Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study

Hellen Livia Drumond Marra, Martin Luiz Myczkowski, Cláudia Maia Memória, Débora Arnaut, Philip Leite Ribeiro, Carlos Gustavo Sardinha Mansur, Rodrigo Lancelote Alberto, Bianca Boura Bellini, Adriano Alves Fernandes da Silva, Gabriel Tortella, Daniel Ciampi de Andrade, Manoel Jacobsen Teixeira, Orestes Vicente Forlenza, Marco Antonio Marcolin, Hellen Livia Drumond Marra, Martin Luiz Myczkowski, Cláudia Maia Memória, Débora Arnaut, Philip Leite Ribeiro, Carlos Gustavo Sardinha Mansur, Rodrigo Lancelote Alberto, Bianca Boura Bellini, Adriano Alves Fernandes da Silva, Gabriel Tortella, Daniel Ciampi de Andrade, Manoel Jacobsen Teixeira, Orestes Vicente Forlenza, Marco Antonio Marcolin

Abstract

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersen's MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction (p = 0.05), favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration.

Figures

Figure 1
Figure 1
Flow diagram of referred and enrolled patients.
Figure 2
Figure 2
Comparison of RBMT means scores in T0, T1, and T2. Two-way ANOVA for repeated measures. Timing of procedures: T0: baseline cognitive assessment and 1st rTMS; T1: 10th rTMS session and 2nd cognitive assessment; T2: 30 days after T1 and 3rd cognitive assessment. Student's t-test for comparison of rTMS versus sham basal means, p = 0.292.
Figure 3
Figure 3
Comparison of logical memory II means scores in T0, T1, and T2. Two-way ANOVA for repeated measures. Timing of procedures: T0: baseline cognitive assessment and 1st rTMS; T1: 10th rTMS session and 2nd cognitive assessment; T2: 30 days after T1 and 3rd cognitive assessment. Student's t-test for comparison of rTMS versus sham basal means, p = 0.087.
Figure 4
Figure 4
Comparison of letter-number sequencing means scores in T0, T1, and T2. Two-way ANOVA for repeated measures. Timing of procedures: T0: baseline cognitive assessment and 1st rTMS; T1: 10th rTMS session and 2nd cognitive assessment; T2: 30 days after T1 and 3rd cognitive assessment. Student's t-test for comparison of rTMS versus sham basal means, p = 0.211.
Figure 5
Figure 5
Comparison of Trail Making Test B means scores in T0, T1, and T2. Two-way ANOVA for repeated measures. Timing of procedures: T0: baseline cognitive assessment and 1st rTMS; T1: 10th rTMS session and 2nd cognitive assessment; T2: 30 days after T1 and 3rd cognitive assessment. Mann-Whitney-Wilcoxon test for comparison of rTMS versus sham basal means, p = 0.986.
Figure 6
Figure 6
Comparison of semantic verbal fluency/animal naming means scores in T0, T1, and T2. Two-way ANOVA for repeated measures. Timing of procedures: T0: baseline cognitive assessment and 1st rTMS; T1: 10th rTMS session and 2nd cognitive assessment; T2: 30 days after T1 and 3rd cognitive assessment. Student's t-test for comparison of rTMS versus sham basal means, p = 0.081.

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