Transcranial magnetic stimulation improves cognition over time in Parkinson's disease

Trung, Jessica; Hanganu, Alexandru; Jobert, Stevan; Degroot, Clotilde; Mejía-Constaín, Beatriz; Kibreab, Mekale; Bruneau, Marie‐Andrée; Lafontaine, Anne‐Louise; Strafella, Antonio P.; Monchi, Oury

doi:10.1016/j.parkreldis.2019.07.006

Cited by 67 publications

(56 citation statements)

References 30 publications

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“…A study of dementia in patients with PD identified age, male sex, baseline RBD, orthostatic hypotension, and mild cognitive impairment (MCI) as significant predictors of dementia, and the co-existence of RBD, MCI, and orthostatic hypotension at baseline was found to be the strongest determinant for the development of dementia [40]. A recent study suggested that transcranial magnetic stimulation may improve cognition in PD patients [41]. Ongoing projects in this research axis are continuing to investigate cognitive function in patients with PD, as well as auditory, speech, and olfactory functions.…”

Section: Recent Studies and Trials Facilitated By The Quebec Parkinsomentioning

confidence: 99%

The Quebec Parkinson Network: A Researcher-Patient Matching Platform and Multimodal Biorepository

Gan‐Or

Rao

Léveillé

et al. 2019

Journal of Parkinson’s Disease

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Background: Genetic, biologic and clinical data suggest that Parkinson's disease (PD) is an umbrella for multiple disorders with clinical and pathological overlap, yet with different underlying mechanisms. To better understand these and to move towards neuroprotective treatment, we have established the Quebec Parkinson Network (QPN), an open-access patient registry, and data and bio-samples repository. Objective: To present the QPN and to perform preliminary analysis of the QPN data. Methods: A total of 1,070 consecutively recruited PD patients were included in the analysis. Demographic and clinical data were analyzed, including comparisons between males and females, PD patients with and without RBD, and stratified analyses comparing early and late-onset PD and different age groups. Results: QPN patients exhibit a male:female ratio of 1.8:1, an average age-at-onset of 58.6 years, an age-at-diagnosis of 60.4 years, and average disease duration of 8.9 years. REM-sleep behavior disorder (RBD) was more common among men, and RBD was associated with other motor and non-motor symptoms including dyskinesia, fluctuations, postural hypotension and hallucinations. Older patients had significantly higher rates of constipation and cognitive impairment, and longer disease duration was associated with higher rates of dyskinesia, fluctuations, freezing of gait, falls, hallucinations and cognitive impairment. Since QPN's creation, over 60 studies and 30 publications have included patients and data from the QPN. Conclusions: The QPN cohort displays typical PD demographics and clinical features. These data are open-access upon application (http://rpq-qpn.ca/en/), and will soon include genetic, imaging and bio-samples. We encourage clinicians and researchers to perform studies using these resources.

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Section: Recent Studies and Trials Facilitated By The Quebec Parkinsomentioning

confidence: 99%

The Quebec Parkinson Network: A Researcher-Patient Matching Platform and Multimodal Biorepository

Gan‐Or

Rao

Léveillé

et al. 2019

Journal of Parkinson’s Disease

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“…Theta-burst stimulation is thought to mimic naturally occurring brain rhythms (Huang and Rothwell, 2004) and in intermittent theta-burst stimulation, three pulses are delivered at 50-Hz every 200 ms for 2 s, followed by 8 s of rest (Huang et al, 2005). Initial effects were seen when delivered over motor cortex (Huang and Rothwell, 2004;Huang et al, 2005), and since then, it has been increasingly used to modulate cognitive networks (Hoy et al, 2016;Chung et al, 2018;Ji et al, 2019;Trung et al, 2019). However, a recent study of iTBS in PD showed failure to improve frontal executive function and memory when delivered via TMS, which suggests a single session of therapy is not sufficient (Hill et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…However, a recent study of iTBS in PD showed failure to improve frontal executive function and memory when delivered via TMS, which suggests a single session of therapy is not sufficient (Hill et al, 2020). Multiple sessions may provide benefit (Trung et al, 2019), but frequent re-application may not be logistically feasible for patients (Dinkelbach et al, 2017). In addition, the field of spread of the TMS pulse is variable due to tissue inhomogeneity, reducing the precision and predictability of this technique (Opitz et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…An emerging therapy that shows promise for improving cognition that is now Food and Drug Administration (FDA) approved for depression (Blumberger et al, 2018) is intermittent theta-burst stimulation (iTBS), delivered via transcranial magnetic stimulation (TMS) to the prefrontal cortex (Hoy et al, 2016;Lowe et al, 2018). This form of therapy is thought to mimic natural brain activity, and in addition to enhancing memory in healthy adults (Hoy et al, 2016;Reinhart and Nguyen, 2019), it may also have effects on cognitive function in PD (Benninger et al, 2011;Dinkelbach et al, 2017;Trung et al, 2019). However, the effects of TMS are transient, requiring frequent re-application.…”

Section: Introductionmentioning

confidence: 99%

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Subcortical Intermittent Theta-Burst Stimulation (iTBS) Increases Theta-Power in Dorsolateral Prefrontal Cortex (DLPFC)

et al. 2020

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“…No significant group differences were observed for their primary outcome: the total score on the Dementia Rating Scale II. The second study investigated the effects of intermittent thetaburst stimulation (iTBS) over the left DLPFC (15). iTBS is a patterned form of TMS (16) that can be administered in less time than rTMS, may facilitate induction of plasticity mechanisms (17), and may have a beneficial effect on executive functions in healthy subjects (9).…”

Section: Introductionmentioning

confidence: 99%

Theta-Burst Stimulation for Cognitive Enhancement in Parkinson's Disease With Mild Cognitive Impairment: A Randomized, Double-Blind, Sham-Controlled Trial

et al. 2020

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Background: Mild cognitive impairment is a common non-motor symptom of Parkinson's disease (PD-MCI) and has minimal treatment options.Objective: In this double-blind, randomized, sham-controlled trial, we assessed the effect of repeated sessions of intermittent theta-burst stimulation over the left dorsolateral prefrontal cortex on cognition and brain connectivity in subjects with PD-MCI.Methods: Forty-one subjects were randomized to receive real (n = 21) or sham stimulation (n = 20). All subjects underwent neuropsychological assessments before, 1 day, and 1 month after stimulation. Subjects also underwent resting-state functional magnetic resonance imaging before and 48 h after stimulation. The primary outcome was the change in the cognitive domain (executive function, attention, memory, language, and visuospatial abilities) z-scores across time.Results: There was an insignificant effect on cognitive domain z-scores across time when comparing real with sham stimulation and correcting for multiple comparisons across cognitive domains (p > 0.05 Bonferroni correction). However, the real stimulation group demonstrated a trend toward improved executive functioning scores at the 1-month follow-up compared with sham (p < 0.05 uncorrected). After real stimulation, the connectivity of the stimulation site showed decreased connectivity to the left caudate head. There was no change in connectivity within or between the stimulation network (a network of cortical regions connected to the stimulation site) and the striatal network. However, higher baseline connectivity between the stimulation network and the striatal network was associated with improved executive function scores at 1 month.Conclusions: These results suggest that intermittent theta-burst stimulation over the dorsolateral prefrontal cortex in subjects with PD-MCI has minimal effect on cognition compared with sham, although there were trends toward improved executive function. This intervention may be more effective in subjects with higher baseline connectivity between the stimulation network and the striatal network. This trial supports further investigation focusing on executive function and incorporating connectivity-based targeting.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03243214.

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Transcranial magnetic stimulation improves cognition over time in Parkinson's disease

Cited by 67 publications

References 30 publications

The Quebec Parkinson Network: A Researcher-Patient Matching Platform and Multimodal Biorepository

The Quebec Parkinson Network: A Researcher-Patient Matching Platform and Multimodal Biorepository

Subcortical Intermittent Theta-Burst Stimulation (iTBS) Increases Theta-Power in Dorsolateral Prefrontal Cortex (DLPFC)

Theta-Burst Stimulation for Cognitive Enhancement in Parkinson's Disease With Mild Cognitive Impairment: A Randomized, Double-Blind, Sham-Controlled Trial

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