Enhancing cognitive training effects in Alzheimer’s disease: rTMS as an add-on treatment

• Main Authors: Chiara Bagattini, Mara Zanni, Federica Barocco, Paolo Caffarra, Debora Brignani, Carlo Miniussi, Carlo Alberto Defanti
• Format: Article
• Language: English
• Published: Elsevier 2020-11-01
• Series: Brain Stimulation
• Subjects: rTMS treatment; Alzheimer’s disease; Mild cognitive impairment; Cognitive training; Add-on effect; Face-name associative memory
• Online Access: http://www.sciencedirect.com/science/article/pii/S1935861X20302497

The treatment of Alzheimer’s disease (AD) in the field of non-pharmacological interventions is a challenging issue, given the limited benefits of the available drugs. Cognitive training (CT) represents a commonly recommended strategy in AD. Recently, repetitive transcranial magnetic stimulation (rTMS) has gained increasing attention as a promising therapeutic tool for the treatment of AD, given its ability of enhancing neuroplasticity. In the present randomized, double-blind, sham-controlled study, we aimed at investigating the add-on effect of a high frequency rTMS protocol applied over the left dorsolateral prefrontal cortex (DLPFC) combined with a face-name associative memory CT in the continuum of AD pathology. Fifty patients from a very early to a moderate phase of dementia were randomly assigned to one of two groups: CT plus real rTMS or CT plus placebo rTMS. The results showed that the improvement in the trained associative memory induced with rTMS was superior to that obtained with CT alone. Interestingly, the extent of the additional improvement was affected by disease severity and levels of education, with less impaired and more educated patients showing a greater benefit. When testing for generalization to non-trained cognitive functions, results indicated that patients in CT-real group showed also a greater improvement in visuospatial reasoning than those in the CT-sham group. Interestingly, this improvement persisted over 12 weeks after treatment beginning.The present study provides important hints on the promising therapeutic use of rTMS in AD.