Repetitive transcranial magnetic stimulation for apathy in mild cognitive impairment: A double-blind, randomized, sham-controlled, cross-over pilot study

Abstract

Apathy is a common and disabling behavioral concomitant of many neurodegenerative conditions. The presence of apathy with Mild Cognitive Impairment (MCI) is linked with heightened rates of conversion to Alzheimer's disease. Improving apathy may slow the neurodegenerative process. The objective was to establish the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving apathy in older adults with MCI. An 8-week, double-blind, randomized, sham-controlled cross-over study was conducted in nine subjects (66 ± 9 years) with apathy and MCI. Subjects were randomized to rTMS or sham treatment (5 days/week) for 2 weeks following which they underwent a 4-week treatment-free period. Subjects then crossed-over to receive the other treatment for 2 weeks. The primary (apathy (AES-C)) and secondary (cognition (3MS & MMSE), executive function (TMT-A & TMT-B), and clinical global impression (CGI)) outcomes were assessed at baseline, 2, 6, and 8 weeks. After adjusting for baseline, there was a significantly greater improvement in the AES-C with rTMS compared to sham treatment at 2 weeks. There was significantly greater improvement in 3MS, MMSE, TMT-A, and CGI-I with rTMS compared to the sham treatment. This study establishes that rTMS is efficacious in improving apathy in subjects with MCI.

Trial registration: ClinicalTrials.gov NCT02190019.

Keywords: Apathy; Behavioral problems of dementia; Dementia; Mild cognitive impairment; rTMS.

Conflict of interest statement

Conflict of Interest: There are no financial conflicts of interest or personal conflict of interest relevant to the submitted manuscript for any authors.

Published by Elsevier B.V.

Figures

Figure 1:

Screening, Enrollment and Participation a Reason for exclusion: 8-substance abuse, 8-travel, 5-time, 5-bipolar disorder, 5-recent start of antidepressants, 2-did not meet criteria for MCI, 4-brain injuries, 7-contraindicated medication (bupropion), 4-implants, 1- seizure disorder, 1-another study, 7-younger age, 9-unknown.

Figure 2:

Apathy Evaluation Scores over time