Enhancing cognitive training effects in Alzheimer’s disease: rTMS as an add-on treatment

• Published in: Brain stimulation Vol. 13; no. 6; pp. 1655 - 1664
• Main Authors: Bagattini, Chiara, Zanni, Mara, Barocco, Federica, Caffarra, Paolo, Brignani, Debora, Miniussi, Carlo, Defanti, Carlo Alberto
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020; Elsevier
• Subjects: Add-on effect; Aged; Aged, 80 and over; Alzheimer Disease - diagnosis; Alzheimer Disease - psychology; Alzheimer Disease - therapy; Alzheimer’s disease; Cognition - physiology; Cognitive Behavioral Therapy - methods; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - psychology; Cognitive Dysfunction - therapy; Cognitive training; Combined Modality Therapy - methods; Double-Blind Method; Face-name associative memory; Female; Humans; Male; Memory - physiology; Middle Aged; Mild cognitive impairment; Prefrontal Cortex - physiology; rTMS treatment; Transcranial Magnetic Stimulation - methods; Treatment Outcome; Cognitive training; Face-name associative memory; Alzheimer’s disease; Mild cognitive impairment; Add-on effect; rTMS treatment
• ISSN: 1935-861X; 1876-4754
• DOI: 10.1016/j.brs.2020.09.010

The treatment of Alzheimer’s disease (AD) in the field of non-pharmacological interventions is a challenging issue, given the limited benefits of the available drugs. Cognitive training (CT) represents a commonly recommended strategy in AD. Recently, repetitive transcranial magnetic stimulation (rTMS) has gained increasing attention as a promising therapeutic tool for the treatment of AD, given its ability of enhancing neuroplasticity. In the present randomized, double-blind, sham-controlled study, we aimed at investigating the add-on effect of a high frequency rTMS protocol applied over the left dorsolateral prefrontal cortex (DLPFC) combined with a face-name associative memory CT in the continuum of AD pathology. Fifty patients from a very early to a moderate phase of dementia were randomly assigned to one of two groups: CT plus real rTMS or CT plus placebo rTMS. The results showed that the improvement in the trained associative memory induced with rTMS was superior to that obtained with CT alone. Interestingly, the extent of the additional improvement was affected by disease severity and levels of education, with less impaired and more educated patients showing a greater benefit. When testing for generalization to non-trained cognitive functions, results indicated that patients in CT-real group showed also a greater improvement in visuospatial reasoning than those in the CT-sham group. Interestingly, this improvement persisted over 12 weeks after treatment beginning. The present study provides important hints on the promising therapeutic use of rTMS in AD. •rTMS enhanced the effect of face-name associative memory cognitive training.•The add-on rTMS effect was influenced by disease severity and education.•rTMS amelioration generalized to visuospatial reasoning.