Shaping memory accuracy by left prefrontal transcranial direct current stimulation

Towards optimized methodological parameters for maximizing the behavioral effects of transcranial direct current stimulation

Introduction

Transcranial direct current stimulation (tDCS) administers low-intensity direct current electrical stimulation to brain regions via electrodes arranged on the surface of the scalp. The core promise of tDCS is its ability to modulate brain activity and affect performance on diverse cognitive functions (affording causal inferences regarding regional brain activity and behavior), but the optimal methodological parameters for maximizing behavioral effects remain to be elucidated. Here we sought to examine the effects of 10 stimulation and experimental design factors across a series of five cognitive domains: motor performance, visual search, working memory, vigilance, and response inhibition. The objective was to identify a set of optimal parameter settings that consistently and reliably maximized the behavioral effects of tDCS within each cognitive domain.

Methods

We surveyed tDCS effects on these various cognitive functions in healthy young adults, ultimately resulting in 721 effects across 106 published reports. Hierarchical Bayesian meta-regression models were fit to characterize how (and to what extent) these design parameters differentially predict the likelihood of positive/negative behavioral outcomes.

Results

Consistent with many previous meta-analyses of tDCS effects, extensive variability was observed across tasks and measured outcomes. Consequently, most design parameters did not confer consistent advantages or disadvantages to behavioral effects-a domain-general model suggested an advantage to using within-subjects designs (versus between-subjects) and the tendency for cathodal stimulation (relative to anodal stimulation) to produce reduced behavioral effects, but these associations were scarcely-evident in domain-specific models.

Discussion

These findings highlight the urgent need for tDCS studies to more systematically probe the effects of these parameters on behavior to fulfill the promise of identifying causal links between brain function and cognition.

Ameliorating cognitive control in patients with binge eating disorder by electrical brain stimulation: study protocol of the randomized controlled ACCElect pilot trial

BACKGROUND

The current first-line treatment for binge eating disorder (BED), which is psychotherapy, is moderately effective in terms of abstinence from binge-eating. Neurobiological evidence suggests that people affected by BED show difficulties along the spectrum of impulsivity, including inhibitory control impairments and highlights the potential of novel treatment approaches directly targeting inhibitory control, including cognitive training approaches and non-invasive brain stimulation.

METHODS

ACCElect is a prospective, randomized controlled pilot trial investigating a novel, food-related inhibitory control training combined with transcranial direct current stimulation (tDCS). 40 patients with BED will be randomly assigned to receive the training either combined with verum or with sham stimulation (control condition). The inhibitory control training is based on principles of the antisaccade paradigm and comprises six training sessions over two weeks. Core aims are the investigation of feasibility and clinically relevant effects of a tDCS-enhanced inhibitory control training in BED patients and the establishment of a data basis for a larger efficacy trial. The primary clinical endpoint is binge-eating (BE) frequency in terms of changes in BE episodes four weeks after treatment termination as compared to baseline. Key secondary outcomes comprise ED pathology and general psychopathology, inhibitory control capacities, quality of life as well as acceptability and satisfaction with the intervention.

DISCUSSION

The results of the present trial will contribute to the development of novel neurobiologically informed treatment approaches for patients suffering from BED. Trial registration The ACCElect trial was prospectively registered on October 1, 2020, under the registration number NCT04572087 at ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT04572087 ).

Effects of combining retrieval practice and tDCS over long-term memory: A randomized controlled trial

The ability to retain new information is important in daily life. In particular, two techniques have shown promise for improving long-term retention: retrieval practice (RP), which consists of actively retrieving information from long-term memory to make it more accessible in the future; and transcranial direct current stimulation (tDCS), which consists of non-invasive brain stimulation that modulates cognitive processes by increasing and decreasing neuronal excitability. Previous studies have implicated the left dorsolateral prefrontal cortex (l-dlPFC) in memory encoding and memory organization. We examined whether RP associated with a single 20-min tDCS session over the l-dlPFC could improve long-term memory retention. Participants (N = 119) repeatedly studied a list of related words either via RP or via restudy, while undergoing either anodal or sham stimulation. Participants returned 2 days later for a free-recall test. Results showed that the RP group outperformed the restudy group in all measures, regardless of stimulation type. Also, recall organization was higher in the RP group than in the restudy group. The data support previous findings and indicate that RP may enhance performance by improving the organization of the to-be-remembered list items.

Examining the influence of brain stimulation to the medial prefrontal cortex on the self-reference effect in memory

Past work shows that processing information in relation to the self improves memory which is known as the self-reference effect in memory. Other work suggests that transcranial direct current stimulation (tDCS) can also improve memory. Given recent research on self-reference context memory effects (improved memory for contextual episodic details associated with self-referential processing), we were interested in examining the extent stimulation might increase the magnitude of the self-reference context memory effect. In this investigation, participants studied objects superimposed on different background scenes in either a self-reference or other-reference condition while receiving either active or sham stimulation to the dorsal medial prefrontal cortex (dmPFC), a cortical region known to support self-reference context memory effects. Participants then completed a memory test that assessed item memory (have you seen this object before?) and context memory (with which background scene was this object paired?). Results showed a self-reference context memory effect driven by enhanced memory for stimuli processed in the self-reference compared to the other-reference condition across all participants (regardless of stimulation condition). tDCS, however, had no effect on memory. Specifically, stimulation did not increase the magnitude of the self-reference context memory effect under active compared to sham stimulation. These results suggest that stimulation of the dmPFC at encoding may not add to the memory benefits induced by self-referential processing suggesting a boundary condition to tDCS effects on memory.

Personality Traits Modulate the Effect of tDCS on Reading Speed of Social Sentences

In this case, 62 university students participated in the study, in which a between-subjects design was adopted. Participants were also given the behavioral approach system (BAS) and behavioral inhibition system (BIS) scales. Participants had to read a list of 60 sentences with interpersonal and neutral content: 20 approach (“Pedro accepted Rosa in Whatsapp”), 20 avoidance (“Pedro Blocked Rosa in Whatsapp”) and 20 neutral (“Marta thought about the causes of the problem”). After reading them, they were subjected to 20 min of transcranial direct current stimulation (tDCS) in one of the two conditions: anodal (31) or sham (31). After tDCS, they had to read other list of 60 sentences matched in approach, avoidance and neutral contents with the former list. We found significant improvement in reading speed after anodal stimulation for social and neutral sentences. Regarding affective traits, we found that anodal stimulation benefitted reading speed in low-BIS and low-BAS participants and had no effect in either high BAS or high BIS participants. In addition, tDCS improvement in reading speed was significantly lower in avoidance sentences in low-BIS (avoidance) participants. We discuss these results at the light of previous research and highlight the importance of approach and avoidance traits as moderators of tDCS effects.

Stimulation of the left dorsolateral prefrontal cortex with slow rTMS enhances verbal memory formation

Encoding of episodic memories relies on stimulus-specific information processing and involves the left prefrontal cortex. We here present an incidental finding from a simultaneous EEG-TMS experiment as well as a replication of this unexpected effect. Our results reveal that stimulating the left dorsolateral prefrontal cortex (DLPFC) with slow repetitive transcranial magnetic stimulation (rTMS) leads to enhanced word memory performance. A total of 40 healthy human participants engaged in a list learning paradigm. Half of the participants (N = 20) received 1 Hz rTMS to the left DLPFC, while the other half (N = 20) received 1 Hz rTMS to the vertex and served as a control group. Participants receiving left DLPFC stimulation demonstrated enhanced memory performance compared to the control group. This effect was replicated in a within-subjects experiment where 24 participants received 1 Hz rTMS to the left DLPFC and vertex. In this second experiment, DLPFC stimulation also induced better memory performance compared to vertex stimulation. In addition to these behavioural effects, we found that 1 Hz rTMS to DLPFC induced stronger beta power modulation in posterior areas, a state that is known to be beneficial for memory encoding. Further analysis indicated that beta modulations did not have an oscillatory origin. Instead, the observed beta modulations were a result of a spectral tilt, suggesting inhibition of these parietal regions. These results show that applying 1 Hz rTMS to DLPFC, an area involved in episodic memory formation, improves memory performance via modulating neural activity in parietal regions.

Encoding of episodic memories relies on stimulus-specific information processing and involves the left prefrontal cortex. An incidental finding from a simultaneous EEG-TMS experiment reveals that applying 1-Hz repetitive transcranial magnetic stimulation to this area of the brain improves memory performance by modulating neural activity in parietal regions.

Transcranial direct current stimulation over the left anterior temporal lobe during memory retrieval differentially affects true and false recognition in the DRM task

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that has been used to modulate human brain activity and cognition. One area which has not yet been extensively explored using tDCS is the generation of false memories. In this study, we combined the Deese-Roediger-McDermott (DRM) task with stimulation of the left anterior temporal lobe (ATL) during retrieval. This area has been shown to be involved in semantic processing in general and retrieval of false memories in the DRM paradigm in particular. During stimulation, 0.7 mA were applied via a 9 cm² electrode over the left ATL, with the 35 cm² return electrode placed over the left deltoid. We contrasted the effects of cathodal, anodal, and sham stimulation, which were applied in the recognition phase of the experiment on a sample of 78 volunteers. Results showed impaired recognition of true memories after both anodal and cathodal stimulation in comparison to sham stimulation, suggesting a reduced signal-to-noise ratio. In addition, the results revealed enhanced false recognition of concept lure items during cathodal stimulation compared to anodal stimulation, indicating a polarity-dependent impact of tDCS on false memories in the DRM task. The pathway by which tDCS modulated false recognition remains unclear: stimulation may have changed the activation of irrelevant lures or affected the weighting and monitoring of lure activations. Nevertheless, these results are a first step towards using brain stimulation to decrease false memories. Practical implications of the findings for real-life settings, for example, in the courtroom, need to be addressed in future work.

Examining the effects of transcranial direct current stimulation on human episodic memory with machine learning

We aimed to replicate a published effect of transcranial direct-current stimulation (tDCS)-induced recognition enhancement over the human ventrolateral prefrontal cortex (VLPFC) and analyse the data with machine learning. We investigated effects over an adjacent region, the dorsolateral prefrontal cortex (DLPFC). In total, we analyzed data from 97 participants after exclusions. We found weak or absent effects over the VLPFC and DLPFC. We conducted machine learning studies to examine the effects of semantic and phonetic features on memorization, which revealed no effect of VLPFC tDCS on the original dataset or the current data. The highest contributing factor to memory performance was individual differences in memory not explained by word features, tDCS group, or sample size, while semantic, phonetic, and orthographic word characteristics did not contribute significantly. To our knowledge, this is the first tDCS study to investigate cognitive effects with machine learning, and future studies may benefit from studying physiological as well as cognitive effects with data-driven approaches and computational models.

No Effect of Anodal tDCS on Verbal Episodic Memory Performance and Neurotransmitter Levels in Young and Elderly Participants

Healthy ageing is accompanied by cognitive decline that affects episodic memory processes in particular. Studies showed that anodal transcranial direct current stimulation (tDCS) to the left dorsolateral prefrontal cortex (DLPFC) may counteract this cognitive deterioration by increasing excitability and inducing neuroplasticity in the targeted cortical region. While stimulation gains are more consistent in initial low performers, relying solely on behavioural measures to predict treatment benefits does not suffice for a reliable implementation of this method as a therapeutic option. Hence, an exploration of the underlying neurophysiological mechanisms regarding the differential stimulation effect is warranted. Glutamatergic metabolites (Glx) and γ-aminobutyric acid (GABA) are involved in learning and memory processes and can be influenced with tDCS; wherefore, they present themselves as potential biomarkers for tDCS-induced behavioural gains, which are affiliated with neuroplasticity processes. In the present randomized, double-blind, sham-controlled, crossover study, 33 healthy young and 22 elderly participants received anodal tDCS to their left DLPFC during the encoding phase of a verbal episodic memory task. Using MEGA-PRESS edited magnetic resonance spectroscopy (MRS), Glx and GABA levels were measured in the left DLPFC before and after the stimulation period. Further, we tested whether baseline performance and neurotransmitter levels predicted subsequent gains. No beneficial group effects of tDCS emerged in either verbal retrieval performances or neurotransmitter concentrations. Moreover, baseline performance levels did not predict stimulation-induced cognitive gains, nor did Glx or GABA levels. Nevertheless, exploratory analyses suggested a predictive value of the Glx : GABA ratio, with lower ratios at baseline indicating greater tDCS-related gains in delayed recall performance. This highlights the importance of further studies investigating neurophysiological mechanisms underlying previously observed stimulation-induced cognitive benefits and their respective interindividual heterogeneity.

Enhancing Memory for Relationship Actions by Transcranial Direct Current Stimulation of the Superior Temporal Sulcus

We examine the effect of transcranial direct current stimulation (tDCS) of right superior temporal sulcus (rSTS) in memorization of approach/avoidance relationship-action sentences; for example, “Alejandro accepted/rejected Marta in his group.” Sixty-five university students participated in a tDCS study, in which a between-subjects design was adopted. Sixty-four participants were also given the behavioral approach system (BAS) and behavioral inhibition system (BIS) scales. Participants were subjected to 20 min of stimulation: anodal (N = 24), cathodal (N = 21), or sham (N = 20); subsequently, they were given a list of 40 sentences (half approach and half avoidance) and told to try to memorize them. Finally, they performed a changed/same memory task (half the sentences were the “same” and half were “changed”). Previously, we had examined performance in the memory task without tDCS with another group of participants (N = 20). We found that anodal stimulation improved d’ index of discriminability (hits-false alarms) compared to sham and cathodal conditions for both approach and avoidance sentences. Moreover, the comparison between anodal and task-alone performance showed that stimulation improved d’ index of approach sentences more, as task-alone performance showed better discrimination for avoidance than for approach. Likewise, we explored a potential modulation of tDCS effect by (BAS) and (BIS) traits. We found that d’ index improvement in anodal stimulation condition only benefited low BAS and low BIS participants. Implications of these results are discussed in the context of rSTS function in encoding and memorizing verbally described intentional relationship-actions and the role of individual differences on modulating tDCS effect.

Reducing negative affect with anodal transcranial direct current stimulation increases memory performance in young-but not in elderly-individuals

Affect can directly influence memory storage and retrieval, which offers the opportunity to improve memory performance by changing affective responses. A promising target is the left dorsolateral prefrontal cortex (dlPFC), as it is functionally involved in both affect and memory. This study explores whether anodal transcranial direct current stimulation (tDCS) to the left dlPFC improves memory retrieval through the reduction of negative affect and if this interacts with age. We randomly assigned 94 healthy individuals (n = 43 young, n = 51 elderly) to either sham or active tDCS during encoding of a verbal episodic memory task. Participants completed two questionnaires assessing affective states pre- and post-stimulation. They had to recall items unexpectedly 20 min after encoding and to name which feelings were associated with this free recall. We applied mediation models to explore the relation between tDCS, change in affect, and memory retrieval. In young participants, the reduction of negative affect via anodal tDCS fully mediated the increase in memory retrieval (R² = 57%; p < 0.001); that is, a stronger reduction of negative affect via tDCS led to better memory performance. We did not observe these effects in the elderly. Our study provides a further link between affect and memory: as increased activity in the dlPFC is crucial for successfully coping with affective interference, anodal tDCS seems to help preventing irrelevant negative thoughts, thus foster attention allocation. Studies applying anodal tDCS to the left dlPFC in healthy young participants should consider changes in affect when interpreting the effect of stimulation on memory performance.

Anodal Transcranial Direct Current Stimulation to the Left Rostrolateral Prefrontal Cortex Selectively Improves Source Memory Retrieval

Functional neuroimaging studies have consistently implicated the left rostrolateral prefrontal cortex (RLPFC) as playing a crucial role in the cognitive operations supporting episodic memory and analogical reasoning. However, the degree to which the left RLPFC causally contributes to these processes remains underspecified. We aimed to assess whether targeted anodal stimulation—thought to boost cortical excitability—of the left RLPFC with transcranial direct current stimulation (tDCS) would lead to augmentation of episodic memory retrieval and analogical reasoning task performance in comparison to cathodal stimulation or sham stimulation. Seventy-two healthy adult participants were evenly divided into three experimental groups. All participants performed a memory encoding task on Day 1, and then on Day 2, they performed continuously alternating tasks of episodic memory retrieval, analogical reasoning, and visuospatial perception across two consecutive 30-min experimental sessions. All groups received sham stimulation for the first experimental session, but the groups differed in the stimulation delivered to the left RLPFC during the second session (either sham, 1.5 mA anodal tDCS, or 1.5 mA cathodal tDCS). The experimental group that received anodal tDCS to the left RLPFC during the second session demonstrated significantly improved episodic memory source retrieval performance, relative to both their first session performance and relative to performance changes observed in the other two experimental groups. Performance on the analogical reasoning and visuospatial perception tasks did not exhibit reliable changes as a result of tDCS. As such, our results demonstrate that anodal tDCS to the left RLPFC leads to a selective and robust improvement in episodic source memory retrieval.

Elaborately rehearsed information can be forgotten: A new paradigm to investigate directed forgetting

In previous item-method directed forgetting (DF) studies, forgetting may have occurred when the maintenance rehearsal of memory items was performed. In this study, a modified item-method DF paradigm was adopted to investigate whether forgetting instruction could produce a positive effect on forgetting the items that were elaborately rehearsed. During the study phase, a to-be-forgotten (TBF) word was followed by a forgetting cue. If no cue followed, the word was a to-be-remembered (TBR) item. Participants were required to intentionally memorize the word when it appeared. During the test phase, a yes/no recognition (Experiment 1) or a remember/know procedure (Experiment 2) was adopted. The behavioural results revealed that both the hit rate (Experiment 1) and remembering rate (Experiment 2) were higher for TBR relative to TBF words. For correctly identified old words, reaction times were consistently shorter for TBR compared to TBF words. These results revealed superior memory retention for TBR than for TBF words. The event-related potential (ERP) results revealed that, during both FN400 and late-positive complex (LPC) time windows, the remembered TBR words evoked more positive ERPs than the remembered TBF words and correctly rejected (CR) words (i.e., FN400 and LPC old/new effects). However, more negative ERPs were evoked for both remembered and forgotten TBF words than for CR words during the LPC time window (i.e., reversed LPC old/new effect). These results demonstrated that TBF words were associated with lower level of familiarity and recollection process than TBR words. The memory representation of TBF information might be inhibited.

Modulating Applied Task Performance via Transcranial Electrical Stimulation

Basic and applied research are increasingly adopting transcranial electrical stimulation (tES) for modulating perceptual, cognitive, affective, and motor processes. Industry and defense applications of tES hold potential for accelerating training and knowledge acquisition and sustaining work-related performance in the face of fatigue, workload, and stress. This mini-review article describes the promises and perils of tES, and reviews research testing its influence on two broad applied areas: sustaining and dividing attention, and operating in virtual environments. Also included is a discussion of challenges related to viable mechanistic explanations for tES effectiveness, attempts at replication and consideration of null results, and the potential importance of individual differences in predicting tES influences on human performance. Finally, future research directions are proposed to address these challenges and help develop a fuller understanding of tES viability for enhancing real-world performance.

Enhancement of Declarative Memory: From Genetic Regulation to Non-invasive Stimulation

The problem of memory enhancement is extremely important in intellectual activity areas and therapy of different types of dementia, including Alzheimer's disease (AD). The attempts to solve this problem have come from different research fields. In the first part of our review, we describe the results of targeting certain genes involved in memory-associated molecular pathways. The second part of the review is focused on the deep stimulation of brain structures that can slow down memory loss in AD. The third part describes the results of the use of non-invasive brain stimulation techniques for memory modulation, consolidation, and retrieval in healthy people and animal models. Integration of data from different research fields is essential for the development of efficient strategies for memory enhancement.

Beneficial effects of anodal transcranial direct current stimulation (tDCS) on spatial working memory in patients with schizophrenia

Schizophrenia is a severe and often detrimental psychiatric disorder. The individual patients' level of functioning is essentially determined by cognitive, particularly working memory (WM), deficits that are critically linked to dysfunctional activity of the dorsolateral prefrontal cortex (dlPFC). Transcranial direct current stimulation (tDCS) can transiently modulate activity of the dlPFC and remote areas and has been shown to improve WM functions. It may therefore provide a new, targeted treatment option. For this aim, the present study investigated the effect of anodal tDCS of different intensities on spatial WM in patients with schizophrenia. In two experiments, 32 patients performed a spatial n-back task with increasing WM load (1-, 2-, and 3-back) at baseline and in two sessions with anodal or sham tDCS (EXP I [n = 16]: 1 mA; EXP II [n = 16]: 2 mA) to the right dlPFC (cathode: left m. deltoideus). With 1 mA anodal tDCS, no effect on WM performance could be detected. However, 2 mA anodal tDCS increased accuracy (measured by d') of the task with the highest WM load (3-back). This effect was larger in patients with a lower level of general neurocognitive functioning. These results demonstrate a beneficial effect of 2 mA anodal tDCS on deficient WM accuracy in patients with schizophrenia particularly under challenging conditions and in subjects with higher cognitive impairments. This data will inform future clinical trials on tDCS-enhanced cognitive training to improve treatment of schizophrenia.

A systematic review and meta-analysis of the effects of transcranial direct current stimulation (tDCS) on episodic memory

BACKGROUND

In the past decade, several studies have examined the effects of transcranial direct current stimulation (tDCS) on long-term episodic memory formation and retrieval. These studies yielded conflicting results, likely due to differences in stimulation parameters, experimental design and outcome measures.

OBJECTIVES

In this work we aimed to assess the robustness of tDCS effects on long-term episodic memory using a meta-analytical approach.

METHODS

We conducted four meta-analyses to analyse the effects of anodal and cathodal tDCS on memory accuracy and response times. We also used a moderator analysis to examine whether the size of tDCS effects varied as a function of specific stimulation parameters and experimental conditions.

RESULTS

Although all selected studies reported a significant effect of tDCS in at least one condition in the published paper, the results of the four meta-analyses showed only statistically non-significant close-to-zero effects. A moderator analysis suggested that for anodal tDCS, the duration of the stimulation and the task used to probe memory moderated the effectiveness of tDCS. For cathodal tDCS, site of stimulation was a significant moderator, although this result was based on only a few observations.

CONCLUSIONS

To warrant theoretical advancement and practical implications, more rigorous research is needed to fully understand whether tDCS reliably modulates episodic memory, and the specific circumstances under which this modulation does, and does not, occur.

Verbal long-term memory is enhanced by retrieval practice but impaired by prefrontal direct current stimulation

Retrieval practice involves repeatedly testing a student during the learning experience, reliably conferring learning advantages relative to repeated study. Transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (dlPFC) has also been shown to confer learning advantages for verbal memory, though research is equivocal. The present study examined the effects of retrieval versus study practice with or without left dlPFC tDCS on verbal episodic memory. Participants (N = 150) experienced either retrieval practice or study practice, and active anodal, active cathodal, or sham tDCS while encoding word lists, and then returned two days later for a final recall test. Three primary patterns emerged: first, during encoding, tDCS did not influence recall rates in the retrieval practice group. Second, during final recall, participants in the retrieval practice groups recalled more than those in the study practice groups. Finally, during final recall, anodal tDCS decreased recall relative to sham and cathodal stimulation, suggesting that it interfered with developing highly detailed memories that could be relied upon for subsequent recollection. Data support existing research demonstrating the effectiveness of retrieval practice as a learning strategy, but also suggest that anodal dlPFC stimulation can induce long-term negative impacts on verbal episodic memory retrieval.

Too hard to forget? ERPs to remember, forget, and uninformative cues in the encoding phase of item-method directed forgetting

In item-method directed forgetting, worse memory performance occurs for to-be-forgotten (TBF) than for to-be-remembered (TBR) items. However, recently TBF items have been found to be recognized more accurately than uninformative (UI) items not associated with any specific task. Here, we compare ERPs elicited by cues signaling the remember or the forget instruction with those elicited by uninformative cues. Participants were presented with a series of complex pictures, each followed by a symbolic TBR, TBF, or UI cue. On a yes-no recognition test, accuracy was higher for TBR than for both TBF and UI items. However, TBF items were recognized more accurately than UI items. ERPs elicited by the TBR cue were larger than ERPs elicited by both TBF and UI cues at the frontal P2, the late frontal negativity, and the late parietal positivity complex. This is consistent with more attention capture, selective rehearsal, and long-term memory encoding of TBR. In contrast, both TBF and UI cues induced a larger frontal N2 than TBR cues. Critically, TBF elicited a larger late right-frontal positivity than both UI and TBR cues and a larger late parietal positivity than UI cues. Moreover, the late right-frontal positivity was correlated with better recognition performance. It may therefore reflect processing orientation rather than inhibition per se. Results suggest that, when compared to UI cues, both TBR and TBF cues are processed actively. Distinct processing is seen at right frontal and centroparietal positive ERPs that may mediate better subsequent recognition of TBF than of UI items.

Transcranial Stimulation Over the Dorsolateral Prefrontal Cortex Increases the Impact of Past Expenses on Decision-Making

Goal-directed choices should be guided by the expected value of the available options. However, people are often influenced by past costs in their decisions, thus succumbing to a bias known as the "sunk-cost effect." Recent functional magnetic resonance imaging data show that the sunk-cost effect is associated with increased activity in dorsolateral prefrontal cortex (dlPFC) and altered crosstalk of the dlPFC with other prefrontal areas. Are these correlated neural processes causally involved in the sunk-cost effect? Here, we employed transcranial direct current stimulation (tDCS) to examine the role of the dlPFC for biasing choices in line with the cost of past expenses. Specifically, we applied different types of tDCS over the right dlPFC while participants performed an investment task designed to assess the impact of past investments on current choices. Our results show a pronounced sunk-cost effect that was significantly increased by anodal tDCS, but left unaltered by cathodal or sham stimulation. Importantly, choices were not affected by stimulation when no prior investments had been made, underlining the specificity of the obtained effect. Our findings suggest a critical role of the dlPFC in the sunk-cost effect and thus elucidate neural mechanisms by which past investments may influence current decision-making.

Multitarget transcranial direct current stimulation for freezing of gait in Parkinson's disease

BACKGROUND

Recent findings suggest that transcranial direct current stimulation of the primary motor cortex may ameliorate freezing of gait. However, the effects of multitarget simultaneous stimulation of motor and cognitive networks are mostly unknown. The objective of this study was to evaluate the effects of multitarget transcranial direct current stimulation of the primary motor cortex and left dorsolateral prefrontal cortex on freezing of gait and related outcomes.

METHODS

Twenty patients with Parkinson's disease and freezing of gait received 20 minutes of transcranial direct current stimulation on 3 separate visits. Transcranial direct current stimulation targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously, primary motor cortex only, or sham stimulation (order randomized and double-blinded assessments). Participants completed a freezing of gait-provoking test, the Timed Up and Go, and the Stroop test before and after each transcranial direct current stimulation session.

RESULTS

Performance on the freezing of gait-provoking test (P = 0.010), Timed Up and Go (P = 0.006), and the Stroop test (P = 0.016) improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after primary motor cortex only or sham stimulation.

CONCLUSIONS

Transcranial direct current stimulation designed to simultaneously target motor and cognitive regions apparently induces immediate aftereffects in the brain that translate into reduced freezing of gait and improvements in executive function and mobility. © 2018 International Parkinson and Movement Disorder Society.

Switching between Multiple Codes of SNARC-Like Associations: Two Conceptual Replication Attempts with Anodal tDCS in Sham-Controlled Cross-Over Design

In societies with left-to-right reading direction, left-side vs. right-side behavioral decisions are faster for relatively small vs. large number magnitudes, and vice versa, a phenomenon termed Spatial-Numerical Associations of Response Codes (SNARC) effect. But also for non-numerical sequential items, SNARC-like effects were observed, suggesting a common neurocognitive mechanism based on the ordinal structures of both numbers and sequences. Modulation of prefrontal networks that are involved in providing spatial associations during cognitive behavior can contribute to elaborate their neuropsychological theoretical foundations. With transcranial direct current stimulation (tDCS) directed to the left prefrontal cortex, we recently showed that (i) cathodal tDCS can block the emergence of spatial-numerical associations and that (ii) anodal tDCS can reverse spatial associations of sequential order, most likely based on markedness correspondence. Two conceptual replication attempts of the latter reversal of space-order associations are presented in the current sham-controlled experiment, using either weekdays (Monday-Friday) or month names (January-December) as stimuli in the temporal order classification task. In addition, to control for possible influences of notation, number stimuli were presented as written German names (One-Five). We report on a successful modulation of spatial-numerical associations of response codes (SNARC) effects with month stimuli induced by anodal tDCS, but failed to observe the same reversal of SNARC effects for weekday stimuli. The former stimulation effect was orthogonal to the small anodal tDCS effect on written number words, which replicates the dissociation of SNARC effects for numbers vs. non-numerical sequences. Moreover, this result reinforces the hypothesis that the ordinal item and task structure was the source of dissociation (as opposed to verbal presentation). We suggest that the diverging results can be explained by the markedness correspondence account of spatial associations in a multiple coding framework. Left-hemispheric prefrontal excitation from anodal tDCS renders verbal markedness relatively more dominant, but this effect is not absolute. We discuss task contagion, study design, and individual differences in performance measures or tDCS response as possible contributors to systematic variation of the weights of multiple coding parameters for spatial-numerical associations.

No effect of transcranial direct current stimulation of the dorsolateral prefrontal cortex on short-term memory

INTRODUCTION

Short-term memory refers to the capacity for holding information in mind for a short period of time with conscious memorization. It is an important ability for daily life and is impaired in several neurological and psychiatric disorders. Anodal transcranial direct current stimulation (tDCS) applied to the dorsolateral prefrontal cortex (DLPFC) was reported to enhance the capability of short-term memory in healthy subjects. However, results were not consistent and what is the possible impact factor is not known. One important factor that may significantly influence the effect of tDCS is the timing of tDCS administration.

AIMS

In order to explore whether tDCS impact short-term memory and the optimal timing of tDCS administration, we applied anodal tDCS to the left DLPFC to explore the modulatory effect of online and off-line tDCS on digit span as well as visual short-term memory performance in healthy subjects.

RESULTS

Results showed tDCS of the left DLPFC did not influence intentional digit span memory performance, whether before the task or during the task. In addition, tDCS of the DLPFC administered before the task showed no effect on visual short-term memory, while there was a trend of increase in false alarm when tDCS of the DLPFC administered during the task.

CONCLUSIONS

These results did not provide evidence for the enhancement of short-term memory by tDCS of the left DLPFC in healthy subjects, but it suggested an importance of administration time for visual short-term memory. Further studies are required to taking into account the baseline performance of subjects and time-dependence feature of tDCS.

Oscillatory Reinstatement Enhances Declarative Memory

Declarative memory recall is thought to involve the reinstatement of neural activity patterns that occurred previously during encoding. Consistent with this view, greater similarity between patterns of activity recorded during encoding and retrieval has been found to predict better memory performance in a number of studies. Recent models have argued that neural oscillations may be crucial to reinstatement for successful memory retrieval. However, to date, no causal evidence has been provided to support this theory, nor has the impact of oscillatory electrical brain stimulation during encoding and retrieval been assessed. To explore this we used transcranial alternating current stimulation over the left dorsolateral prefrontal cortex of human participants [n = 70, 45 females; age mean (SD) = 22.12 (2.16)] during a declarative memory task. Participants received either the same frequency during encoding and retrieval (60–60 or 90–90 Hz) or different frequencies (60–90 or 90–60 Hz). When frequencies matched there was a significant memory improvement (at both 60 and 90 Hz) relative to sham stimulation. No improvement occurred when frequencies mismatched. Our results provide support for the role of oscillatory reinstatement in memory retrieval.

SIGNIFICANCE STATEMENT Recent neurobiological models of memory have argued that large-scale neural oscillations are reinstated to support successful memory retrieval. Here we used transcranial alternating current stimulation (tACS) to test these models. tACS has recently been shown to induce neural oscillations at the frequency stimulated. We stimulated over the left dorsolateral prefrontal cortex during a declarative memory task involving learning a set of words. We found that tACS applied at the same frequency during encoding and retrieval enhances memory. We also find no difference between the two applied frequencies. Thus our results are consistent with the proposal that reinstatement of neural oscillations during retrieval supports successful memory retrieval.

Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines

Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.

Therapeutic effect of transcranial direct current stimulation on neuropsychological symptoms of an elderly patient: A case report

ABSTRACT Although growing evidence points to the potential therapeutic effects of transcranial Direct Current Stimulation (tDCS), there is still no consensus on the most appropriate protocol to be used in specific neurological and neuropsychological symptoms. This case report evaluated the neuromodulatory therapeutic effects of two 15-day courses of tDCS on an elderly female patient, aged 78 years with mild neurocognitive disorder, chronic pain and depression-related symptoms. Results indicated an overall significant improvement of cognitive and executive functions, as well as reduction in both depression and chronic pain symptoms. These results highlight the potential of tDCS as a safe and useful neuromodulatory clinical tool in the rehabilitation of elderly patients.

Augmentation of working memory training by transcranial direct current stimulation (tDCS)

Transcranial direct current stimulation (tDCS) to the dorsolateral prefrontal cortex (dlPFC) can modulate working memory (WM) performance. However, evidence regarding the enhancement of WM training, its sustainability and transferability is ambiguous. Since WM functioning appears to be lateralized in respect to stimulus characteristics, this study examined the difference between task-congruent (spatial-right, verbal-left), task-incongruent (spatial-left, verbal-right) and sham tDCS in regards to the efficacy of WM training. In a randomized, sham-controlled experiment, 71 healthy adults trained on a spatial or verbal adaptive n-back task. After a baseline session, anodal or sham tDCS (1 mA) to the right or left dlPFC was applied during the next three training sessions. Sustainability of training gains and near-transfer (verbal or spatial 3-back task) were tested in a fourth training and a follow-up session. Compared to sham stimulation, we found a steeper learning curve when WM training was combined with task-congruent tDCS. This advantage was also present compared to task-incongruent tDCS. Moreover, these effects lasted for up to nine months and transferred to the respective untrained task. These long-lasting, transferable, task-specific effects demonstrate a behaviorally relevant and sustainable facilitation of neuroplastic processes by tDCS that could be harnessed for the treatment of disorders associated with deficient WM.

Transcranial Electrical Stimulation to Enhance Cognitive Performance of Healthy Minors: A Complex Governance Challenge

An increasing number of healthy adolescents are consuming products that can enhance their cognitive performance in educational settings. Currently, the use of pharmaceuticals is the most widely discussed enhancement method in the literature, but new evidence suggests that other methods based on Transcranial Electrical Stimulation (tES) also have potential as cognitive enhancer. Just like pharmaceutical enhancers, the availability and education-related use of tES-devices raise a broad range of ethical, legal, and societal issues that need to be addressed by policy-makers. Few studies, however, have specifically explored these issues in relation to child wellbeing. In this narrative review with systematic search, we describe the issues for child wellbeing that could arise from the availability and education-related use of tES-based enhancers by healthy minors. We demonstrate that the issues form a complex web of uncertainties and concerns, which are mainly incited by two factors. First is the high level of factual uncertainty due to gaps in empirical evidence about the exact working mechanisms and efficacy of tES. Moreover, a lack of insight into the technique’s (long-term) effects on healthy developing brains, and uncertainties about potential cognitive trade-offs have fueled concerns about the technique’s safety and impact. The second factor that contributes to the complexity of issues is the presence of moral diversity in our society. Different opinions exist on whether a certain enhancement effect would be desirable and whether potential risks would be acceptable. These opinions depend on one’s moral perspective, and the way one interprets and weights values such as the child’s autonomy and authenticity. The challenge for proper governance resides in the design of an appropriate framework that is capable of balancing the different moral perspectives in society, while recognizing the uncertainties that still exist. We therefore argue for a responsible innovation approach, which encourages an adaptive attitude toward emerging knowledge and dynamic societal values, to deal with the identified issues regarding tES-based enhancement appropriately.

Activating Developmental Reserve Capacity Via Cognitive Training or Non-invasive Brain Stimulation: Potentials for Promoting Fronto-Parietal and Hippocampal-Striatal Network Functions in Old Age

Existing neurocomputational and empirical data link deficient neuromodulation of the fronto-parietal and hippocampal-striatal circuitries with aging-related increase in processing noise and declines in various cognitive functions. Specifically, the theory of aging neuronal gain control postulates that aging-related suboptimal neuromodulation may attenuate neuronal gain control, which yields computational consequences on reducing the signal-to-noise-ratio of synaptic signal transmission and hampering information processing within and between cortical networks. Intervention methods such as cognitive training and non-invasive brain stimulation, e.g., transcranial direct current stimulation (tDCS), have been considered as means to buffer cognitive functions or delay cognitive decline in old age. However, to date the reported effect sizes of immediate training gains and maintenance effects of a variety of cognitive trainings are small to moderate at best; moreover, training-related transfer effects to non-trained but closely related (i.e., near-transfer) or other (i.e., far-transfer) cognitive functions are inconsistent or lacking. Similarly, although applying different tDCS protocols to reduce aging-related cognitive impairments by inducing temporary changes in cortical excitability seem somewhat promising, evidence of effects on short- and long-term plasticity is still equivocal. In this article, we will review and critically discuss existing findings of cognitive training- and stimulation-related behavioral and neural plasticity effects in the context of cognitive aging, focusing specifically on working memory and episodic memory functions, which are subserved by the fronto-parietal and hippocampal-striatal networks, respectively. Furthermore, in line with the theory of aging neuronal gain control we will highlight that developing age-specific brain stimulation protocols and the concurrent applications of tDCS during cognitive training may potentially facilitate short- and long-term cognitive and brain plasticity in old age.

Genetic Modulation of Transcranial Direct Current Stimulation Effects on Cognition

High inter-individual variability substantially challenges the explanatory power of studies on the modulation of cognitive functions with transcranial direct current stimulation (tDCS). These differences in responsivity have been linked with a critical state-dependency of stimulation effects. In general, genetic diversity is a decisive biological basis of variations in neuronal network functioning. Therefore, it is most likely that inter-individual variability of tDCS-induced changes in cognitive functions is due to specific interactions between genetically determined network properties and the specific type of stimulation. In this context, predominantly the brain-derived neurotrophic factor (BDNF) Val66Met and the catechol-O-methyltransferase (COMT) Val108/158Met polymorphisms have been investigated. The studies on the interaction between the BDNF Val66Met polymorphism and the effect of brain stimulation indicate a critical but yet heterogeneous interaction. But up to now, data on the interplay between this polymorphism and tDCS on cognitive functioning are not available. However, recently, the functional Val(108/158)Met polymorphism in the COMT gene, that is particularly involved in the regulation of executive functions by means of the dopaminergic tone in frontal brain areas, has been demonstrated to specifically predict the effect of tDCS on cognitive control. Following an inverted U-shaped function, the high dopaminergic activity in Met allele homozygous individuals has been shown to be associated with a reduction of executive functioning by anodal tDCS to the prefrontal cortex. Consistently, Val homozygous individuals with lower dopaminergic tone show a clear reduction of response inhibition with cathodal tDCS. These findings exemplify the notion of a complex but neurophysiologically consistent interaction between genetically determined variations of neuronal activity and tDCS, particularly in the cognitive domain. Consequently, a systematic analysis and consideration of genetic modulators of tDCS effects will be helpful to improve the efficacy of brain stimulation and particularly tDCS in the investigation and treatment of cognitive functions.

Counteracting Implicit Conflicts by Electrical Inhibition of the Prefrontal Cortex

Cognitive conflicts and distractions by task-irrelevant information often counteract effective and goal-directed behaviors. In some cases, conflicting information can even emerge implicitly, without an overt distractor, by the automatic activation of mental representations. For instance, during number processing, magnitude information automatically elicits spatial associations resembling a mental number line. This spatial–numerical association of response codes (SNARC) effect can modulate cognitive-behavioral performance but is also highly flexible and context-dependent, which points toward a critical involvement of working memory functions. Transcranial direct current stimulation to the PFC, in turn, has been effective in modulating working memory-related cognitive performance. In a series of experiments, we here demonstrate that decreasing activity of the left PFC by cathodal transcranial direct current stimulation consistently and specifically eliminates implicit cognitive conflicts based on the SNARC effect, but explicit conflicts based on visuospatial distraction remain unaffected. This dissociation is polarity-specific and appears unrelated to functional magnitude processing as classified by regular numerical distance effects. These data demonstrate a causal involvement of the left PFC in implicit cognitive conflicts based on the automatic activation of spatial–numerical processing. Corroborating the critical interaction of brain stimulation and neurocognitive functions, our findings suggest that distraction from goal-directed behavior by automatic activation of implicit, task-irrelevant information can be blocked by the inhibition of prefrontal activity.

Transcranial Electrical Stimulation: What We Know and Do Not Know About Mechanisms

In recent years, there has been remarkable progress in the understanding and practical use of transcranial electrical stimulation (tES) techniques. Nevertheless, to date, this experimental effort has not been accompanied by substantial reflections on the models and mechanisms that could explain the stimulation effects. Given these premises, the aim of this article is to provide an updated picture of what we know about the theoretical models of tES that have been proposed to date, contextualized in a more specific and unitary framework. We demonstrate that these models can explain the tES behavioral effects as distributed along a continuum from stimulation dependent to network activity dependent. In this framework, we also propose that stochastic resonance is a useful mechanism to explain the general online neuromodulation effects of tES. Moreover, we highlight the aspects that should be considered in future research. We emphasize that tES is not an "easy-to-use" technique; however, it may represent a very fruitful approach if applied within rigorous protocols, with deep knowledge of both the behavioral and cognitive aspects and the more recent advances in the application of stimulation.

Controlling the Emotional Bias: Performance, Late Positive Potentials, and the Effect of Anodal Transcranial Direct Current Stimulation (tDCS)

Cognitive control of emotional processing is essential for adaptive human behavior. Biased attention toward emotionally salient information is critically linked with affective disorders and is discussed as a promising treatment target. Anodal (activity enhancing) transcranial direct current stimulation (tDCS) has been shown to increase healthy and impaired cognitive control over emotional distraction and is therefore widely used for the investigation and experimental treatment of this disorder. In this study, event-related potential (ERP) were recorded parallel to tDCS to track its online effects. Healthy volunteers (n = 87) performed a delayed working memory paradigm with emotional salient and neutral distractors during stimulation with different intensities (sham, 0.5, 1, 1.5 mA). Measuring the late positive potential (LPP), an ERP that indexes attention allocation, we found that a valence-specific increase of the early portion of the LPP (eLPP, 250-500 ms) was associated with less emotional distraction in the sham group. Of note, stimulation with tDCS exerted an intensity related effect on this correlation. The later part of the LPP (lLPP, 500-1000 ms) was found to be correlated with reaction time, regardless of valence. General effect of tDCS on LPPs and task performance were not observed. These findings demonstrate that ERP recordings parallel to tDCS are feasible to investigate the neuronal underpinnings of stimulation effects on executive functions. Furthermore, they support the notion that the LPP induced by a distractive stimulus during a working memory task mirrors the additional allocation of neuronal resources with a specific sensitivity of the early LPP for highly arousing negative stimuli. Finally, together with the variable magnitude and direction of the emotional bias, the lack of systematic modulations of LPPs and behavior by tDCS further underlines the important influence of the individual brain activity patterns on stimulation effects both on the behavioral and neurophysiological level.

Transcranial Stimulation of the Dorsolateral Prefrontal Cortex Prevents Stress-Induced Working Memory Deficits

Stress is known to impair working memory performance. This disruptive effect of stress on working memory has been linked to a decrease in the activity of the dorsolateral prefrontal cortex (dlPFC). In the present experiment, we tested whether transcranial direct current stimulation (tDCS) of the dlPFC can prevent stress-induced working memory impairments. We tested 120 healthy participants in a 2 d, sham-controlled, double-blind between-subjects design. Participants completed a test of their individual baseline working memory capacity on day 1. On day 2, participants were exposed to either a stressor or a control manipulation before they performed a visuospatial and a verbal working memory task. While participants completed the tasks, anodal, cathodal, or sham tDCS was applied over the right dlPFC. Stress impaired working memory performance in both tasks, albeit to a lesser extent in the verbal compared with the visuospatial working memory task. This stress-induced working memory impairment was prevented by anodal, but not sham or cathodal, stimulation of the dlPFC. Compared with sham or cathodal stimulation, anodal tDCS led to significantly better working memory performance in both tasks after stress. Our findings indicate a causal role of the dlPFC in working memory impairments after acute stress and point to anodal tDCS as a promising tool to reduce cognitive deficits related to working memory in stress-related mental disorders, such as depression, schizophrenia, or post-traumatic stress disorder.

SIGNIFICANCE STATEMENT

Working memory deficits are prominent in stress-related mental disorders, such as depression, schizophrenia, or post-traumatic stress disorder. Similar working memory impairments have been observed in healthy individuals exposed to acute stress. So far, attempts to prevent such stress-induced working memory deficits focused mainly on pharmacological interventions. Here, we tested the idea that transcranial direct current stimulation of the dorsolateral prefrontal cortex (dlPFC), a critical neural substrate of working memory, may prevent working memory impairments after stress. Our results indicate that anodal stimulation of the dlPFC may indeed preserve working memory performance under stress, suggesting that the dlPFC plays a causal role in stress-induced working memory deficits and pointing to a potential new avenue to prevent stress-induced cognitive impairments.

A network approach for modulating memory processes via direct and indirect brain stimulation: Toward a causal approach for the neural basis of memory

Electrical stimulation of the brain is a unique tool to perturb endogenous neural signals, allowing us to evaluate the necessity of given neural processes to cognitive processing. An important issue, gaining increasing interest in the literature, is whether and how stimulation can be employed to selectively improve or disrupt declarative memory processes. Here, we provide a comprehensive review of both invasive and non-invasive stimulation studies aimed at modulating memory performance. The majority of past studies suggest that invasive stimulation of the hippocampus impairs memory performance; similarly, most non-invasive studies show that disrupting frontal or parietal regions also impairs memory performance, suggesting that these regions also play necessary roles in declarative memory. On the other hand, a handful of both invasive and non-invasive studies have also suggested modest improvements in memory performance following stimulation. These studies typically target brain regions connected to the hippocampus or other memory "hubs," which may affect endogenous activity in connected areas like the hippocampus, suggesting that to augment declarative memory, altering the broader endogenous memory network activity is critical. Together, studies reporting memory improvements/impairments are consistent with the idea that a network of distinct brain "hubs" may be crucial for successful memory encoding and retrieval rather than a single primary hub such as the hippocampus. Thus, it is important to consider neurostimulation from the network perspective, rather than from a purely localizationalist viewpoint. We conclude by proposing a novel approach to neurostimulation for declarative memory modulation that aims to facilitate interactions between multiple brain "nodes" underlying memory rather than considering individual brain regions in isolation.