovestibulography (EVestG), which is predominantly a measure of vestibular neural activity to not only quantitatively detect and measure comorbid anxiety disorder but also to quantitatively measure the impacts of anti-depressant, anti-psychotic, and mood stabilizer medication groups on anxiety measures in BD patients. Methods In a population of 50 (24 with anxiety disorder) depressive phase BD patients, EVestG signals were measured. Participants were labeled depression-wise as anxious or non-anxious using standard questionnaires. Analyses were conducted on the whole dataset as well as on matched (age/gender/MADRS) and "modeled medication-free" subsets. Modulations of the low-frequency EVestG firing pattern data were measured. Findings For BD, the main anxious minus non-anxious difference was the presence of an increase in spectral power proximal to 8-9 Hz, which was best attenuated by mood stabilizers. Novelty This is the first study to use an oto-acoustic physiological measure to quantify anxiety disorder in BD wherein it appears to manifest as a peak proximal to 8-9 Hz which we hypothesize as likely linked to hippocampal theta.
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Affiliation(s)
- Brian J. Lithgow
- Diagnostic and Neurosignal Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Winnipeg, MB, Canada
- Monash Alfred Psychiatry Research Centre, Prahran, VIC, Australia
| | - Zahra Moussavi
- Diagnostic and Neurosignal Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Winnipeg, MB, Canada
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Dastgheib ZA, Lithgow BJ, Moussavi ZK. Evaluating the Diagnostic Value of Electrovestibulography (EVestG) in Alzheimer's Patients with Mixed Pathology: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2091. [PMID: 38138194 PMCID: PMC10744488 DOI: 10.3390/medicina59122091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Diagnosis of dementia subtypes caused by different brain pathophysiologies, particularly Alzheimer's disease (AD) from AD mixed with levels of cerebrovascular disease (CVD) symptomology (AD-CVD), is challenging due to overlapping symptoms. In this pilot study, the potential of Electrovestibulography (EVestG) for identifying AD, AD-CVD, and healthy control populations was investigated. Materials and Methods: A novel hierarchical multiclass diagnostic algorithm based on the outcomes of its lower levels of binary classifications was developed using data of 16 patients with AD, 13 with AD-CVD, and 24 healthy age-matched controls, and then evaluated on a blind testing dataset made up of a new population of 12 patients diagnosed with AD, 9 with AD-CVD, and 8 healthy controls. Multivariate analysis was run to test the between population differences while controlling for sex and age covariates. Results: The accuracies of the multiclass diagnostic algorithm were found to be 85.7% and 79.6% for the training and blind testing datasets, respectively. While a statistically significant difference was found between the populations after accounting for sex and age, no significant effect was found for sex or age covariates. The best characteristic EVestG features were extracted from the upright sitting and supine up/down stimulus responses. Conclusions: Two EVestG movements (stimuli) and their most informative features that are best selective of the above-populations' separations were identified, and a hierarchy diagnostic algorithm was developed for three-way classification. Given that the two stimuli predominantly stimulate the otholithic organs, physiological and experimental evidence supportive of the results are presented. Disruptions of inhibition associated with GABAergic activity might be responsible for the changes in the EVestG features.
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Affiliation(s)
| | | | - Zahra K. Moussavi
- Diagnostic and Neurological Processing Research Laboratory, Biomedical Engineering Program, University of Manitoba, Riverview Health Centre, Winnipeg, MB R3L 2P4, Canada; (Z.A.D.); (B.J.L.)
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Wang J, Zhou F, Xiong CE, Wang GP, Chen LW, Zhang YT, Qi SG, Wang ZH, Mei C, Xu YJ, Zhan JB, Cheng J. Serum sirtuin1: a potential blood biomarker for early diagnosis of Alzheimer's disease. Aging (Albany NY) 2023; 15:9464-9478. [PMID: 37742223 PMCID: PMC10564418 DOI: 10.18632/aging.205015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Sirtuin 1, a nicotinamide adenine dinucleotide-dependent deacetylase that is highly expressed in the hippocampus and anterior cortex tissues related to Alzheimer's Disease pathology, can cross the blood-brain barrier and is a promising biomarker. METHODS A 1:1:1 case-control study was conducted and serum fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, SIRT1, IL-6, Aβ1-42, T-tau and P-tau-181 levels were evaluated in blood samples of 26 patients form the Alzheimer's Disease group, 26 patients form the mild cognitive impairment group, and 26 individuals form the normal control group. Receiver operator characteristic curves were used to evaluate the diagnostic significance. RESULTS Serum SIRT1 level was significantly down-regulated in the mild cognitive impairment patients and Alzheimer's Disease patients compared with that in the normal control group (P<0.05). ROC curve analysis demonstrated that SIRT1 was a promising biomarker to distinguish Alzheimer's Disease patients from the mild cognitive impairment patients and the normal control group. In addition, SIRT1 was estimated to perform well in the diagnosis of Alzheimer's Disease ([AUC] = 0.742). CONCLUSIONS In summary, the present study suggested that serum SIRT1 might be an early promising diagnostic biomarker for Alzheimer's Disease.
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Affiliation(s)
- Jia Wang
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
| | - Fang Zhou
- Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, Hubei, China
| | - Chang-E Xiong
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
| | - Gui-Ping Wang
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
| | - Lin-Wanyue Chen
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
| | - Yu-Tong Zhang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Shi-Ge Qi
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Zhi-Hui Wang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Can Mei
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
| | - Yu-Jia Xu
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
| | - Jian-Bo Zhan
- Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, Hubei, China
| | - Jing Cheng
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China
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