Non-invasive brain stimulation: enhancing motor and cognitive functions in healthy old subjects

Maximo Zimerman, Friedhelm C Hummel, Maximo Zimerman, Friedhelm C Hummel

Abstract

Healthy aging is accompanied by changes in cognitive and motor functions that result in impairment of activities of daily living. This process involves a number of modifications in the brain and is associated with metabolic, structural, and physiological changes; some of these serving as adaptive responses to the functional declines. Up to date there are no universally accepted strategies to ameliorate declining functions in this population. An essential basis to develop such strategies is a better understanding of neuroplastic changes during healthy aging. In this context, non-invasive brain stimulation techniques, such as transcranial direct current or transcranial magnetic stimulation, provide an attractive option to modulate cortical neuronal assemblies, even with subsequent changes in neuroplasticity. Thus, in the present review we discuss the use of these techniques as a tool to study underlying cortical mechanisms during healthy aging and as an interventional strategy to enhance declining functions and learning abilities in aged subjects.

Keywords: TMS; brain plasticity; brain stimulation; cognition; healthy aging; motor; tDCS.

Figures

Figure 1
Figure 1
Disruption of function of the ipsilateral motor cortex by tDCS. tDCS disrupting effects on ipsilateral motor cortex during a motor learning task (single subject data). Design: cathodal (inhibitory) tDCS or Sham was applied concurrent with training of a finger sequence, performed with the right hand. The stimulation was delivered in a counterbalanced double-blind design. The motor task was re-evaluated 90 min and 24 h after training. Questionnaires (Q1–6) regarding attention, fatigue, and hand fatigue were given before and after each session. Results: decreased number of correct sequences was seen with cathodal tDCS applied to the ipsilateral motor cortex but not with Sham stimulation. This data supports the functional relevance of the ipsilateral motor cortex for hand functions and support the view of a compensatory mechanism that takes place in old subjects. (This single subject data is part of a study presented in the international conference of TMS and tDCS by the authors, Gottingen, 2008).
Figure 2
Figure 2
Facilitating skilled motor functions by tDCS. Effect of anodal (excitatory) tDCS applied to the primary motor cortex on the Jebsen-Taylor hand function test (Hummel et al., 2009a). Design: After familiarization with the JTT, subjects took part in two sessions (before and after tDCS) composed of 3 JTT. tDCS or Sham was applied during the first 20 min of the second session in a counterbalanced double-blind design. Questionnaires assessing attention and fatigue during the experiment where given (Q1–4). Results: (A) tDCS but not Sham stimulation resulted in shorter total time of JTT (JTT1–3 vs JTT4–6). Performance improvements with tDCS persisted for at least 30 min. (B) Correlation between age and tDCS-induced improvement indicating that the older the subjects the more prominent was the improvement in JTT. (Figure modified from Hummel et al., 2009a).
Figure 3
Figure 3
Improving motor learning by tDCS: single subject data. Performance enhancing effects of tDCS on a motor learning task (single subject data). Design: anodal (facilitatory) tDCS or Sham was applied concurrent with training of a finger sequence, performed with the right. Result: The main finding was that anodal tDCS combined with a motor training enhanced the number of correctly played sequences in old healthy subjects but not with Sham stimulation. Performance improvements persisted beyond the stimulation period and were evident at least 24 h after the training concurrent with tDCS. (This single subject data is part of a study presented in the international conference of Neurorehabilitation by the authors, Vienna 2010).

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