Brain Stimulation in the Treatment of Late-Life Severe Mental Illness Other than Unipolar Nonpsychotic Depression

Abstract

Late-life mental illness is a growing concern. Current medications have limited efficacy and are associated with safety concerns. A variety of brain stimulation approaches offer alternative treatments. We performed a systematic literature search on the efficacy and safety of brain stimulation in late-life mental illnesses, excluding unipolar non-psychotic depression. Studies on deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and vagal nerve stimulation (VNS) that enrolled exclusively older adults (age 65 or older) or analyzed older adults as a separate group were included. The search identified 1,181 publications, of which 43 met the above inclusion criteria: 24 were related to the treatment of non-unipolar depression (ECT: 21; rTMS: 2; ECT and rTMS: 1), 14 to dementia (ECT: 7; VNS: 2; rTMS: 4; DBS: 1) – three ECT studies included under both depression and dementia – and 7 to schizophrenia (ECT: 7). These studies reported a high degree of variability in efficacy and safety with promising results in general, particularly in the treatment of dementia and schizophrenia. Most publications were limited by small sample sizes, lack of control conditions, and lack of randomization. Large studies with a randomized controlled design or other designs such as crossover or off-on-off-on are needed. In contrast to the empiric and nonspecific use of ECT, future studies using modalities other than ECT could focus on novel biologically-based interventions that can target specific circuitry. These interventions could also be combined with other non-brain stimulation treatments for possible synergistic effects.

Multimodal MRI of the hippocampus in Parkinson’s disease with visual hallucinations

“…The microstructural and functional connectivity findings are consistent with the hypothesis of imbalanced integration of internal memory and external visual input (Diederich et al 2005 ; Goetz 2009 ) which contribute to visual hallucinations in Parkinson’s disease, and implicating that this pathological phenomenon can be underlied by the microstructural deficit and dysfunction in hippocampus. The consistent result of the hippocampal biomarker indicated in the present study supports future development of therapeutic strategy on the basis of neuro-guided stimulation approach, such as transcranial magnetic stimulation (TMS) (Liu et al 2013 ) and transcranial direct current stimulation (tDCS) (Brunoni et al 2013 ) to modulate the connectivity strength of visual networks.…”

Cognition in Late-Life Depression: Treatment Considerations

“…It has been proposed that potential pro-cognitive effects of DBS may be enhanced by combining stimulation with another intervention, such as cognitive remediation [64]. …”

Adverse events of repetitive transcranial magnetic stimulation in older adults with depression, a systematic review of the literature

“…16 Rare serious AE (<1%) are seizures and induction of hypomania, hearing changes and burns from the coil. 4,14,[17][18][19][20][21] Most often, people aged over 60 are excluded from trials. The National Institute for Health Care Excellence (NICE)-guideline of rTMS for depression is based on studies with a mean age between 38.4 and 50.5 years, the remaining studies used in the NICE-guideline did not mention a mean age.…”

“…Studies on the tolerability of rTMS in adults has reported several AE such as headache (9.7%), local pain and discomfort (9.3%), and neck pain, toothache, and paresthesia (together 4.7%) 16 . Rare serious AE (<1%) are seizures and induction of hypomania, hearing changes and burns from the coil 4,14,17‐21 …”