Investigating the efficacy of high-frequency rTMS treatment for Alzheimer’s disease
The University of Manitoba, Deer Lodge Centre, St. Boniface Hospital
Alzheimer’s disease has no known cure and is called the pandemic of the century. Transcranial Magnetic Stimulation (TMS) is a safe and non-invasive procedure, in which a current passes through a coil placed on the scalp producing a magnetic field . The magnetic field passes through the skull to the brain, wherein a small current is induced. Application of TMS repetitively (rTMS) at either low or high frequencies has been used for treatment of many neurological and neurodegenerative disorders (e.g., Depression, Alzheimer’s, Parkinson, Stroke, etc.). Recent trials applying rTMS on Alzheimer’s patients have reported encouraging results for improving or stabilizing cognition. However, due to small samples and lack of a well-controlled double-blind design, the results to date are lacking in statistical rigor. This proposal is the first large placebo-controlled double-blind study designed with sufficient statistical rigor to measure the efficacy of rTMS treatment in Alzheimer’s. To patients with early to moderate stages of Alzheimer’s we will apply bilaterally to the dorsolateral prefrontal cortex high-frequency rTMS pulses. The treatment is for 4 consecutive weeks, everyday (except weekends). A total of 1500 pulses/day will be applied; each treatment session will take approximately 30 minutes. We will asses the patients patients’ cognitive state by standard neurophysiological assessments at the baseline and immediately after the end of treatment block and every 4 weeks after that up to 6 months.
Relevance to the acceleration of therapeutics for neurodegenerative diseases of aging
No currently-available medications change the progressive course of Alzheimer’s disease. At best, the available medications have benefit for 20-40% of patients, and they often have some side effects. rTMS is non-invasive and well-tolerated. The results of recent studies of rTMS application on Alzheimer’s suggest it has promise to improve or stabilize cognitive functioning in the short term. We hypothesize the application rTMS to Alzheimer patients in the early stages produces a marked improvement in cognitive functioning, which can last a few months. If our hypotheses are correct, our study will provide evidence that clinically-relevant improvements in functioning consequent to rTMS treatment can be maintained over time, thereby delaying patients’ progression to severe impairment and institutionalization. This evidence will support the further development of this treatment modality to make it available as a clinical treatment for Alzheimer’s patients.
We anticipate a marked cognitive improvement in patients in the early stages of Alzheimer’s, and slight improvement or stabilizing effect in patients at moderate stages. We also anticipate the positive effects of rTMS treatment to last a few months importantly delaying disease progression.