Enhancing Cognition in Older Persons with Depression or Anxiety with a Combination of Mindfulness-Based Stress Reduction (MBSR) and Transcranial Direct Current Stimulation (tDCS): Results of a Pilot Randomized Clinical Trial

Heather Brooks, Hanadi Ajam Oughli, Lojine Kamel, Subha Subramanian, Gwen Morgan, Daniel M Blumberger, Jeanne Kloeckner, Sanjeev Kumar, Benoit H Mulsant, Eric J Lenze, Tarek K Rajji, Heather Brooks, Hanadi Ajam Oughli, Lojine Kamel, Subha Subramanian, Gwen Morgan, Daniel M Blumberger, Jeanne Kloeckner, Sanjeev Kumar, Benoit H Mulsant, Eric J Lenze, Tarek K Rajji

Abstract

Objectives: Individuals with subjective memory complaints and symptoms of depression and/or anxiety are at high risk for further cognitive decline, and possible progression to dementia. Low-burden interventions to help slow or prevent cognitive decline in this high-risk group are needed. The objective of this study is to assess the feasibility of combining Mindfulness-Based Stress Reduction (MBSR) with transcranial direct current stimulation (tDCS) to increase putative benefits of MBSR for cognitive function and everyday mindfulness in depressed or anxious older adults with subjective cognitive decline.

Methods: We conducted a two-site pilot double-blind randomized sham-controlled trial, combining active MBSR with either active or sham tDCS. The intervention included weekly in-class group sessions at the local university hospital and daily at-home practice. Anodal tDCS was applied for 30 min during MBSR meditative practice, both in-class and at-home.

Results: Twenty-six individuals with subjective cognitive complaints and symptoms of depression and/or anxiety were randomized to active (n = 12) or sham tDCS (n = 14). The combination of MBSR and tDCS was safe and well tolerated, though at-home adherence and in-class attendance were variable. While they were not statistically significant, the largest effect sizes for active vs. sham tDCS were for everyday mindfulness (d = 0.6) and social functioning (d = 0.9) (F (1,21) = 3.68, p = 0.07 and F (1,21) = 3.9, p = 0.06, respectively).

Conclusions: Our findings suggest that it is feasible and safe to combine tDCS with MBSR in older depressed and anxious adults, including during remote, at-home use. Furthermore, tDCS may enhance MBSR via transferring its meditative learning and practice into increases in everyday mindfulness. Future studies need to improve adherence to MBSR with tDCS.

Trial registration: ClinicalTrials.gov (NCT03653351 and NCT03680664).

Supplementary information: The online version contains supplementary material available at 10.1007/s12671-021-01764-9.

Keywords: Cognitive function; Late-life anxiety; Late-life depression; MBSR; Mindfulness; Subjective cognitive complaints; tDCS.

Conflict of interest statement

Conflict of interestDMB has received research support from CIHR, NIH, Brain Canada, and the Temerty Family through the CAMH Foundation and the Campbell Family Research Institute. He received research support and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. He is the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He also receives in-kind equipment support from Magventure for two investigator-initiated research. He received medication supplies for an investigator-initiated trial from Indivior. SK receives research support from Brain and Behavior Foundation, National institute on Ageing, BrightFocus Foundation, Brain Canada, Canadian Institute of Health Research, Centre for Ageing and Brain Health Innovation, Centre for Addiction and Mental Health, University of Toronto. He also receives equipment support from Soterix Medical. SK has received grant support from Brain Canada, NIH, Brain and Behavior Foundation (NARSAD), BrightFocus Foundation, Weston Brain Institute, Canadian Centre for Ageing and Brain Health Innovation, CAMH foundation and University of Toronto, and in-kind equipment support from Soterix Medical Inc. BHM receives research support from Brain Canada, CIHR, the CAMH Foundation, the Patient-Centered Outcomes Research Institute (PCORI), and the US National Institutes of Health (NIH); during the past three years, he has received non-financial support from Eli Lilly (medications and matching placebo for a NIH-funded clinical trial) and Pfizer (medications for a NIH-funded clinical trial), Capital Solution Design LLC (software used in a study funded by the CAMH Foundation), and HAPPYneuron (software used in a study founded by Brain Canada). EJL received in-kind equipment support for this investigator-initiated study from Magstim. He receives or has received support from National Institutes of Health (NIH), Takeda, Lundbeck, Acadia, the Taylor Family Institute for Innovative Psychiatric Research, the McKnight Brain Research Foundation, the Center for Brain Research in Mood Disorders, and PCORI. He has received consulting fees from Janssen and Jazz Pharmaceuticals. TKR has received research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, Canadian Institutes of Health Research, Centre for Aging and Brain Health Innovation, National Institutes of Health, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute. TKR also received in-kind equipment support for this investigator-initiated study from Magstim, and in-kind research accounts from Scientific Brain Training Pro for other studies. HB, HAO, LK, SS, JK, and GM have no conflicts to disclose.

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.

Figures

Fig. 1
Fig. 1
Consort chart showing participant flow throughout the study
Fig. 2
Fig. 2
Changes in mindfulness and social functioning. Line diagrams showing changes in scores on a the CAMS-R and b the PROMIS Ability to Participate in Social Roles in the active and sham tDCS groups across baseline and follow-up (x-axis). Bars represent 95% confidence intervals

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