Clinical Implications of Transcranial Magnetic Stimulation in Alzheimer's Dementia

Dong Woo Kang; Soo-hyun Joo; Chang Uk Lee

doi:10.4306/jknpa.2016.55.1.1

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Kang, Joo, and Lee: Clinical Implications of Transcranial Magnetic Stimulation in Alzheimer's Dementia

Review Article

Journal of Korean Neuropsychiatric Association 2016; 55(1): 1-11.

Published online: 29 February 2016

DOI: https://doi.org/10.4306/jknpa.2016.55.1.1

Clinical Implications of Transcranial Magnetic Stimulation in Alzheimer's Dementia

Dong Woo Kang, MD¹, Soo-hyun Joo, MD^2,³, Chang Uk Lee, MD, PhD³

¹Department of Psychiatry, Medical Corps, Republic of Korea Marine Corps, Hwaseong, Korea.

²Department of Psychiatry, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.

³Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address for correspondence: Chang Uk Lee, MD, PhD. Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel +82-2-2258-6082, Fax +82-2-536-8744, jihan@catholic.ac.kr

Received 22 November 2015 Revised 22 December 2015 Accepted 22 December 2015

Abstract

The objective is this study is to provide a comprehensive understanding of the clinical implication of transcranial magnetic stimulation (TMS) in Alzheimer's dementia (AD). We collected studies using TMS in patients with AD and reviewed 41 identified articles. Thirty five articles were about measures of cortical reactivity, plasticity, connectivity, and six articles were about the enhancement of cognitive function in AD. Reduced short-latency afferent inhibition and resting motor threshold which reflect cholinergic dysfunction and enhanced cortical excitability respectively are consistent findings of altered cortical reactivity in AD. In addition, cortical plasticity and connectivity have shown impaired results in AD compared with healthy controls. Repetitively delivered TMS can improve several domains of cognitive function impaired in AD. Although the evidence is still preliminary, TMS has a clinical implication as a diagnostic and therapeutic method in AD. Thorough investigation of factors that can affect the results of TMS and further studies to clarify the results are needed.

Keywords: Alzheimer's dementia, Transcranial magnetic stimulation, Cortical reactivity, Cortical plasticity

Figures and Tables

Table 1

Schematic representation of TMS measures of cortical reactivity, plasticity and connectivity in Alzheimer's dementia

TMS measures of cortical reactivity : SAI, rMT, cSP, SICI, LICI, ICF, MEP amp ; TMS measures of cortical plasticity : rTMS, PAS ; TMS measures of cortical connectivity : TMS+EEG. Each value is compared to matched controls. Note that the derived values are based on what has been reported by majority, not all, of studies for each condition. TMS : Transcranial magnetic stimulation, RMT : Resting motor threshold, MEP amp : Motor evoked potential amplitude, cSP : Cortical silent period, SICI : Short intracortical inhibition, LICI : Long intracortical inhibition, SAI : Short afferent inhibition, ICF : Intracortical facilitation, PAS : Paired associative stimulation, rTMS : Repetitive transcranial magnetic stimulation, TMS+EEG : Integration of TMS with electroencephalography

Table 2

Major findings of studies on enhancing cognitive function with Alzheimer's dementia (AD) with transcranial magnetic stimulation

- : Not done or not applicable, % : Percent, ↑ : Increase/improvement. ^* : Mean±standard deviation, ^† : The experiment includes 3 set of objects and actions corresponding to 3 stimulation sites : left DLPFC, right DLPFC, sham stimulation. N : Number of subjects, yrs : Years, No. : Number, RCT : Randomized controlled trial, se : Sessions, wk : Week, mon : Month, M/F : Male/female, MMSE : Mini-Mental State Examination, I-ADL : Instrumental activities of daily living, GDS : Geriatric Depression Scale, ADAS-cog : Alzheimer Disease Assessment Scale-cognitive, CGIC : Clinical Global Impression of Change Scale, rTMS : Repetitive transcranial magnetic stimulation, Hz : Hertz, MT : Motor threshold, ms : Miliseconds, DLPFC : Dorsolateral prefrontal cortex, PSAC : Parietal somatosensory association cortex, Mi : Mild, M-S : Moderate to severe

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

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