Consequences of cathodal stimulation for behavior: when does it help and when does it hurt performance?

Effect of transcranial direct current stimulation in the initial weeks post-stroke: a pilot randomized study

OBJECTIVE

This study aimed at assessing the alterations in upper limb motor impairment and connectivity between motor areas following the post-stroke delivery of cathodal transcranial direct current stimulation sessions.

METHODS

Modifications in the Fugl-Meyer Assessment scores, connectivity between the primary motor cortex of the unaffected and affected hemispheres, and between the primary motor and premotor cortices of the unaffected hemisphere were compared prior to and following six sessions of cathodal transcranial direct current stimulation application in 13 patients (active = 6; sham = 7); this modality targets the primary motor cortex of the unaffected hemisphere early after a stroke.

RESULTS

Clinically relevant distinctions in Fugl-Meyer Assessment scores (≥9 points) were observed more frequently in the Sham Group than in the Active Group. Between-group differences in the alterations in Fugl-Meyer Assessment scores were not statistically significant (Mann-Whitney test, p=0.133). ROI-to-ROI correlations between the primary motor cortices of the affected and unaffected hemispheres post-therapeutically increased in 5/6 and 2/7 participants in the Active and Sham Groups, respectively. Between-group differences in modifications in connectivity between the aforementioned areas were not statistically significant. Motor performance enhancements were more frequent in the Sham Group compared to the Active Group.

CONCLUSION

The results of this hypothesis-generating investigation suggest that heightened connectivity may not translate into early clinical benefits following a stroke and will be crucial in designing larger cohort studies to explore mechanisms underlying the impacts of this intervention. ClinicalTrials.gov Identifier: NCT02455427.

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.

Different montages of transcranial direct current stimulation on postural stability in chronic low back pain patients: A randomized sham-controlled study

BACKGROUND

Impairment in both the motor and cognitive aspects of postural control is a critical issue in patients with chronic low back pain (CLBP) who experience high pain anxiety (HPA).

OBJECTIVE

This study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on postural control during cognitive postural tasks in CLBP patients with HPA.

METHODS

This study included 66 patients randomly assigned to three groups: DLPFC a-tDCS, DLPFC c-tDCS, and sham tDCS. All groups received 20 minutes of tDCS, but the stimulation was gradually turned off in the sham group. Postural stability indices were assessed using the Biodex Balance System.

RESULTS

Both the a-tDCS and c-tDCS groups showed a significant reduction in most postural stability indices at static and dynamic levels after the interventions (immediately, 24 hours, and one-week follow-up) during the cognitive postural task (P< 0.01). Additionally, there was a significant improvement in postural balance in the a-tDCS and c-tDCS groups compared to the sham tDCS group (P< 0.01). Furthermore, the a-tDCS group showed significantly greater improvement than the c-tDCS group (P< 0.01).

CONCLUSION

Based on the results, both a-tDCS and c-tDCS over the DLPFC had positive effects on postural control during cognitive postural tasks in CLBP patients with HPA.

The use of noninvasive brain stimulation techniques in autism spectrum disorder

Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device-based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open-label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off-label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.

Transcranial direct current stimulation over dorsolateral prefrontal cortex improves postural stability in non-specific chronic low back pain patients with high fear of pain: A randomized sham-controlled trial

Deficits in postural stability in response to environmental challenges are seen in chronic low back pain (CLBP) patients with high fear of pain (HFP). Hence, it is essential to follow effective approaches to treat postural stability deficits and improve the health status of these patients. The current study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on postural stability in non-specific CLBP patients with HFP. In this randomized clinical trial study, 75 patients were randomly assigned to left DLPFC a-tDCS, left DLPFC c-tDCS and sham stimulation groups (n = 25 in each group). All groups received a single-session 2 mA tDCS for 20 min, but the stimulation was slowly turned off after 30 s in the sham group. Before, immediately, 24 h and 1 week after the interventions, postural stability indices were assessed using a Biodex Balance System. A significant reduction in most indices was shown in both a-tDCS and c-tDCS groups after interventions (immediately, 24 h and 1 week follow-up) during static and dynamic postural tasks compared with the sham tDCS group (p < .01). In addition, some tests showed a significant difference between a-tDCS and c-tDCS (p < .05). The findings indicated positive effects of both a-tDCS and c-tDCS on the left DLPFC, with more efficacy of a-tDCS on postural stability in LBP patients with HFP.

Frontal two-electrode transcranial direct current stimulation protocols may not affect performance on a combined flanker Go/No-Go task

Transcranial direct current stimulation (tDCS) has been tested to modulate cognitive control or response inhibition using various electrode montages. However, electrode montages and current polarities have not been systematically compared when examining tDCS effects on cognitive control and response inhibition. In this randomized, sham-controlled study, 38 healthy volunteers were randomly grouped into receiving one session of sham, anodal, and cathodal each in an electrode montage that targeted either the dorsolateral prefrontal cortex (DLPFC) or the fronto-medial (FM) region. Participants performed a combined flanker Go/No-Go task during stimulation. No effect of tDCS was found in the DLPFC and FM groups neither using anodal nor cathodal stimulation. No major adverse effects of tDCS were identified using either montage or stimulation type and the two groups did not differ in terms of the reported sensations. The present study suggests that single-session tDCS delivered in two two-electrode montages might not affect cognitive control or response inhibition, despite using widely popular stimulation parameters. This is in line with the heterogeneous findings in the field and calls for further systematic research to exclude less reliable methods from those with more pronounced effects, identify the determinants of responsiveness, and develop optimal ways to utilize this technique.

A narrative review of the anatomy and function of the white matter tracts in language production and comprehension

Much is known about the role of cortical areas in language processing. The shift towards network approaches in recent years has highlighted the importance of uncovering the role of white matter in connecting these areas. However, despite a large body of research, many of these tracts’ functions are not well-understood. We present a comprehensive review of the empirical evidence on the role of eight major tracts that are hypothesized to be involved in language processing (inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, extreme capsule, middle longitudinal fasciculus, superior longitudinal fasciculus, arcuate fasciculus, and frontal aslant tract). For each tract, we hypothesize its role based on the function of the cortical regions it connects. We then evaluate these hypotheses with data from three sources: studies in neurotypical individuals, neuropsychological data, and intraoperative stimulation studies. Finally, we summarize the conclusions supported by the data and highlight the areas needing further investigation.

Targeted neurorehabilitation strategies in post-stroke aphasia

BACKGROUND

Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability.

OBJECTIVE

This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia.

METHODS

We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation.

RESULTS

This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia.

CONCLUSIONS

This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.

Inter-Individual Variability in tDCS Effects: A Narrative Review on the Contribution of Stable, Variable, and Contextual Factors

Due to its safety, portability, and cheapness, transcranial direct current stimulation (tDCS) use largely increased in research and clinical settings. Despite tDCS’s wide application, previous works pointed out inconsistent and low replicable results, sometimes leading to extreme conclusions about tDCS’s ineffectiveness in modulating behavioral performance across cognitive domains. Traditionally, this variability has been linked to significant differences in the stimulation protocols across studies, including stimulation parameters, target regions, and electrodes montage. Here, we reviewed and discussed evidence of heterogeneity emerging at the intra-study level, namely inter-individual differences that may influence the response to tDCS within each study. This source of variability has been largely neglected by literature, being results mainly analyzed at the group level. Previous research, however, highlighted that only a half—or less—of studies’ participants could be classified as responders, being affected by tDCS in the expected direction. Stable and variable inter-individual differences, such as morphological and genetic features vs. hormonal/exogenous substance consumption, partially account for this heterogeneity. Moreover, variability comes from experiments’ contextual elements, such as participants’ engagement/baseline capacity and individual task difficulty. We concluded that increasing knowledge on inter-dividual differences rather than undermining tDCS effectiveness could enhance protocols’ efficiency and reproducibility.

Blinding in tDCS Studies: Correct End-of-Study Guess Does Not Moderate the Effects on Associative and Working Memory

Transcranial direct current stimulation (tDCS) has become a valuable tool in cognitive neuroscience research as it enables causal inferences about neural underpinnings of cognition. However, studies using tDCS to modulate cognitive functions often yield inconsistent findings. Hence, there is an increasing interest in factors that may moderate the effects, one of which is the participants’ beliefs of the tDCS condition (i.e., real or sham) they received. Namely, whether participants’ correct guessing of sham condition may lead to false-positive tDCS effects. In this study, we aimed to explore if participants’ beliefs about received stimulation type (i.e., the success of blinding) impacted their task performance in tDCS experiments on associative (AM) and working memory (WM). We analyzed data from four within-subject, sham-controlled tDCS memory experiments (N = 83) to check if the correct end-of-study guess of sham condition moderated tDCS effects. We found no evidence that sham guessing moderated post-tDCS memory performance in experiments in which tDCS effects were observed as well as in experiments that showed null effects of tDCS. The results suggest that the correct sham guessing (i.e., placebo-like effect) is unlikely to influence the results in tDCS memory experiments. We discuss the results in light of the growing debate about the relevance and effectiveness of blinding in brain stimulation research.

A Combination of Caffeine, TeaCrine® (Theacrine), and Dynamine® (Methylliberine) Increases Cognitive Performance and Reaction Time Without Interfering With Mood in Adult Male Egamers

Background

Involvement in video game activities and competitive video gaming (esports) is a rapidly growing field. Moreover, there is a marked interest in identifying nutritional supplements to safely improve egamer performance.

Methodology

We conducted a repeated-measure, randomized crossover study to compare the effects of caffeine (125 mg), caffeine (125 mg) + Dynamine® (75 mg) + TeaCrine® (50 mg) (CDT), and matched placebo across three testing sessions (one week apart) among 50 young male egamers. We tested the effect of each product on multiple measures of cognition, self-reported mood (anxiety, alertness, and headache), and biomarkers of arousal (cortisol and salivary alpha-amylase). We also measured electroencephalogram power during the cognitive tasks. Finally, we tested whether individual differences in xenobiotic metabolism would affect the study outcome measures by genotyping each participant for cytochrome P450 1A2*1F (CYP1A2*1F) allele status.

Results

Compared to pre-dose, CDT improved performance on the Flanker Test of Inhibitory Control and improved reaction time on the Psychomotor Vigilance Task post-dose. Compared to the placebo, caffeine increased self-reported anxiety whereas the CDT combination increased self-reported alertness. Compared to the CDT combination, caffeine increased self-reported headaches. Physiological measures suggested that increases in delta EEG power and cortisol production are associated with the effects observed in the CDT condition to optimize certain aspects of egamer performance. CYP1A2*1F allele status did not moderate outcome variables between conditions in this study.

Conclusions

CDT is a safe and effective product for improving cognitive performance among egamers without increasing self-reported anxiety or headaches. EEG changes demonstrate that CDT increased attention to internal processing (i.e., increased cortical delta power) and potentially increased cognitive control (i.e., increased cortical theta frequency), while the increases in cortisol suggest increased energy mobilization. Future work should aim to clarify the physiological underpinnings of CDT-induced changes in performance and examine the effects of CDT under naturalistic egamer conditions.

Modulation of Working Memory and Resting-State fMRI by tDCS of the Right Frontoparietal Network

Many cognitive functions, including working memory, are processed within large-scale brain networks. We targeted the right frontoparietal network (FPN) with one session of transcranial direct current stimulation (tDCS) in an attempt to modulate the cognitive speed of a visual working memory task (WMT) in 27 young healthy subjects using a double-blind crossover design. We further explored the neural underpinnings of induced changes by performing resting-state fMRI prior to and immediately after each stimulation session with the main focus on the interaction between a task-positive FPN and a task-negative default mode network (DMN). Twenty minutes of 2 mA anodal tDCS was superior to sham stimulation in terms of cognitive speed manipulation of a subtask with processing of objects and tools in unconventional views (i.e., the higher cognitive load subtask of the offline WMT). This result was linked to the magnitude of resting-state functional connectivity decreases between the stimulated FPN seed and DMN seeds. We provide the first evidence for the action reappraisal mechanism of object and tool processing. Modulation of cognitive speed of the task by tDCS was reflected by FPN-DMN cross-talk changes.

Effects of single-session transcranial direct current stimulation on reactive response inhibition

Transcranial direct current stimulation (tDCS) is widely used to explore the role of various cortical regions for reactive response inhibition. In recent years, tDCS studies reported polarity-, time- and stimulation-site dependent effects on response inhibition. Given the large parameter space in which study designs, tDCS procedures and task procedures can differ, it is crucial to systematically explore the existing tDCS literature to increase the current understanding of potential modulatory effects and limitations of different approaches. We performed a systematic review on the modulatory effects of tDCS on response inhibition as measured by the Stop-Signal Task. The final dataset shows a large variation in methodology and heterogeneous effects of tDCS on performance. The most consistent result across studies is a performance enhancement due to anodal tDCS over the right prefrontal cortex. Partially sub-optimal choices in study design, methodology and lacking consistency in reporting procedures may impede valid conclusions and obscured the effects of tDCS on response inhibition in some previous studies. Finally, we outline future directions and areas to improve research.

Using high-definition transcranial direct current stimulation to investigate the role of the dorsolateral prefrontal cortex in explicit sequence learning

Though we have a general understanding of the brain areas involved in motor sequence learning, there is more to discover about the neural mechanisms underlying skill acquisition. Skill acquisition may be subserved, in part, by interactions between the cerebellum and prefrontal cortex through a cerebello-thalamo-prefrontal network. In prior work, we investigated this network by targeting the cerebellum; here, we explored the consequence of stimulating the dorsolateral prefrontal cortex using high-definition transcranial direct current stimulation (HD-tDCS) before administering an explicit motor sequence learning paradigm. Using a mixed within- and between- subjects design, we employed anodal (n = 24) and cathodal (n = 25) HD-tDCS (relative to sham) to temporarily alter brain function and examine effects on skill acquisition. The results indicate that both anodal and cathodal prefrontal stimulation impedes motor sequence learning, relative to sham. These findings suggest an overall negative influence of active prefrontal stimulation on the acquisition of a sequential pattern of finger movements. Collectively, this provides novel insight on the role of the dorsolateral prefrontal cortex in initial skill acquisition, when cognitive processes such as working memory are used. Exploring methods that may improve motor learning is important in developing therapeutic strategies for motor-related diseases and rehabilitation.

Noninvasive brain stimulation to lateral prefrontal cortex alters the novelty of creative idea generation

Theories of the processes involved in creative cognition posit that cognitive control has a negative effect on creative idea generation but a positive effect on creative idea evaluation. Brain stimulation research has started to examine empirically the effects of cognitive control, with several reports of decreased cognitive control facilitating creative ideation. Such studies have shown how decreased cognitive control mechanisms facilitate creative idea generation, potentially by allowing participants access to less inhibited weaker-related associations, thereby increasing novelty. In the current study, we advance this line of work by investigating how cognitive control affects creative thinking, potentially inhibiting or facilitating novel idea generation based on task demands. Participants read sentences with the final word missing and were instructed to complete the sentence with an uncommon (but appropriate) ending. Participants performed this task while undergoing either anodal (excitatory), cathodal (inhibitory), or sham (control) transcranial direct current stimulation over their left prefrontal cortex. These responses were then rated for their novelty and appropriateness by an independent sample of raters. We found that anodal stimulation increased the appropriateness and decreased the novelty of participants' responses. Contrary to previous studies, we did not find that cathodal stimulation increased the novelty of participants' responses, which may be due to the nature of our task. Overall, we demonstrate how cognitive control mechanisms may inhibit novel idea generation.

The effects of offline and online prefrontal vs parietal transcranial direct current stimulation (tDCS) on verbal and spatial working memory

Working memory (WM) is a limited-capacity system or set of processes that enables temporary storage and manipulation of information essential for complex cognitive processes. The WM performance is supported by a widespread neural network in which fronto-parietal functional connections have a pivotal role. Transcranial direct current stimulation (tDCS) is rapidly emerging as a promising tool for understanding the role of various cortical areas and their functional networks on cognitive performance. Here we comprehensively evaluated the effects of tDCS on WM by conducting three cross-over counterbalanced sham-controlled experiments in which we contrasted the effects and interactions of the anodal (i.e. facilitatory) tDCS across anterior-posterior (i.e. DLPFC vs PPC) and left-right (i.e. the lateralization) axes, and across online and offline protocols using both verbal and spatial WM (3-back) tasks as outcomes. In the offline protocols, left DLPFC stimulation affected neither verbal nor spatial WM, while left PPC stimulation increased spatial WM. When applied offline over right DLPFC, tDCS improved verbal WM task and marginally enhanced spatial WM; while when tDCS was applied over the right PPC, facilitatory effects were observed on verbal WM. In the online protocol, tDCS did not modulate WM regardless of the task modality or stimulation loci. In summary, the study did not replicate the left DLPFC tDCS effect on WM, found in some of the previous studies, but demonstrated positive effects of stimulation of the right DLPFC as well as PPC bilaterally. The observed effects varied across modality of the 3-back task, and tDCS protocol applied. The results of this study argue for moving towards targeting the lesser-explored stimulation sites within the fronto-parietal network, such as PPC, to gain a better understanding of the usefulness of tDCS for WM neuromodulation.

Effects of Cerebellar tDCS on Inhibitory Control: Evidence from a Go/NoGo Task

Response inhibition as an executive function refers to the ability to suppress inappropriate but prepotent responses. Several brain regions have been implicated in the process underlying inhibitory control, including the cerebellum. The aim of the present study was to explore the role of the cerebellum in executive functioning, particularly in response inhibition. For this purpose, we transitorily inhibited cerebellar activity by means of cathodal tDCS and studied the effects of this inhibition on ERP components elicited during a Go/NoGo task in healthy subjects. Sixteen healthy subjects underwent a Go/NoGo task prior to and after cathodal and sham cerebellar tDCS in separate sessions. A reduction in N2-NoGo amplitude and a prolongation in N2-NoGo latency emerged after cathodal tDCS whereas no differences were detected after sham stimulation. Moreover, commission errors in NoGo trials were significantly higher after cathodal tDCS than at the basal evaluation. No differences emerged between performances in Go trials and those after sham stimulation. These data indicate that cerebellar inhibition following cathodal stimulation alters the ability to allocate attentional resources to stimuli containing conflict information and the inhibitory control. The cerebellum may regulate the attentional mechanisms of stimulus orientation and inhibitory control both directly, by making predictions of errors or behaviors related to errors, and indirectly, by controlling the functioning of the cerebral cortical areas involved in the perception of conflict signals and of the basal ganglia involved in the inhibitory control of movement.

Task load modulates tDCS effects on brain network for phonological processing

Motor participation in phonological processing can be modulated by task nature across the speech perception to speech production range. The pars opercularis of the left inferior frontal gyrus (LIFG) would be increasingly active across this range, because of changing motor demands. Here, we investigated with simultaneous tDCS and fMRI whether the task load modulation of tDCS effects translates into predictable patterns of functional connectivity. Findings were analysed under the "multi-node framework", according to which task load and the network structure underlying cognitive functions are modulators of tDCS effects. In a within-subject study, participants (N = 20) performed categorical perception, lexical decision and word naming tasks [which differentially recruit the target of stimulation (LIFG)], which were repeatedly administered in three tDCS sessions (anodal, cathodal and sham). The LIFG, left superior temporal gyrus and their right homologues formed the target network subserving phonological processing. C-tDCS inhibition and A-tDCS excitation should increase with task load. Correspondingly, the larger the task load, the larger the relevance of the target for the task and smaller the room for compensation of C-tDCS inhibition by less relevant nodes. Functional connectivity analyses were performed with partial correlations, and network compensation globally inferred by comparing the relative number of significant connections each condition induced relative to sham. Overall, simultaneous tDCS and fMRI was adequate to show that motor participation in phonological processing is modulated by task nature. Network responses induced by C-tDCS across phonological processing tasks matched predictions. A-tDCS effects were attributed to optimisation of network efficiency.

Anodal tDCS of right temporo-parietal junction promotes threat detection in low-spatial-frequency channels

Fast detection of threat is crucial for survival. Previous studies have suggested the involvement of low- and high-spatial-frequency (LSF and HSF) information in the process of threat detection. However, the specific contributions of LSF and HSF information to it are still controversial. Here we probed this issue by utilizing a prime procedure coupled with the transcranial direct current stimulation (tDCS) technique. Specifically, in a single-blind design, participants were exposed to LSF or HSF faces prior to the presentation of looming or receding spheres. Meanwhile, tDCS was applied over the right or left temporo-parietal junction (TPJ), which has been found to be preferentially associated with the processing of LSF and HSF information, respectively. The results showed significant LSF-related facilitation of threat detection when anodal tDCS was applied to the right TPJ. However, HSF-related facilitation of threat detection was not observed when anodal tDCS was applied to the left TPJ. The findings support the idea that LSF information can facilitate threat detection, and provide direct evidence that the right TPJ is vital for LSF-related facilitation of threat detection.

Theory of Mind Performance Predicts tDCS-Mediated Effects on the Medial Prefrontal Cortex: A Pilot Study to Investigate the Role of Sex and Age

Transcranial Direct Current Stimulation (tDCS) has become an increasingly promising tool for understanding the relationship between brain and behavior. The purpose of this study was to investigate whether the magnitude of sex- and age-related tDCS effects previously found in the medial prefrontal cortex (mPFC) during a Theory of Mind (ToM) task correlates with social cognition performance; in particular, we explored whether different patterns of activity would be detected in high- and low-performing participants. For this, young and elderly, male and female participants were categorized as a low- or high-performer according to their score on the Reading the Mind in the Eyes task. Furthermore, we explored whether sex- and age-related effects associated with active tDCS on the mPFC were related to cognitive functioning. We observed the following results: (i) elderly participants experience a significant decline in ToM performance compared to young participants; (ii) low-performing elderly females report slowing of reaction time when anodal tDCS is applied over the mPFC during a ToM task; and (iii) low-performing elderly females are characterized by lower scores in executive control functions, verbal fluency and verbal short-term memory. The relationship between tDCS results and cognitive functioning is discussed in light of the neuroscientific literature on sex- and age-related differences.

Impact of 3-Day Combined Anodal Transcranial Direct Current Stimulation-Visuospatial Training on Object-Location Memory in Healthy Older Adults and Patients with Mild Cognitive Impairment

BACKGROUND

Associative object-location memory (OLM) is known to decline even in normal aging, and this process is accelerated in patients with mild cognitive impairment (MCI). Given the lack of curative treatment for Alzheimer's disease, activating cognitive resources during its preclinical phase might prevent progression to dementia.

OBJECTIVE

To evaluate the effects of anodal transcranial direct current stimulation (atDCS) combined with an associative episodic memory training on OLM in MCI patients and in healthy elderly (HE).

METHODS

In a single-blind cross-over design, 16 MCI patients and 32 HE underwent a 3-day visuospatial OLM training paired with either 20 min or 30 s (sham) atDCS (1 mA, right temporoparietal cortex). Effects on immediate (training success) and long-term memory (1-month) were investigated by conducting Mixed Model analyses. In addition, the impact of combined intervention on within-session (online) and on between-session (offline) performance were explored.

RESULTS

OLM training+atDCS enhanced training success only in MCI patients, but not HE (difference n.s.). Relative performance gain was similar in MCI patients compared to HE under atDCS. No beneficial effect was found after 1-month. Exploratory analyses suggested a positive impact on online, but a negative effect on offline performance in MCI patients. In both groups, exploratory post-hoc analyses indicated an association between initially low-performers and greater benefit from atDCS.

CONCLUSION

Cognitive training in MCI may be enhanced by atDCS, but further delineation of the impact of current brain state, as well as temporal characteristics of multi-session atDCS-training application, may be needed to induce longer-lasting effects.

Aging, sex and cognitive Theory of Mind: a transcranial direct current stimulation study

Aging is accompanied by changes in cognitive abilities and a great interest is spreading among researchers about aging impact on social cognition skills, such as the Theory of Mind (ToM). Transcranial direct current stimulation (tDCS) has been used in social cognition studies founding evidence of sex-related different effects on cognitive ToM task in a young people sample. In this randomized, double-blind, sham-controlled study, we applied one active and one sham tDCS session on the medial prefrontal cortex (mPFC) during a cognitive ToM task, including both social (i.e., communicative) and nonsocial (i.e., private) intention attribution conditions, in sixty healthy aging individuals (30 males and 30 females). In half of the participants the anode was positioned over the mPFC, whereas in the other half the cathode was positioned over the mPFC. The results showed that: (i) anodal tDCS over the mPFC led to significant slower reaction times (vs. sham) for social intention attribution task only in female participants; (ii) No effects were found in both females and males during cathodal stimulation. We show for the first time sex-related differences in cognitive ToM abilities in healthy aging, extending previous findings concerning young participants.

tDCS to the left DLPFC modulates cognitive and physiological correlates of executive function in a state-dependent manner

BACKGROUND

The use of transcranial Direct Current Stimulation (tDCS) to study anatomical and physiological dynamics and circuits supporting cognition and executive functions in particular has dramatically increased in recent years. However, its mechanisms of action remain only partially understood.

OBJECTIVE

In this study we assess the cognitive and physiological effects of anodal tDCS to the DLPFC on executive function in order to understand (1) the role of DLPFC laterality, (2) the physiological dynamics sustaining the modulation of executive function by tDCS, and (3) the impact of state-dependent dynamics.

METHODS

In a randomized, placebo-controlled, cross-over study, we applied anodal tDCS targeting the left vs. right DLPFC vs. sham in 20 healthy individuals (10 males, 10 females). Immediately before and after tDCS, subjects performed the Flanker Task while we measured behavioral (reaction time and accuracy) and neurophysiological (ERP) responses. Specifically, the amplitude of N200, P300, ERN and Pe is compared before and after stimulation.

RESULTS

Anodal tDCS to the left DLPFC lead to a significant improvement in reaction time, an increase in P300 amplitude and a decrease in N200 amplitude in a state-dependent manner: baseline ERP amplitudes conditioned the effects of tDCS.

CONCLUSION

Given the role of these ERPs in conflict-related tasks, we speculate that tDCS is modulating the subconstructs of selective attention, conflict monitoring and response inhibition. These findings contribute to a further understanding of the role of left DLPFC in the modulation of executive function, and shed light into the mechanisms of action and the state dependent nature of tDCS.

The creative thinking cognitive process influenced by acute stress in humans: an electroencephalography study

This study examined the underlying neural mechanism of acute stress affecting creative thinking. Twenty-six male participants underwent the Alternative Uses Test before and after acute stress test (Montreal Imaging Stress Task). Compared to before stress, stressed participants responded with higher salivary cortisol and salivary alpha-amylase. The electroencephalogram results indicated a general decrease in upper-frequency alpha power after stress, compared with that of before stress. The decrease in upper-frequency alpha power observed in the first stage after exposure to stress was related to memory and attention. Additionally, stress also reduced the differences between individuals with different creative abilities. In summary, these findings indicated that acute stress impaired creative thinking and primarily affected the earlier phase of the process of creative cognition. This study provides some practical implications for educational practice and corporate innovation in that a more relaxed environment promotes creative output. Lay Summary Acute stress impaired creative thinking performance and mainly affects the earlier phase of the process of creative cognition. Additionally, stress seems to reduce the differences between individuals with different creative abilities.

tDCS modulates behavioral performance and the neural oscillatory dynamics serving visual selective attention

Transcranial direct-current stimulation (tDCS) is a noninvasive method for modulating human brain activity. Although there are several hypotheses about the net effects of tDCS on brain function, the field's understanding remains incomplete and this is especially true for neural oscillatory activity during cognitive task performance. In this study, we examined whether different polarities of occipital tDCS differentially alter flanker task performance and the underlying neural dynamics. To this end, 48 healthy adults underwent 20 min of anodal, cathodal, or sham occipital tDCS, and then completed a visual flanker task during high-density magnetoencephalography (MEG). The resulting oscillatory responses were imaged in the time-frequency domain using beamforming, and the effects of tDCS on task-related oscillations and spontaneous neural activity were assessed. The results indicated that anodal tDCS of the occipital cortices inhibited flanker task performance as measured by reaction time, elevated spontaneous activity in the theta (4-7 Hz) and alpha (9-14 Hz) bands in prefrontal and occipital cortices, respectively, and reduced task-related theta oscillatory activity in prefrontal cortices during task performance. Cathodal tDCS of the occipital cortices did not significantly affect behavior or any of these neuronal parameters in any brain region. Lastly, the power of theta oscillations in the prefrontal cortices was inversely correlated with reaction time. In conclusion, anodal tDCS modulated task-related oscillations and spontaneous activity across multiple cortical areas, both near the electrode and in distant sites that were putatively connected to the targeted regions.

The Role of Frontostriatal Systems in Instructed Reinforcement Learning: Evidence From Genetic and Experimentally-Induced Variation

Instructions have a powerful effect on learning and decision-making, biasing choice even in the face of disconfirming feedback. Detrimental biasing effects have been reported in a number of studies in which instruction was given prior to trial-and-error learning. Previous work has attributed individual differences in instructional bias to variations in prefrontal and striatal dopaminergic genes, suggesting a role for prefrontally-mediated cognitive control processes in biasing learning. The current study replicates and extends these findings. Human subjects performed a probabilistic reinforcement learning task after receiving inaccurate instructions about the quality of one of the options. In order to establish a causal relationship between prefrontal cortical mechanisms and instructional bias, we applied transcranial direct current stimulation over dorsolateral prefrontal cortex (anodal, cathodal, or sham) while subjects performed the task. We additionally genotyped subjects for the COMT Val158Met genetic polymorphism, which influences the breakdown of prefrontal dopamine, and for the DAT1/SLC6A3 variable number tandem repeat, which affects expression of striatal dopamine transporter. We replicated the finding that the COMT Met allele is associated with increased instructional bias and further demonstrated that variation in DAT1 has similar effects to variation in COMT, with 9-repeat carriers demonstrating increased bias relative to 10-repeat homozygotes. Consistent with increased top-down regulation of reinforcement learning, anodal subjects demonstrated greater bias relative to sham, though this effect was present only early in training. In contrast, there was no effect of cathodal stimulation. Finally, we fit computational models to subjects' data to better characterize the mechanisms underlying instruction bias. A novel choice bias model, in which instructions influence decision-making rather than learning, was found to best account for subjects' behavior. Overall, these data provide further evidence for the role of frontostriatal interactions in biasing instructed reinforcement learning, which adds to the growing literature documenting both costs and benefits of cognitive control.

Using tDCS to facilitate motor learning in speech production: The role of timing

There exists debate regarding the extent to which transcranial direct current stimulation (tDCS) can affect or enhance human behavior. Here, we examined a previously unexplored domain: speech motor learning. We investigated whether speech motor learning in unimpaired participants can be enhanced using a single-session tDCS experiment, and investigated whether the timing of tDCS relative to a behavioral task affected performance. Participants (N = 80) performed a twenty minute learning task with nonwords containing non-native consonant clusters (e.g., GDEEVOO), and were assigned to groups receiving either sham or active tDCS either immediately before or during the task. Both accuracy and properties of errors were examined throughout the course of the practice task, and then practice was compared to a retention period 30 min later (R1) and two days later (R2). For cluster and whole-(non)word accuracy measures, acquisition was observed for all groups during the practice session. Compared to the beginning of practice, the tDCS-Before group showed significantly greater improvement than both the sham group and the tDCS-During group at R1. An effect was also observed for vowel duration in errors (/gdivu/ → [gədivu]), with the tDCS-Before group showing significant shortening of vowel errors throughout practice. Overall, the findings suggest that tDCS can improve speech motor learning, and that the improvement may be greater when tDCS is applied immediately before practice, warranting further exploration of this new domain for tDCS research.

Frontotemporal stimulation modulates semantically-guided visual search during confrontation naming: A combined tDCS and eye tracking investigation

Transcranial direct current stimulation (tDCS) was paired with eye tracking to elucidate contributions of frontal, temporoparietal and anterior temporal cortex to early visual search patterns during picture naming (e.g., rapid visual scanning to diagnostic semantic features). Neurotypical adults named line drawings of objects prior to and following tDCS in three separate sessions, each employing a unique electrode montage. The gaze data revealed montage by stimulation (pre/post) interaction effects characterized by longer initial visual fixations (mean difference = 89 ms; Cohen's d = .8) and cumulative fixation durations (mean difference = 98 ms; Cohen's d = .9) on key semantic features (e.g., the head of an animal) after cathodal frontotemporal stimulation relative to the pre-stimulation baseline. We interpret these findings as reflecting a tDCS-induced modulation of semantic contributions of the anterior temporal lobe(s) to top-down influences on object recognition. Further, we discuss implications for the optimization of tDCS for the treatment of anomia in aphasia.

Exploring the effects of anodal and cathodal high definition transcranial direct current stimulation targeting the dorsal anterior cingulate cortex

The dorsal anterior cingulate cortex (dACC) has been identified as a core region affected by many disorders, representing a promising target for neuromodulation. High Definition-transcranial Direct Current Stimulation (HD-tDCS) is a non-invasive neuromodulation technique that has already shown promising outcomes and has been tested to engage deeper structures. This study investigates whether it is possible to modulate dACC activity using anodal and cathodal HD-tDCS. Furthermore, it examines what effects anodal and cathodal HD-tDCS targeting dACC have on cognitive and emotional processing. Forty-five healthy subjects were randomly assigned to 1 of 3 groups: anodal, cathodal, and sham. Resting-state electroencephalography (rsEEG) and a cognitive and emotional Counting Stroop task were administered before and after HD-tDCS. RsEEG showed changes: anodal HD-tDCS showed significant increase in beta frequency band activity in dACC, while cathodal HD-tDCS led to significant increase in activity at dorsal and rostral ACC in the theta frequency band. Behavioral changes were also found after anodal HD-tDCS in the cognitive Counting Stroop for incongruent trials and after cathodal HD-tDCS in the emotional Counting Stroop for emotional trials. This study demonstrated that HD-tDCS is able to modulate dACC activity, suggesting that it has the potential to be used as a treatment tool.

The Role of Left Dorsolateral Prefrontal Cortex in Language Processing

In addition to the role of left frontotemporal areas in language processing, there is increasing evidence that language comprehension and production require cognitive control and working memory resources involving the left dorsolateral prefrontal cortex (DLPFC). The aim of this study was to investigate the role of the left DLPFC in both language comprehension and production. In a double-blind, sham-controlled crossover experiment, thirty-two participants received cathodal or sham transcranial direct current stimulation (tDCS) to the left DLPFC while performing a language comprehension and a language production task. Results showed that cathodal tDCS increases reaction times in the language comprehension task, but decreases naming latencies in the language production task. However, additional analyses revealed that the polarity of tDCS effects was highly correlated across tasks, implying differential individual susceptibility to the effect of tDCS within participants. Overall, our findings demonstrate that left DLPFC is part of the complex cortical network associated with language processing.

Cathodal tDCS of the bilateral anterior temporal lobes facilitates semantically-driven verbal fluency

In a verbal fluency task, a person is required to produce as many exemplars of a given category (e.g., 'animals', or words starting with 'f') as possible within a fixed duration. Successful verbal fluency performance relies both on the depth of search within semantic/phonological neighborhoods ('clustering') and the ability to flexibly disengage between exhausted clusters ('switching'). Convergent evidence from functional imaging and neuropsychology suggests that cluster-switch behaviors engage dissociable brain regions. Switching has been linked to a frontoparietal network dedicated to executive functioning and controlled lexical retrieval, whereas clustering is more commonly associated with temporal lobe regions dedicated to semantic and phonological processing. Here we attempted to modulate cluster-switch dynamics among neurotypical adults (N = 24) using transcranial direct current stimulation (tDCS) delivered at three sites: a) anterior temporal cortex; b) frontal cortex; and c) temporoparietal cortex. Participants completed letter-guided and semantic category verbal fluency tasks pre/post stimulation. Cathodal stimulation of anterior temporal cortex facilitated the total number of words generated and the number of words generated within clusters during semantic category verbal fluency. These neuromodulatory effects were specific to stimulation of the one anatomical site. Our findings highlight the role of the anterior temporal lobes in representing semantic category structure and support the claim that clustering and switching behaviors have distinct substrates. We discuss implications both for theory and application to neurorehabilitation.

Transcranial Direct Current Stimulation (tDCS): A Beginner's Guide for Design and Implementation

Transcranial direct current stimulation (tDCS) is a popular brain stimulation method that is used to modulate cortical excitability, producing facilitatory or inhibitory effects upon a variety of behaviors. There is, however, a current lack of consensus between studies, with many results suggesting that polarity-specific effects are difficult to obtain. This article explores some of these differences and highlights the experimental parameters that may underlie their occurrence. We provide a general, practical snapshot of tDCS methodology, including what it is used for, how to use it, and considerations for designing an effective and safe experiment. Our aim is to equip researchers who are new to tDCS with the essential knowledge so that they can make informed and well-rounded decisions when designing and running successful experiments. By summarizing the varied approaches, stimulation parameters, and outcomes, this article should help inform future tDCS research in a variety of fields.

Interference effects of transcranial direct current stimulation over the right frontal cortex and adrenergic system on conditioned fear

RATIONALE

The effects of pharmacological interventions on fear memory have widely been studied, but there are very few studies about the effects of brain electrical stimulation on fear memory function.

OBJECTIVE

Therefore, our aim was to determine whether anodal/cathodal transcranial direct current stimulation (tDCS) over the right frontal cortex would modify propranolol-induced contextual and auditory fear memory deficits, before or after training.

METHODS

The adult NMRI male mice were randomly assigned into three groups: the sham group, the anodal tDCS group, and the cathodal tDCS group. Fear memories were evaluated using a classical fear conditioning apparatus.

RESULTS

While the anodal stimulation did not affect fear retrieval, post-training cathodal stimulation improved fear memory retrieval. Regardless of when propranolol (0.1 mg/kg) was administered, it impaired fear memory retrieval. However, when anodal stimulation and propranolol were applied prior to the training, contextual fear memory retrieval was increased and auditory fear memory was reversed. An enhanced contextual retrieval was also observed when propranolol was administered prior to the training and stimulation occurred after the training. Only when the stimulation occurred prior to the training and propranolol was administered after the training was there a selective improvement in contextual fear memory retrieval, leaving the auditory fear memory retrieval impaired. Interestingly, cathodal stimulation improved the effects of propranolol on auditory fear memory only when it occurred prior to the training.

CONCLUSION

The results highlight possible improving effects for anodal/cathodal tDCS on propranolol-induced deficits on fear memories. The timing of the interventions related to the specific phases of memory formation is important in modulating fear behaviors.

The effects of utterance timing and stimulation of left prefrontal cortex on the production of referential expressions

We examined the relationship between the timing of utterance initiation and the choice of referring expressions, e.g., pronouns (it), zeros (…and went down), or descriptive NPs (the pink pentagon). We examined language production in healthy adults, and used anodal transcranial direct current stimulation (tDCS) to test the involvement of the left prefrontal cortex (PFC) in the timing of utterance production and the selection of reference forms in a discourse context. Twenty-two subjects (11 anodal, 11sham) described fast-paced actions, e.g. The gray oval flashes, then it moves right 2 blocks. We only examined trials in contexts that supported pronoun/zero use. For sham participants, pronouns/zeros increased on trials with longer latencies to initiate the target utterance, and trials where the previous trial was short. We argue that both of these conditions enabled greater message pre-planning and greater discourse connectedness: The strongest predictor of pronoun/zero usage was the presence of a connector word like and or then, which was also tended to occur on trials with longer latencies. For the anodal participants, the latency effect disappeared. PFC stimulation appeared to enable participants to produce utterances with greater discourse connectedness, even while planning incrementally.

Using transcranial direct-current stimulation (tDCS) to understand cognitive processing

Noninvasive brain stimulation methods are becoming increasingly common tools in the kit of the cognitive scientist. In particular, transcranial direct-current stimulation (tDCS) is showing great promise as a tool to causally manipulate the brain and understand how information is processed. The popularity of this method of brain stimulation is based on the fact that it is safe, inexpensive, its effects are long lasting, and you can increase the likelihood that neurons will fire near one electrode and decrease the likelihood that neurons will fire near another. However, this method of manipulating the brain to draw causal inferences is not without complication. Because tDCS methods continue to be refined and are not yet standardized, there are reports in the literature that show some striking inconsistencies. Primary among the complications of the technique is that the tDCS method uses two or more electrodes to pass current and all of these electrodes will have effects on the tissue underneath them. In this tutorial, we will share what we have learned about using tDCS to manipulate how the brain perceives, attends, remembers, and responds to information from our environment. Our goal is to provide a starting point for new users of tDCS and spur discussion of the standardization of methods to enhance replicability.

Mapping the Parameter Space of tDCS and Cognitive Control via Manipulation of Current Polarity and Intensity

In the cognitive domain, enormous variation in methodological approach prompts questions about the generalizability of behavioral findings obtained from studies of transcranial direct current stimulation (tDCS). To determine the impact of common variations in approach, we systematically manipulated two key stimulation parameters—current polarity and intensity—and assessed their impact on a task of inhibitory control (the Eriksen Flanker). Ninety participants were randomly assigned to one of nine experimental groups: three stimulation conditions (anode, sham, cathode) crossed with three intensity levels (1.0, 1.5, 2.0 mA). As participants performed the Flanker task, stimulation was applied over left dorsolateral prefrontal cortex (DLPFC; electrode montage: F3-RSO). The behavioral impact of these manipulations was examined using mixed effects linear regression. Results indicate a significant effect of stimulation condition (current polarity) on the magnitude of the interference effect during the Flanker; however, this effect was specific to the comparison between anodal and sham stimulation. Inhibitory control was therefore improved by anodal stimulation over the DLPFC. In the present experimental context, no reliable effect of stimulation intensity was observed, and we found no evidence that inhibitory control was impeded by cathodal stimulation. Continued exploration of the stimulation parameter space, particularly with more robustly powered sample sizes, is essential to facilitating cross-study comparison and ultimately working toward a reliable model of tDCS effects.

No Modulation of Visual Cortex Excitability by Transcranial Direct Current Stimulation

Measuring phosphene thresholds (PTs) is often used to investigate changes in the excitability of the human visual cortex through different brain stimulation methods like repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS). In several studies, PT increase or decrease has been shown after rTMS or tDCS application. Recently, using PT measurements we showed that the state of the neurons in the visual cortex after rTMS might have an influence on the modulatory effects of stimulation. In the present study we aimed to investigate whether visual cortex activity following stimulation influences the modulatory effects of tDCS as well. In a between-group design, anodal or cathodal tDCS was applied to the visual cortex twice per subject, with either high or low visual demand following stimulation. We observed no modulation of PT neither directly following both anodal and cathodal tDCS nor following the visual demand periods. We rather found high inter-individual variability in the response to tDCS, and intra-individual reliability in the direction of modulation was observed for cathodal tDCS only. Thus, our results do not confirm the modulatory effects of tDCS on visual cortex excitability published previously. Moreover, they support the confirmation that tDCS effects have little reliability on varied TMS outcome measurements.

Improving Interference Control in ADHD Patients with Transcranial Direct Current Stimulation (tDCS)

The use of transcranial direct current stimulation (tDCS) in patients with attention deficit hyperactivity disorder (ADHD) has been suggested as a promising alternative to psychopharmacological treatment approaches due to its local and network effects on brain activation. In the current study, we investigated the impact of tDCS over the right inferior frontal gyrus (rIFG) on interference control in 21 male adolescents with ADHD and 21 age matched healthy controls aged 13–17 years, who underwent three separate sessions of tDCS (anodal, cathodal, and sham) while completing a Flanker task. Even though anodal stimulation appeared to diminish commission errors in the ADHD group, the overall analysis revealed no significant effect of tDCS. Since participants showed a considerable learning effect from the first to the second session, performance in the first session was separately analyzed. ADHD patients receiving sham stimulation in the first session showed impaired interference control compared to healthy control participants whereas ADHD patients who were exposed to anodal stimulation, showed comparable performance levels (commission errors, reaction time variability) to the control group. These results suggest that anodal tDCS of the right inferior frontal gyrus could improve interference control in patients with ADHD.

Language and Memory Improvements following tDCS of Left Lateral Prefrontal Cortex

Recent research demonstrates that performance on executive-control measures can be enhanced through brain stimulation of lateral prefrontal regions. Separate psycholinguistic work emphasizes the importance of left lateral prefrontal cortex executive-control resources during sentence processing, especially when readers must override early, incorrect interpretations when faced with temporary ambiguity. Using transcranial direct current stimulation, we tested whether stimulation of left lateral prefrontal cortex had discriminate effects on language and memory conditions that rely on executive-control (versus cases with minimal executive-control demands, even in the face of task difficulty). Participants were randomly assigned to receive Anodal, Cathodal, or Sham stimulation of left lateral prefrontal cortex while they (1) processed ambiguous and unambiguous sentences in a word-by-word self-paced reading task and (2) performed an n-back memory task that, on some trials, contained interference lure items reputed to require executive-control. Across both tasks, we parametrically manipulated executive-control demands and task difficulty. Our results revealed that the Anodal group outperformed the remaining groups on (1) the sentence processing conditions requiring executive-control, and (2) only the most complex n-back conditions, regardless of executive-control demands. Together, these findings add to the mounting evidence for the selective causal role of left lateral prefrontal cortex for executive-control tasks in the language domain. Moreover, we provide the first evidence suggesting that brain stimulation is a promising method to mitigate processing demands encountered during online sentence processing.