Increasing Brain Gamma Activity Improves Episodic Memory and Restores Cholinergic Dysfunction in Alzheimer's Disease

Alberto Benussi, Valentina Cantoni, Mario Grassi, Lucie Brechet, Christoph M Michel, Abhishek Datta, Chris Thomas, Stefano Gazzina, Maria Sofia Cotelli, Marta Bianchi, Enrico Premi, Yasmine Gadola, Maria Cotelli, Marta Pengo, Federica Perrone, Maria Scolaro, Silvana Archetti, Eino Solje, Alessandro Padovani, Alvaro Pascual-Leone, Barbara Borroni, Alberto Benussi, Valentina Cantoni, Mario Grassi, Lucie Brechet, Christoph M Michel, Abhishek Datta, Chris Thomas, Stefano Gazzina, Maria Sofia Cotelli, Marta Bianchi, Enrico Premi, Yasmine Gadola, Maria Cotelli, Marta Pengo, Federica Perrone, Maria Scolaro, Silvana Archetti, Eino Solje, Alessandro Padovani, Alvaro Pascual-Leone, Barbara Borroni

Abstract

Objective: This study aimed to assess whether non-invasive brain stimulation with transcranial alternating current stimulation at gamma-frequency (γ-tACS) applied over the precuneus can improve episodic memory and modulate cholinergic transmission by modulating cerebral rhythms in early Alzheimer's disease (AD).

Methods: In this randomized, double-blind, sham controlled, crossover study, 60 AD patients underwent a clinical and neurophysiological evaluation including assessment of episodic memory and cholinergic transmission pre and post 60 minutes treatment with γ-tACS targeting the precuneus or sham tACS. In a subset of 10 patients, EEG analysis and individualized modelling of electric field distribution were carried out. Predictors to γ-tACS efficacy were evaluated.

Results: We observed a significant improvement in the Rey Auditory Verbal Learning (RAVL) test immediate recall (p < 0.001) and delayed recall scores (p < 0.001) after γ-tACS but not after sham tACS. Face-name associations scores improved with γ-tACS (p < 0.001) but not after sham tACS. Short latency afferent inhibition, an indirect measure of cholinergic transmission, increased only after γ-tACS (p < 0.001). ApoE genotype and baseline cognitive impairment were the best predictors of response to γ-tACS. Clinical improvement correlated with the increase in gamma frequencies in posterior regions and with the amount of predicted electric field distribution in the precuneus.

Interpretation: Precuneus γ-tACS, able to increase γ-power activity on the posterior brain regions, showed a significant improvement of episodic memory performances, along with restoration of intracortical excitability measures of cholinergic transmission. Response to γ-tACS was dependent on genetic factors and disease stage. ANN NEUROL 2022;92:322-334.

Trial registration: ClinicalTrials.gov NCT04842955.

Conflict of interest statement

A.B. and B.B. have pending patent on the use of non‐invasive brain stimulation to increase memory functions in patients with Alzheimer Disease.

© 2022 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.

Figures

FIGURE 1
FIGURE 1
Neuropsychological and neurophysiological scores pre and post sham or γ‐tACS. (A) Spaghetti plots of RAVL total recall, RAVL long delayed recall, FNAT scores. (B) Spaghetti plots of SAI measures. Legend: RAVL = Rey Auditory Verbal Learning test; FNAT = face–name associations task; tACS = transcranial alternating current stimulation; SAI = short‐latency afferent inhibition. *For FNAT, results are reported during stimulation.
FIGURE 2
FIGURE 2
Result of the EEG frequency analysis. Frequency bands: theta (3–6 Hz), alpha (6–12 Hz), beta (12–20 Hz), gamma (20–40 Hz). (A) Power maps pre and post sham stimulation. (B) Power maps pre and post γ‐tACS. (C) t‐Maps of the paired t‐test post vs. pre γ‐tACS. Blue areas indicate a power decrease after γ‐tACS, red areas a power increase. Significant effects at p < 0.05 were found on electrodes F3, T3, and T4 for theta (decrease after γ‐tACS), on electrodes P3, T5, T6, and O2 for beta (increase after γ‐tACS), and on electrodes T4 and O2 for gamma. No effect was found in the alpha band after γ‐tACS and no effect was found on any bands when comparing pre vs. post sham stimulation. Legend: EEG = electroencephalography; tACS = transcranial alternating current stimulation.

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