Repetitive transcranial magnetic stimulation for the treatment of Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials

Dong, Xin; Yan, Lanyun; Huang, Lin; Guan, Xinying; Dong, Changhong; Tao, Huimin; Wang, Teng; Qin, Xiaoxuan; Wan, Qi

doi:10.1371/journal.pone.0205704

Cited by 60 publications

(73 citation statements)

References 35 publications

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“…It was also notable that improvements in cognition in both groups did not correlate with improvements in mood as would most typically be expected. Multiple lines of evidence have supported the notion that rTMS has the capacity to improve cognition across different neuropsychiatric disorders (for example [40,41]) and our data here in a very preliminary way suggest that potentially iTBS may have more of a pro-cognitive effect than standard TMS approaches.…”

Section: Discussionsupporting

confidence: 65%

A pilot investigation of an intensive theta burst stimulation protocol for patients with treatment resistant depression

et al. 2020

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Introduction: Accelerated or intensive forms of repetitive transcranial magnetic stimulation (rTMS) are increasingly being explored for their potential to produce more efficient and rapid treatment benefits in major depressive disorder (MDD). However, accelerated or intensive protocols using standard forms of rTMS are still quite time-consuming to apply. Theta burst stimulation (TBS) is a novel form of magnetic stimulation with the potential to produce similar anti-depressant effects but in a much abbreviated period of time. The aim of this study was to investigate the comparative efficacy of an intensive TBS protocol compared to standard rTMS treatment. Methods: 74 outpatients (36 female, mean age 44.36 ± 12.1 years) with MDD received either intensive TBS (3 intermittent TBS treatments per day for 3 days in week 1, 3 treatments a day for 2 days in week 2, and 3 treatments in 1 day in week 3 and in week 4, or standard rTMS (5 daily sessions per week for 4 weeks). Patients were assessed weekly throughout the treatment course, and at 4 weeks after treatment end. Results: There were no significant differences in the degree of reduction in depressive symptoms, the rate of reduction in depressive symptoms, remission or response rates (response rates ¼ 27.8% for intensive group, 26.3% for the standard group, p > 0.05 for all analyses) between the intensive TBS and standard rTMS treatment groups. However, the overall response and remission rates were limited in both groups. There was no difference in rates of side effects, no serious adverse events and no alterations in cognitive performance. Conclusion: Intensively applied TBS appears to have similar efficacy to standard rTMS when these were applied as delivered in this study but does not produce more rapid clinical benefits. The overall response rates in both groups in this study were limited, most likely by the total doses provided in both study arms. Clinical trials registration: Australian New Zealand Clinical Trials Registry: ACTRN12616000443493.

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Section: Discussionsupporting

confidence: 65%

A pilot investigation of an intensive theta burst stimulation protocol for patients with treatment resistant depression

et al. 2020

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“…Finally, a variety of approaches to brain stimulation are under development. Non-invasive stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has shown some evidence of benefit on cognition in AD in two recent meta-analyses, although the modality of stimulation, target choice, and frequency used were heterogeneous 115116. In deep brain stimulation (DBS), electrodes are implanted to stimulate targeted regions.…”

Section: Emerging Treatmentsmentioning

confidence: 99%

Cognitive symptoms of Alzheimer’s disease: clinical management and prevention

Joe

Ringman

2019

BMJ

207

127

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Alzheimer’s disease (AD) is a progressive neurodegenerative disease characterized by the accumulation of amyloid β in the form of extracellular plaques and by intracellular neurofibrillary tangles, with eventual neurodegeneration and dementia. There is currently no disease-modifying treatment though several symptomatic medications exist with modest benefit on cognition. Acetylcholinesterase inhibitors have a consistent benefit across all stages of dementia; their benefit in mild cognitive impairment and prodromal AD is unproven. Memantine has a smaller benefit on cognition overall which is limited to the moderate to severe stages, and the combination of a cholinesterase inhibitor and memantine may have additional efficacy. Evidence for the efficacy of vitamin E supplementation and medical foods is weak but might be considered in the context of cost, availability, and safety in individual patients. Apparently promising disease-modifying interventions, mostly addressing the amyloid cascade hypothesis of AD, have recently failed to demonstrate efficacy so novel approaches must be considered.

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“…The searches identified 6,504 published studies, and after screening the titles and removing duplicates, 41 potentially eligible studies were selected for a closer scrutiny by retrieving the full text. Finally, we included 10 MAs (Lee et al, 2009;Alves et al, 2013;Rao et al, 2014;Zhou et al, 2015Zhou et al, , 2017Dong et al, 2018;Du et al, 2018;Huang et al, 2019;Jia et al, 2019;Wang et al, 2020). The study selection process is shown in Figure 1.…”

Section: Study Selection Processmentioning

confidence: 99%

Overview of Meta-Analyses of Five Non-pharmacological Interventions for Alzheimer's Disease

Wang

Pei

Zhan

et al. 2020

Front. Aging Neurosci.

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Background: Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive memory deficits, cognitive decline, and spatial disorientation. Non-pharmacological interventions to treat AD have been reported in many meta-analyses (MAs), but robust conclusions have not been made because of variations in the scope, quality, and findings of these reviews.Objective: This work aimed to review existing MAs to provide an overview of existing evidence on the effects of five non-pharmacological interventions in AD patients on three outcomes: Mini-Mental State Examination (MMSE), activities of daily living (ADL), and Alzheimer's Disease Assessment Scale-cognitive section (ADAS-cog).Methods: The databases PubMed, Cochrane Library, Embase, and Web of Science were searched to collect MAs of non-pharmacological interventions for AD. Two reviewers independently conducted literature screening, data extraction, and quality assessment. We assessed the quality of MAs with the Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and assessed the evidence quality for significant outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.Results: We found 10 eligible MAs, which included between three (133 patients) and 15 randomized trials (1,217 patients), and five non-pharmacological interventions, namely, acupuncture therapy (40%), exercise intervention (30%), music therapy (10%), cognitive intervention (10%), and repetitive transcranial magnetic stimulation (rTMS) (10%). All the included MAs were critically low to low quality by AMSTAR 2. Acupuncture therapy and exercise intervention showed the preliminary potential to improve ADL and MMSE. rTMS and acupuncture therapy show benefits in decreasing ADAS-cog, and there were some evidence of improved MMSE with cognitive intervention. All these outcomes scored very low quality to moderate quality of evidence on the GRADE system.Conclusions: Non-pharmacological therapy shows promise for the treatment of AD, but there is still a lack of high-quality evidence. In the future, the quality of the original research needs to be improved, and strictly designed MAs should be carried out following methodological requirements.

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Repetitive transcranial magnetic stimulation for the treatment of Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials

Cited by 60 publications

References 35 publications

A pilot investigation of an intensive theta burst stimulation protocol for patients with treatment resistant depression

A pilot investigation of an intensive theta burst stimulation protocol for patients with treatment resistant depression

Cognitive symptoms of Alzheimer’s disease: clinical management and prevention

Overview of Meta-Analyses of Five Non-pharmacological Interventions for Alzheimer's Disease

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