A Meta-Analysis of the Effect of Multisession Transcranial Direct Current Stimulation on Cognition in Dementia and Mild Cognitive Impairment

Inagawa, Takuma; Narita, Zui; Sugawara, Norio; Maruo, Kazushi; Stickley, Andrew; Yokoi, Yuma; Sumiyoshi, Tomiki

doi:10.1177/1550059418800889

Cited by 43 publications

(35 citation statements)

References 51 publications

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“…These techniques provide promising and multiple beneficial opportunities in neurologic and psychiatric diseases (Fregni et al, 2006a; Knöchel et al, 2012; Kuo et al, 2014; Forbes et al, 2015) and also in health (Choe et al, 2016; Ward et al, 2017). More specifically, there is increasing evidence from clinical trials that both tDCS and AE can be beneficial in stroke (Duncan et al, 2003; Fregni et al, 2005; Tang et al, 2009; Brunoni et al, 2012; Marquez et al, 2015), fibromyalgia (Castillo-Saavedra et al, 2016; Fink and Lewis, 2017), Alzheimer’s disease (Ferrucci et al, 2008; Intlekofer and Cotman, 2013; Farina et al, 2014; Hsu et al, 2015; Inagawa et al, 2018), Parkinson’s disease (Fregni et al, 2006c; Schenkman et al, 2012), major depressive disorder (Fregni et al, 2006b; Kuo et al, 2014; Schuch et al, 2016; Yokoi et al, 2018), and schizophrenia treatments (Gorczynski and Faulkner, 2010; Kuo et al, 2014; Smith et al, 2015; Yokoi et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

A Review of Acute Aerobic Exercise and Transcranial Direct Current Stimulation Effects on Cognitive Functions and Their Potential Synergies

Steinberg

Pixa

Fregni

2019

Front. Hum. Neurosci.

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Today, several pharmaceutic and non-pharmaceutic approaches exist to treat psychiatric and neurological diseases. Because of the lack of treatment procedures that are medication free and without severe side effects, transcranial direct current stimulation (tDCS) and aerobic exercise (AE) have been tested to explore the potential for initiating and modulating neuroplasticity in the human brain. Both tDCS and AE could support cognition and behavior in the clinical and non-clinical context to improve the recovery process within neurological or psychiatric conditions or to increase performance. As these techniques still lack meaningful effects, although they provide multiple beneficial opportunities within disease and health applications, there is emerging interest to find improved tDCS and AE protocols. Since multimodal approaches could provoke synergetic effects, a few recent studies have begun to combine tDCS and AE within different settings such as in cognitive training in health or for treatment purposes within clinical settings, all of which show superior effects compared to single technique applications. The beneficial outcomes of both techniques depend on several parameters and the understanding of neural mechanisms that are not yet fully understood. Recent studies have begun to directly combine tDCS and AE within one session, although their interactions on the behavioral, neurophysiological and neurochemical levels are entirely unclear. Therefore, this review: (a) provides an overview of acute behavioral, neurophysiological, and neurochemical effects that both techniques provoke within only one single application in isolation; (b) gives an overview regarding the mechanistic pathways; and (c) discusses potential interactions and synergies between tDCS and AE that might be provoked when directly combining both techniques. From this literature review focusing primarily on the cognitive domain in term of specific executive functions (EFs; inhibition, updating, and switching), it is concluded that a direct combination of tDCS and AE provides multiple beneficial opportunities for synergistic effects. A combination could be useful within non-clinical settings in health and for treating several psychiatric and neurologic conditions. However, there is a lack of research and there are several possibly interacting moderating parameters that must be considered and more importantly must be systematically investigated in the future.

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Section: Introductionmentioning

confidence: 99%

A Review of Acute Aerobic Exercise and Transcranial Direct Current Stimulation Effects on Cognitive Functions and Their Potential Synergies

Steinberg

Pixa

Fregni

2019

Front. Hum. Neurosci.

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“…However, many previous studies did not provide sample size calculations and, thus, the results from these studies may be false-negatives, when the results are actually positive. Further, according to our meta-analytic review (Inagawa et al, 2018), the quality of study designs in these previous studies seems to be poor. In fact, many of them did not clearly state allocation concealment, blinding of personnel, or any method of handling missing data.…”

Section: Introductionmentioning

confidence: 94%

“…A recent meta-analysis of randomized controlled trials indicated that tDCS may be effective on cognition in healthy participants (Dedoncker et al, 2016); however, a meta-analysis of randomized controlled trials on the effect of tDCS on cognition in patients with dementia and MCI shows that tDCS is not always effective overall (Inagawa et al, 2018). The discord among the findings of these studies may be due to differences in the electrode montage, stimulation parameters, and timing of tDCS in the training tasks (Liu et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…The discord among the findings of these studies may be due to differences in the electrode montage, stimulation parameters, and timing of tDCS in the training tasks (Liu et al, 2017). Further, according to our systematic review and meta-analysis (Inagawa et al, 2018), only one study among the 11 previous studies on the effects of tDCS on cognition in dementia and MCI described a plan to provide sample size calculation. In addition, although we had planned to estimate sample size from previous studies, no study assessed the effect of tDCS combined with cognitive rehabilitation in patients with MCI at July 2016, when we started this study.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Feasibility of Transcranial Direct Current Stimulation for Cognitive Rehabilitation in Patients With Mild or Major Neurocognitive Disorders: A Randomized Sham-Controlled Pilot Study

Inagawa

Yokoi

Narita

et al. 2019

Front. Hum. Neurosci.

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IntroductionTranscranial direct current stimulation (tDCS) is a potentially novel strategy for cognitive enhancement in patients with mild or major neurocognitive disorders. This study aims to assess the safety and efficacy of tDCS during cognitive training on cognitive functioning in patients with mild or major neurocognitive disorders.MethodsThis study was primarily a single arm for safety, secondary a two-arm, parallel, randomized, and sham-controlled trial for potential efficacy. Patients with mild or major neurocognitive disorders were recruited. The participants and raters were blinded to the group assignment. The participants in the active arm received tDCS (anodal; F3, cathodal, Fp2, 2A, 20 min) twice daily for five consecutive days, whereas those in the sham arm received the same amount of sham-tDCS. Calculation and reading tasks were conducted in both arms as a form of cognitive intervention for 20 min during tDCS. The primary outcome was the attrition rate during the trial in the active arm, which is expected to be less than 10%. The secondary outcomes were the between-group differences of adjusted means for several cognitive scales from baseline to post-intervention and follow-up.ResultsTwenty patients [nine women (45%)], with a mean (standard deviation) age of 76.1 years participated; nine patients (45%) with minor neurocognitive disorders and 11 (55%) with major neurocognitive disorders were randomized, and 19 of them completed the trial. The attrition rate in the active arm was 0%, with no serious adverse events. Further, in the Intention-to-Treat analysis, patients in the active arm showed no statistically significant improvement compared with those who received the sham in the mean change scores of the mini-mental state examination [0.41; 95% CI (−1.85; 2.67) at day five, 1.08; 95% CI (−1.31; 3.46) at follow-up] and Alzheimer’s disease assessment scale – cognition subscale [1.61; 95% CI (−4.2; 0.98) at day 5, 0.36; 95%CI (−3.19; 2.47) at follow-up].ConclusionThese findings suggest that tDCS is safe and tolerable but causes no statistically significant cognitive effects in patients with mild or major neurocognitive disorders. Additional large-scale, well-designed clinical trials are warranted to evaluate the cognitive effects of tDCS as an augmentation to cognitive training.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT03050385.

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“…Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are two forms of noninvasive brain stimulation (NIBS) that are showing promise as potential treatments for AD and related conditions. Although there are several excellent reviews on NIBS and AD, this scoping review focuses on the randomized controlled trials (RCTs) that tested rTMS and tDCS in AD and mild cognitive impairment (MCI) and highlights for future studies some considerations related to mechanistic targets and methodological parameters.…”

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confidence: 99%

Transcranial Magnetic and Electrical Stimulation in Alzheimer's Disease and Mild Cognitive Impairment: A Review of Randomized Controlled Trials

Rajji

2019

Clin Pharma and Therapeutics

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Alzheimer's disease (AD) and related dementia is an immense personal and public health burden. Available treatments have modest efficacy in reducing symptoms of AD and have no significant impact on the course of the illness. Moreover, attempts to discover novel treatments have to date failed. Noninvasive brain stimulation comprises a suite of interventions that are based on transcranial magnetic or electric stimulation of different brain regions. Promising findings are emerging from two forms of noninvasive brain stimulation: repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Here, the results from the randomized controlled trials (RCTs) that assessed rTMS or tDCS in AD or in mild cognitive impairment, a clinical state that typically preceded AD, are reviewed. Overall, there are few RCTs, and most of them are limited by small sample sizes. Larger RCTs and additional research are needed to identify the best stimulation parameters for these two interventions.

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A Meta-Analysis of the Effect of Multisession Transcranial Direct Current Stimulation on Cognition in Dementia and Mild Cognitive Impairment

Cited by 43 publications

References 51 publications

A Review of Acute Aerobic Exercise and Transcranial Direct Current Stimulation Effects on Cognitive Functions and Their Potential Synergies

A Review of Acute Aerobic Exercise and Transcranial Direct Current Stimulation Effects on Cognitive Functions and Their Potential Synergies

Safety and Feasibility of Transcranial Direct Current Stimulation for Cognitive Rehabilitation in Patients With Mild or Major Neurocognitive Disorders: A Randomized Sham-Controlled Pilot Study

Transcranial Magnetic and Electrical Stimulation in Alzheimer's Disease and Mild Cognitive Impairment: A Review of Randomized Controlled Trials

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