Cold Cognition as Predictor of Treatment Response to rTMS; A Retrospective Study on Patients With Unipolar and Bipolar Depression

Abstract

BackgroundCognitive impairments are prevalent in patients with unipolar and bipolar depressive disorder (UDD and BDD, respectively). Considering the fact assessing cognitive functions is increasingly feasible for clinicians and researchers, targeting these problems in treatment and using them at baseline as predictors of response to treatment can be very informative.MethodIn a naturalistic, retrospective study, data from 120 patients (Mean age: 33.58) with UDD (n = 56) and BDD (n = 64) were analyzed. Patients received 20 sessions of bilateral rTMS (10 Hz over LDLPFC and 1 HZ over RDLPFC) and were assessed regarding their depressive symptoms, sustained attention, working memory, and executive functions, using the Beck Depression Inventory (BDI-II) and Neuropsychological Test Automated Battery Cambridge, at baseline and after the end of rTMS treatment course. Generalized estimating equations (GEE) and logistic regression were used as the main statistical methods to test the hypotheses.ResultsFifty-three percentage of all patients (n = 64) responded to treatment. In particular, 53.1% of UDD patients (n = 34) and 46.9% of BDD patients (n = 30) responded to treatment. Bilateral rTMS improved all cognitive functions (attention, working memory, and executive function) except for visual memory and resulted in more modulations in the working memory of UDD compared to BDD patients. More improvements in working memory were observed in responded patients and visual memory, age, and sex were determined as treatment response predictors. Working memory, visual memory, and age were identified as treatment response predictors in BDD and UDD patients, respectively.ConclusionBilateral rTMS improved cold cognition and depressive symptoms in UDD and BDD patients, possibly by altering cognitive control mechanisms (top-down), and processing negative emotional bias.

Use of transcranial magnetic stimulation (TMS) for studying cognitive control in depressed patients: A systematic review

“…From the studies included, three used LF-rTMS, and all of them used 1-Hz frequency (Bermpohl et al, 2006;Pallanti et al, 2012;Schaffer et al, 2020;Rostami et al, 2022). Pallanti et al (2012) used a three 140-s train at 1 Hz with a 30-s intertrain interval.…”

“…Schaffer et al (2020), however, used 1200 pulses at 1 Hz with stimulation delivered in 1-s pulses. Rostami et al (2022) included a 10-s train of 1 Hz, with an intertrain interval of 2 s.…”

“…Concerto et al (2015) and Spampinato et al (2013) used the same protocol of 4-s train duration and 26-s intertrain interval, for a total of 3000 pulses per session lasting 37.5 min. Kedzior et al (2012) and Rostami et al (2022) set the trains at 5 s, but the intertrain was different, lasting 25 and 10 s, respectively. Vanderhasselt et al (2009) delivered 40 trains of 3.9 s, separated by an intertrain interval of 26.1 s.…”

“…However, Bahun et al (2022), combining the block design subtest with dTMS on the left DLPFC found a significant main effect of time (p = 0.022). Rostami et al (2022) and Levkovitz et al (2009) used a different task: the Stocking of Cambridge. Participants had to copy the display of three coloured balls, making as few moves as possible to match the previous pattern.…”

Rationale and design of a double-blinded, randomized placebo-controlled trial of 40 Hz light neurostimulation therapy for depression (FELIX)

“…In addition, intrinsic gamma activity measured by electroencephalography (EEG) or magnetoencephalography (MEG) is associated with higher cognitive functioning, information processing, and working memory [ 23 , 25 ]. Cognitive deficits occurring with depression have an essential role in treatment response and prognosis, and targeting the cognitive domain in depression could be a promising therapeutic approach [ 26 , 27 ]. Sensory stimulation with 40 Hz has not only been able to entrain gamma activity but increased the expression of brain-derived neurotrophic factor in mice [ 28 ], cleared up amyloid and tau proteins involved in Alzheimer’s disease (AD) rodent models [ 19 , 29–31 ], and improved mood, sleep, and daily functionality in patients with AD [ 31–33 ].…”