Cognitive tasks propagate the neural entrainment in response to a visual 40 Hz stimulation in humans

Parvalbumin interneuron cell-to-network plasticity: mechanisms and therapeutic avenues

Alzheimer's disease (AD) and schizophrenia (SCZ) represent two major neuropathological conditions with a high disease burden. Despite their distinct etiologies, patients suffering from AD or SCZ share a common burden of disrupted memory functions unattended by current therapies. Recent preclinical analyses highlight cell-type-specific contributions of parvalbumin interneurons (PVIs), particularly the plasticity of their cellular excitability, towards intact neuronal network function (cell-to-network plasticity) and memory performance. Here we argue that deficits of PVI cell-to-network plasticity may underlie memory deficits in AD and SCZ, and we explore two therapeutic avenues: the targeting of PVI-specific neuromodulation, including by neuropeptides, and the recruitment of network synchrony in the gamma frequency range (40 Hz) by external stimulation. We finally propose that these approaches be merged under consideration of recent insights into human brain physiology.

Multisensory flicker modulates widespread brain networks and reduces interictal epileptiform discharges

Modulating brain oscillations has strong therapeutic potential. Interventions that both non-invasively modulate deep brain structures and are practical for chronic daily home use are desirable for a variety of therapeutic applications. Repetitive audio-visual stimulation, or sensory flicker, is an accessible approach that modulates hippocampus in mice, but its effects in humans are poorly defined. We therefore quantified the neurophysiological effects of flicker with high spatiotemporal resolution in patients with focal epilepsy who underwent intracranial seizure monitoring. In this interventional trial (NCT04188834) with a cross-over design, subjects underwent different frequencies of flicker stimulation in the same recording session with the effect of sensory flicker exposure on local field potential (LFP) power and interictal epileptiform discharges (IEDs) as primary and secondary outcomes, respectively. Flicker focally modulated local field potentials in expected canonical sensory cortices but also in the medial temporal lobe and prefrontal cortex, likely via resonance of stimulated long-range circuits. Moreover, flicker decreased interictal epileptiform discharges, a pathological biomarker of epilepsy and degenerative diseases, most strongly in regions where potentials were flicker-modulated, especially the visual cortex and medial temporal lobe. This trial met the scientific goal and is now closed. Our findings reveal how multi-sensory stimulation may modulate cortical structures to mitigate pathological activity in humans.

Cognitive and Neuropathophysiological Outcomes of Gamma-tACS in Dementia: A Systematic Review

Despite the numerous pharmacological interventions targeting dementia, no disease-modifying therapy is available, and the prognosis remains unfavorable. A promising perspective involves tackling high-frequency gamma-band (> 30 Hz) oscillations involved in hippocampal-mediated memory processes, which are impaired from the early stages of typical Alzheimer's Disease (AD). Particularly, the positive effects of gamma-band entrainment on mouse models of AD have prompted researchers to translate such findings into humans using transcranial alternating current stimulation (tACS), a methodology that allows the entrainment of endogenous cortical oscillations in a frequency-specific manner. This systematic review examines the state-of-the-art on the use of gamma-tACS in Mild Cognitive Impairment (MCI) and dementia patients to shed light on its feasibility, therapeutic impact, and clinical effectiveness. A systematic search from two databases yielded 499 records resulting in 10 included studies and a total of 273 patients. The results were arranged in single-session and multi-session protocols. Most of the studies demonstrated cognitive improvement following gamma-tACS, and some studies showed promising effects of gamma-tACS on neuropathological markers, suggesting the feasibility of gamma-tACS in these patients anyhow far from the strong evidence available for mouse models. Nonetheless, the small number of studies and their wide variability in terms of aims, parameters, and measures, make it difficult to draw firm conclusions. We discuss results and methodological limitations of the studies, proposing possible solutions and future avenues to improve research on the effects of gamma-tACS on dementia.

Forty-Hertz audiovisual stimulation does not have a promoting effect on visual threshold and visual spatial memory

Previous research has demonstrated that 40-Hz audiovisual stimulation can improve pathological conditions and promote cognitive function in mouse models of Alzheimer's disease. However, limited research has been conducted on humans, and the results have been inconsistent. In our study, we divided participants into an experimental group and a control group to investigate whether 40-Hz stimulation could enhance performance in visual threshold tasks and working memory task. In Experiment 1, we used a light bulb as the stimulus source and found a general practice effect, but no difference between the groups. In Experiment 2, we used a computer screen as the stimulus source and set the stimulation frequency to 48 Hz. In Experiment 3 , we used a computer screen and audio as stimulus sources, simultaneously applying a 40-Hz stimulation to both visual and auditory modalities. Both experiments only revealed the disappearance of practice effects in the 40-Hz (48-Hz) group. Experiment 4 focused on testing visual spatial memory, but did not identify any significant differences between or within groups. In Experiment 5, we tested various visual spatial frequencies; yet again, no significant differences were found. Based on the comprehensive results, we conclude that a 40-Hz stimulation does not have a promoting effect on visual threshold or visual spatial memory.

Audiovisual gamma stimulation for the treatment of neurodegeneration

Alzheimer's disease (AD) is the most common type of neurodegenerative disease and a health challenge with major social and economic consequences. In this review, we discuss the therapeutic potential of gamma stimulation in treating AD and delve into the possible mechanisms responsible for its positive effects. Recent studies reveal that it is feasible and safe to induce 40 Hz brain activity in AD patients through a range of 40 Hz multisensory and noninvasive electrical or magnetic stimulation methods. Although research into the clinical potential of these interventions is still in its nascent stages, these studies suggest that 40 Hz stimulation can yield beneficial effects on brain function, disease pathology, and cognitive function in individuals with AD. Specifically, we discuss studies involving 40 Hz light, auditory, and vibrotactile stimulation, as well as noninvasive techniques such as transcranial alternating current stimulation and transcranial magnetic stimulation. The precise mechanisms underpinning the beneficial effects of gamma stimulation in AD are not yet fully elucidated, but preclinical studies have provided relevant insights. We discuss preclinical evidence related to both neuronal and nonneuronal mechanisms that may be involved, touching upon the relevance of interneurons, neuropeptides, and specific synaptic mechanisms in translating gamma stimulation into widespread neuronal activity within the brain. We also explore the roles of microglia, astrocytes, and the vasculature in mediating the beneficial effects of gamma stimulation on brain function. Lastly, we examine upcoming clinical trials and contemplate the potential future applications of gamma stimulation in the management of neurodegenerative disorders.

Promising neurostimulation routes for targeting the hippocampus to improve episodic memory: A review

This review aims to highlight modern neurostimulation approaches that are effectively activating the hippocampus and enhancing episodic memory performance. The hippocampus is a brain region known to play an essential role in episodic memory processes. However, as it is nestled deep within the brain, it has been a challenging target for traditional neurostimulation approaches, with studies reporting inconsistent memory effects. Recent studies suggest more than half of the electrical current from non-invasive transcranial electrical stimulation (tES) methods may be attenuated by the human scalp, skull, and cerebral spinal fluid. Thus, this review aims to highlight novel neurostimulation approaches that are showing promise as alternative routes for activating hippocampal circuitry. Early evidence suggests temporal interference, closed-loop and individualized protocols, sensory stimulation and peripheral nerve-targeted tES protocols warrant further investigation. These approaches each provide promising routes for activating the hippocampus by a) increasing its functional connectiveness to key brain regions, b) strengthening synaptic plasticity mechanisms, or c) enhancing neural entrainment specifically within and between theta and gamma frequencies in these regions. Importantly, these three functional mechanisms and the hippocampus' structural integrity are negatively impacted throughout the progression of Alzheimer's Disease, with episodic memory deficits likewise evident in early stages. Consequently, depending on further validation of the approaches reviewed here, these techniques could offer significant applied therapeutic value for patients suffering from memory deficits or neurodegenerative diseases including amnestic Mild Cognitive Impairment or Alzheimer's disease.

Auditory or Audiovisual Stimulation Ameliorates Cognitive Impairment and Neuropathology in ApoE4 Knock-In Mice

We hypothesized that auditory stimulation could reduce the progression of Alzheimer’s disease (AD), and that audiovisual stimulation could have additional effects through multisensory integration. We exposed 12 month old Apoetm1.1(APOE*4)Adiuj mice (a mouse model of sporadic AD) to auditory (A) or audiovisual stimulation (AV) at 40 Hz for 14 days in a soundproof chamber system (no stimulation, N). Behavioral tests were performed before and after each session, and their brain tissues were assessed for amyloid-beta expression and apoptotic cell death, after 14 days. Furthermore, brain levels of acetylcholine and apoptosis-related proteins were analyzed. In the Y-maze test, the percentage relative alternation was significantly higher in group A than in group N mice. Amyloid-beta and TUNEL positivity in the hippocampal CA3 region was significantly lower in group A and group AV mice than in group N mice (p < 0.05). Acetylcholine levels were significantly higher in group A and group AV mice than in group N mice (p < 0.05). Compared to group N mice, expression of the proapoptotic proteins Bax and caspase-3 was lower in group A, and expression of the antiapoptotic protein Bcl-2 was higher in group AV. In a mouse model of early-stage sporadic AD, auditory or audiovisual stimulation improved cognitive performance and neuropathology.

An update on the use of gamma (multi)sensory stimulation for Alzheimer's disease treatment

Alzheimer's disease (AD) is characterized by reduced fast brain oscillations in the gamma band (γ, > 30 Hz). Several animal studies show that inducing gamma oscillations through (multi)sensory stimulation at 40 Hz has the potential to impact AD-related cognitive decline and neuropathological processes, including amyloid plaques deposition, neurofibrillary tangles formation, and neuronal and synaptic loss. Therefore Gamma Entrainment Using Sensory stimulation (GENUS) is among the most promising approaches for AD patients' treatment. This review summarizes the evidence on GENUS effectiveness, from animal models to AD patients. Despite the application on human is in its infancy, the available findings suggest its feasibility for the treatment of AD. We discuss such results in light of parameter improvement and possible underlying mechanisms. We finally emphasize the need for further research for its development as a disease-modifying non-pharmacological intervention.