Repetitive transcranial magnetic stimulation for apathy in mild cognitive impairment: A double-blind, randomized, sham-controlled, cross-over pilot study

Abstract

Apathy is a common and disabling behavioral concomitant of many neurodegenerative conditions. The presence of apathy with Mild Cognitive Impairment (MCI) is linked with heightened rates of conversion to Alzheimer's disease. Improving apathy may slow the neurodegenerative process. The objective was to establish the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving apathy in older adults with MCI. An 8-week, double-blind, randomized, sham-controlled cross-over study was conducted in nine subjects (66 ± 9 years) with apathy and MCI. Subjects were randomized to rTMS or sham treatment (5 days/week) for 2 weeks following which they underwent a 4-week treatment-free period. Subjects then crossed-over to receive the other treatment for 2 weeks. The primary (apathy (AES-C)) and secondary (cognition (3MS & MMSE), executive function (TMT-A & TMT-B), and clinical global impression (CGI)) outcomes were assessed at baseline, 2, 6, and 8 weeks. After adjusting for baseline, there was a significantly greater improvement in the AES-C with rTMS compared to sham treatment at 2 weeks. There was significantly greater improvement in 3MS, MMSE, TMT-A, and CGI-I with rTMS compared to the sham treatment. This study establishes that rTMS is efficacious in improving apathy in subjects with MCI.

Effects of low-frequency repetitive transcranial magnetic stimulation on depression- and anxiety-like behaviors in epileptic rats

“…rTMS is a brain stimulation method widely used in brain function research, which has the characteristics of focal noninvasive. It has made significant progress in neuropsychiatric and rehabilitation fields such as depression, anxiety, cognitive impairment (Padala et al, 2018), Parkinson's disease (Yokoe et al, 2018) and epilepsy (Chen et al, 2016). In some countries, is regarded one of the standard treatments for depression.…”

Transcranial Magnetic Stimulation in Alzheimer’s Disease: Are We Ready?

“…Although some studies have explicitly excluded patients with depression (Cotelli et al, 2006(Cotelli et al, , 2008(Cotelli et al, , 2011Turriziani et al, 2012;Drumond Marra et al, 2015), others have not reported mood disorders as an exclusion criterion (Ahmed et al, 2012;Rabey et al, 2013;Eliasova et al, 2014;Rabey and Dobronevsky, 2016;Nguyen et al, 2017). The degree to which cognitive improvement following TMS in AD results from alleviating depressive symptoms is therefore difficult to judge, but it is notable in this context that treated patients sometimes also exhibit elevated mood, scoring better on depression and apathy scales (Ahmed et al, 2012;Lee et al, 2016;Nguyen et al, 2017;Padala et al, 2018).…”

Virtual Reality Meets Non-invasive Brain Stimulation: Integrating Two Methods for Cognitive Rehabilitation of Mild Cognitive Impairment

“…Another study (72) reported long-term memory and executive functioning improvements after 10 high-frequency rTMS sessions over the left DLPFC. One study (74) considered the effectiveness of rTMS over the DLPCF at reducing apathy, a symptom frequently reported in MCI patients: a significant improvement in apathy scores resulted following 10 sessions of active TMS compared to sham. Interestingly, authors observed positive outcomes in executive functions as well, as assessed by the Trail Making Test (75).…”