Repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training is a safe and effective modality for the treatment of Alzheimer’s disease: clinical experience

Abstract

Alzheimer's disease (AD) is the most common type of dementia among the elderly. Common treatments available and non-pharmacological interventions have their limitations, and new therapeutic approaches are critically needed. Transcranial magnetic stimulation (TMS) is a non-invasive technique that generates an electric current-inducing modulation in cortical excitability. The previous clinical trials showed that combinations of rTMS and cognitive training (rTMS-COG), as provided by the NeuroAD medical device system, offer a novel, safe, and effective method improving mild-to-moderate AD patients. In this article, we present our experience with rTMS-COG treatment, in clinical settings, of 30 mild-to-moderate AD patients that received rTMS-COG commercial treatments in two clinics for 1-h daily sessions, 5 days per week, for 6 weeks (30 sessions). Five patients returned for a second treatment. ADAS-Cog and MMSE scores were measured pre- and post-treatments. The main analyses were conducted on patients who received 1 treatment (n = 30). Data received from the five returning patients were analyzed separately. The effect of rTMS-COG treatment was statistically significant regarding both ADAS-Cog (-2.4 point improvement, PV <0.001) and MMSE (+1.7 points improvement, PV <0.001) scores. About 80 % of patients gained some cognitive improvement following NeuroAD treatment, with more than 60 % improving by more than two points, for a minimum of 9 months. The Neuronix NeuroAD System was shown to be a safe and effective non-invasive modality for cognitive improvement of Alzheimer patients, with measurable outcomes lasting, in some of them, for up to 1 year, following completion of the 6-week daily intervention course (a carryover effect).

Revolution of Alzheimer Precision Neurology. Passageway of Systems Biology and Neurophysiology

“…However, there are few controlled studies for rTMS in AD and even less for tDCS, for a total of a few dozens of patients treated so far [421]. What is emerging as a possible role for non-invasive neuromodulation is the coupling of stimulation with cognitive therapy, with the aim to promote plastic associative learning mechanisms to synergically improve the effects of cognitive rehabilitation only [427–429]. This approach, while still in need of quantitative characterization [430–432] seems promising only in mild AD, when the severity of neurodegeneration makes still available a residual neural substrate to possibly intervene on [433].…”

Non-Invasive Brain Stimulation in Dementia: A Complex Network Story

“…For studies with AD patients, roughly half of studies employed tDCS as the stimulation tool [81-87], the other using TMS [88-94]. Moreover, the majority of the studies have focused on memory, the core clinical symptom.…”

“…Moreover, the majority of the studies have focused on memory, the core clinical symptom. Ten studies were designed as multiple session paradigm [81, 83, 84, 86-88, 90, 92-94], and a cognitive training was combined with the stimulation protocol in 3 of the brain stimulation studies on AD [84, 93, 94]. …”

Transcranial direct current stimulation in mild cognitive impairment: methodology for a randomized controlled trial

“…Good results have also been reported concerning memory and language in patients with mild Alzheimer's disease when TMS was administered together with cognitive training (Rabey et al, 2013;Rabey & Dobronevsky, 2016). Furthermore, TMS can influence brain function if delivered repetitively; repetitive TMS (rTMS) is capable of modulating cortical excitability and inducing long-lasting neuroplastic changes.…”