Repetitive Transcranial Magnetic Stimulation as a Treatment for Veterans with Cognitive Impairment and Multiple Comorbidities

Article type: Research Article

Authors: Cheng, Jauhtai^{a; b; *} | Fairchild, J. Kaci^{a; b} | McNerney, M. Windy^{a; b} | Noda, Art^b | Ashford, J. Wesson^{a; b} | Suppes, Trisha^{a; b} | Chao, Steven Z.^{a; c} | Taylor, Joy^{a; b} | Rosen, Allyson C.^{a; b} | Durazzo, Timothy C.^{a; b} | Lazzeroni, Laura C.^b | Yesavage, Jerome^{a; b}

Affiliations: [a] VA Palo Alto Health Care System, Palo Alto, CA, USA | [b] Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA | [c] Department of Neurology and Neurological Science, Stanford University School of Medicine, Palo Alto, CA, USA

Correspondence: [*] Correspondence to: Jauhtai (Joseph) Cheng, MD, PO Box 6, Palo Alto, CA 94304, USA. Tel.: +1 650 384 9364; 650 493 5000 ext 63617; Fax: +1 650 852 3297; E-mails: [email protected]; [email protected].

Abstract: Background:Despite decades of research efforts, current treatments for Alzheimer’s disease (AD) are of limited effectiveness and do not halt the progression of the disease and associated cognitive decline. Studies have shown that repetitive transcranial magnetic stimulation (rTMS) may improve cognition. Objective:We conducted a pilot study to investigate the effect of rTMS on cognitive function in Veterans with numerous medical comorbidities. Methods:Participants underwent 20 sessions, over the course of approximately 4 weeks, of 10 Hz rTMS at the left dorsolateral prefrontal cortex with intensity of 120% resting motor threshold. Outcome measures including memory, language, verbal fluency, and executive functions were acquired at baseline, end of treatment, and 4 months after the last rTMS session. Twenty-six Veterans completed the study (13 in the active rTMS group, 13 in the sham rTMS group). Results:The study protocol was well-tolerated. Active, compared to sham, rTMS showed improved auditory-verbal memory at the end of treatment and at 4-month follow-up. However, the active rTMS group demonstrated a trend in decreased semantic verbal fluency at the end of treatment and at 4-month follow up. Conclusion:These preliminary results show rTMS is safe in general in this elderly Veteran population with multiple co-morbidities. Patients in the sham group showed an expected, slight decline in the California Verbal Learning Test scores over the course of the study, whereas the active treatment group showed a slight improvement at the 4-month post-treatment follow up. These effects need to be confirmed by studies of larger sample sizes.

Keywords: Brain stimulation, california verbal learning test, repetitive transcranial magnetic stimulation, veterans

DOI: 10.3233/JAD-210349

Journal: Journal of Alzheimer's Disease, vol. 85, no. 4, pp. 1593-1600, 2022