Repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training is a safe and effective modality for the treatment of Alzheimer’s disease: clinical experience
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Alzheimer’s disease (AD) is the most common type of dementia among the elderly. Common treatments available and non-pharmacological interventions have their limitations, and new therapeutic approaches are critically needed. Transcranial magnetic stimulation (TMS) is a non-invasive technique that generates an electric current-inducing modulation in cortical excitability. The previous clinical trials showed that combinations of rTMS and cognitive training (rTMS-COG), as provided by the NeuroAD medical device system, offer a novel, safe, and effective method improving mild-to-moderate AD patients. In this article, we present our experience with rTMS-COG treatment, in clinical settings, of 30 mild-to-moderate AD patients that received rTMS-COG commercial treatments in two clinics for 1-h daily sessions, 5 days per week, for 6 weeks (30 sessions). Five patients returned for a second treatment. ADAS-Cog and MMSE scores were measured pre- and post-treatments. The main analyses were conducted on patients who received 1 treatment (n = 30). Data received from the five returning patients were analyzed separately. The effect of rTMS-COG treatment was statistically significant regarding both ADAS-Cog (−2.4 point improvement, PV <0.001) and MMSE (+1.7 points improvement, PV <0.001) scores. About 80 % of patients gained some cognitive improvement following NeuroAD treatment, with more than 60 % improving by more than two points, for a minimum of 9 months. The Neuronix NeuroAD System was shown to be a safe and effective non-invasive modality for cognitive improvement of Alzheimer patients, with measurable outcomes lasting, in some of them, for up to 1 year, following completion of the 6-week daily intervention course (a carryover effect).
KeywordsrTMS Alzheimer’s disease Cognitive training Alzheimer’s Disease Assessment Scale-cognitive Dementia Mini–mental state examination
Compliance with ethical standards
Neuronix Ltd, Yokneam, Israel financially supported this study. The study sponsors supported the study by providing funds. The design, the collection, analysis, and interpretation of the data, the writing of the report, and the decision to submit the paper were the entire responsibility of the corresponding author and the co-author. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Conflict of interest
Prof. Rabey (the corresponding author) and Evgenia Dobronevsky are both consultants for Neuronix Ltd.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study received the approval of the Assaf Harofeh Medical Center Ethical Committee.
Informed consent was obtained from all patients.
- Bentwich J, Dobronevsky E, Aichenbaum S, Shorer R, Peretz R, Khaigrekht M, Marton RG, Rabey JM (2011) Beneficial effect of repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer’s disease: a proof of concept study. J Neural Transm 118:463–471CrossRefPubMedGoogle Scholar
- Birks J (2006) Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev 1:CD005593Google Scholar
- Fargo KN, Aisen P, Albert M, Au R, Corrada MM, DeKosky S, Drachman D, Fillit H, Gitlin L, Haas M, Herrup K, Kawas C, Khachaturian AS, Khachaturian ZS, Klunk W, Knopman D, Kukull WA, Lamb B, Logsdon RG, Maruff P, Mesulam M, Mobley W, Mohs R, Morgan D, Nixon RA, Paul S, Petersen R, Plassman B, Potter W, Reiman E, Reisberg B, Sano M, Schindler R, Schneider LS, Snyder PJ, Sperling RA,Yaffe K, Bain LJ, Thies WH, Carrillo MC (2014) 2014 Report on the milestones for the US national plan to address Alzheimer's disease. Alzheimer’s Dement 10(5):S430–S452Google Scholar
- Grayson VK, Velkoff VA, US Census Bureau (2010) The next four decades: the older population in the United States: 2010 to 2050. In: Current population reports. US Census Bureau, US Department of Commerce, Economics and Statistics Administration, Washington DC, pp 25–1138Google Scholar
- Mohs RC, Knopman D, Petersen RC, Ferris SH, Ernesto C, Grundman M, Sano M, Bieliauskas L, Geldmacher D, Clark C, Thal LJ (1997) Development of cognitive instruments for use in clinical trials of antidementia drugs: additions to the Alzheimer’s Disease Assessment Scale that broaden its scope. The Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord 11:S13–S21CrossRefPubMedGoogle Scholar
- NIH National Institute on Aging (2015) Alzheimer’s disease medications fact sheet. Retrieved May 2014, from NIH; National Institute on Aging: http://www.nia.nih.gov/sites/default/files/ad_meds_fact_sheet-2014_update-final_2-12-14.pdf. Accessed 23 May 2014
- Olazarán J, Reisberg B, Clare L, Cruz I, Peña-Casanova J, Del Ser T, Woods B, Beck C, Auer S, Lai C, Spector A, Fazio S, Bond J, Kivipelto M, Brodaty H, Rojo JM, Collins H, Teri L, Mittelman M, Orrell M, Feldman HH, Muñiz R (2010) Nonpharmacological therapies in Alzheimer’s disease: a systematic review of efficacy. Dement Geriatr Cogn Dis 30:161–178CrossRefGoogle Scholar
- Rabey JM, Dobronevsky E, Aichenbaum S, Gonen O, Marton RG, Khaigrekht M (2013) Repetitive transcranial magnetic stimulation combined with cognitive training is a safe and effective modality for the treatment of Alzheimer’s disease: a randomized, double-blind study. J Neural Transm 120:813–819CrossRefPubMedGoogle Scholar
- Rossi S, Hallett M, Rossini PM, Pascual-Leone A, Safety of TMS Consensus Group (2009) Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 120:2008–2039CrossRefPubMedPubMedCentralGoogle Scholar