Abstract
Cognitive impairment has been proposed to be the core feature of schizophrenia (Sz). Transcranial direct current stimulation (tDCS) is a non-invasive form of brain stimulation which can improve cognitive function in healthy participants and in psychiatric patients with cognitive deficits. tDCS has been shown to improve cognition and hallucination symptoms in Sz, a disorder also associated with marked sensory processing deficits. Recent findings in healthy controls demonstrate that anodal tDCS increases auditory deviance detection, as measured by the brain-based event-related potential, mismatch negativity (MMN), which is a putative biomarker of Sz that has been proposed as a target for treatment of Sz cognition. This pilot study conducted a randomized, double-blind assessment of the effects of pre- and post-tDCS on MMN-indexed auditory discrimination in 12 Sz patients, moderated by auditory hallucination (AH) presence, as well as working memory performance. Assessments were conducted in three sessions involving temporal and frontal lobe anodal stimulation (to transiently excite local brain activity), and one control session involving ‘sham’ stimulation (meaning with the device turned off, i.e., no stimulation). Results demonstrated a trend for pitch MMN amplitude to increase with anodal temporal tDCS, which was significant in a subgroup of Sz individuals with AHs. Anodal frontal tDCS significantly increased WM performance on the 2-back task, which was found to positively correlate with MMN-tDCS effects. The findings contribute to our understanding of tDCS effects for sensory processing deficits and working memory performance in Sz and may have implications for psychiatric disorders with sensory deficits.
Similar content being viewed by others
References
Alho K (1995) Cerebral generators of mismatch negativity (MMN) and its magnetic counterpart (MMNm) elicited by sound changes. Ear Hear 16(1):38–51
American Psychiatric Association (APA) (2000) Diagnostic and statistical manual of mental disorders (DSM-IV-TR), 4th edn. American Psychiatric Association, Washington, DC
Andrade C (2013) Once-to twice-daily, 3-year domiciliary maintenance transcranial direct current stimulation for severe, disabling, clozapine-refractory continuous auditory hallucinations in schizophrenia. J ECT 29(3):239–242
Boggio PS, Ferrucci R, Rigonatti SP, Covre P, Nitsche M, Pascual-Leone A et al (2006) Effects of transcranial direct current stimulation on working memory in patients with Parkinson’s disease. J Neurol Sci 249:31–38
Boggio PS, Khoury LP, Martins DC, Martins OE, Macedo EC, Fregni F (2008) Temporal cortex DC stimulation enhances performance on a visual recognition memory task in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 80:444–447
Braff DL, Light GA (2004) Preattentional and attentional cognitive deficits as targets for treating Sz. Psychopharmacology 174:75–85
Brunelin J, Mondino M, Gassab L, Haesebaert F, Gaha L, Suaud-Chagny MF, Poulet E (2012) Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. Am J Psychiatry 169(7):719–724
Brunoni AR, Vanderhasselt MA (2014) Working memory improvement with non-invasive brain stimulation of the dorsolateral prefrontal cortex: a systematic review and meta-analysis. Brain Cogn 86:1–9
Brunoni AR, Nitsche MA, Bolognini N, Bikson M, Wagner T, Merabet L, Ferrucci R (2012) Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions. Brain Stimul 5(3):175–195
Brunoni AR, Shiozawa P, Truong D, Javitt DC, Elkis H, Fregni F, Bikson M (2014) Understanding tDCS effects in schizophrenia: a systematic review of clinical data and an integrated computation modeling analysis. Expert Rev Med Devices 11(4):383–394
Butler PD, Chen Yue, Ford JM, Geyer MA, Silverstein SM, Green MF (2012) Perceptual measurement in schizophrenia: promising electrophysiology and neuroimaging paradigms from CNTRICS: CNTRICS. Schizophr Bull 38:81–91
Chen J, Hammerer D, Strigaro G, Liou LM, Tsai CH, Rothwell JC, Edwards MJ (2014) Domain-specific suppression of auditory mismatch negativity with transcranial direct current stimulation. Clin Neurophysiol 125(3):585–592
Costa TL, Lapenta OM, Boggio PS, Ventura DF (2015) Transcranial direct current stimulation as a tool in the study of sensory-perceptual processing. Atten Percept Psychophys 77(6):1813–1840
Demirtas-Tatlidede A, Vahabzadeh-Hagh AM, Pascual-Leone A (2013) Can noninvasive brain stimulation enhance cognition in neuropsychiatric disorders? Neuropharmacology 64:566–578
Dondé C, Luck D, Grot S, Leitman DI, Brunelin J, Haesebaert F (2017) Tone-matching ability in patients with schizophrenia: a systematic review and meta-analysis. Schizophr Res 181:94–99
Dunn W, Rassovsky Y, Wynn J, Wu AD, Iacoboni M, Hellemann G, Green MF (2017) The effect of bilateral transcranial direct current stimulation on early auditory processing in schizophrenia: a preliminary study. J Neural Transm 124(9):1145–1149
Elvevag B, Goldberg TE (2000) Cognitive impairment in schizophrenia is the core of the disorder. Crit Rev Neurobiol 14(1):1–21
Erickson MA, Ruffle A, Gold JM (2016) A meta-analysis of mismatch negativity in schizophrenia: from clinical risk to disease specificity and progression. Biol Psychiatry 79(12):980–987
Ferrucci R, Mameli F, Guidi I, Mrakic-Sposta S, Vergari M, Marceglia S et al (2008) Transcranial direct current stimulation improves recognition memory in Alzheimer disease. Neurology 71:493–498
Ferrucci R, Bortolomasi M, Tessari E, Bellomo E, Trabucchi L, Gainelli G, Priori A (2014) EPA-1392—transcranial direct-current stimulation (tDCS) in patients with schizophrenia. Eur Psychiatry 29:1
Fisher DJ, Labelle A, Knott VJ (2008) The right profile: mismatch negativity in schizophrenia with and without auditory hallucinations as measured by a multi-feature paradigm. Clin Neurophysiol 119(4):909–921
Fisher DJ, Grant B, Smith DM, Borracci G, Labelle A, Knott J (2011) Effects of auditory hallucinations on the mismatch negativity (MMN) in schizophrenia as measured by a modified ‘optimal’ multi-feature paradigm. Int J Psychophysiol 81(3):245–251
Fisher DJ, Labelle A, Knott VJ (2012) Alterations of mismatch negativity (MMN) in schizophrenia patients with auditory hallucinations experiencing acute exacerbation of illness. Schizophr Res 139(1):237–245
Fregni F, Boggio PS, Nitsche M, Bermpohl F, Antal A, Feredoes E et al (2005) Anodal transcranial direct current stimulation of prefrontal cortex enhances working memory. Exp Brain Res 166:23–30
Fregni F, Boggio PS, Nitsche MA, Marcolin MA, Rigonatti SP, Pascual-Leone A (2006a) Treatment of major depression with transcranial direct current stimulation. Bipolar Disord 8:203–204
Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP et al (2006b) A sham-controlled phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain 122:197–209
Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J, Simis M (2014) Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): review and recommendations from an expert panel. Clin Res Regul Aff 32(1):22–35
Gandiga PC, Hummel FC, Cohen LG (2006) Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation. Clin Neurophysiol 177:845–850
Garrido MI, Kilner JM, Stephan KE, Friston KJ (2009) The mismatch negativity: a review of underlying mechanisms. Clin Neurophysiol 120(3):453–463
Gil-da-Costa R, Stoner GR, Fung R, Albright TD (2013) Nonhuman primate model of schizophrenia using a noninvasive EEG method. Proc Natl Acad Sci USA 110(38):15425–15430
Gray JA, Roth BL (2007) Molecular targets for treating cognitive dysfunction in schizophrenia. Schizophr Bull 33(5):1100–1119
Green MF, Kern RS, Braff DL, Mintz J (2000) Neurocognitive deficits and functional outcome in Sz: are we measuring the “right stuff”. Schiz Bull 26(1):119–136
Haddock G, McCarron J, Tarrier N, Faragher EB (1999) Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psycholl Med 29:879–888
Heekeren K, Daumann J, Neukirch A, Stock C, Kawohl W, Norra C, Gouzoulis-Mayfrank E (2008) Mismatch negativity generation in the human 5HT2A agonist and NMDA antagonist model of psychosis. Psychopharmacology 199(1):77–88
Heimrath K, Breitling C, Krauel K, Heinze HJ, Zaehle T (2015) Modulation of pre-attentive spectro-temporal feature processing in the human auditory system by HD-tDCS. Eur J Neurosci 41(12):1580–1586
Hill AT, Fitzgerald PB, Hoy KE (2015) Effects of anodal transcranial direct current stimulation on working and recognition memory: A systematic review and meta-analysis of findings from healthy and neuropsychiatric populations. Brain Stimul Basic Transl Clin Res Neuromodulation 8(2):331
Hoffman RE, Hampson M (2011) Functional connectivity studies of patients with auditory verbal hallucinations. Front Hum Neurosci 6:6
Horton J, Millar A, Labelle A, Knott VJ (2011) MMN responsivity to manipulations of frequency and duration deviants in chronic clozapine-treated schizophrenia patients. Schizophr Res 126(1):202–211
Hoy KE, Arnold SL, Emonson MR, Daskalakis ZJ, Fitzgerald PB (2014a) An investigation into the effects of tDCS dose on cognitive performance over time in patients with schizophrenia. Schizophr Res 155:96–100
Hoy KE, Arnold SL, Emonson MR, Daskalakis ZJ, Fitzgerald PB (2014b) An investigation into the effects of tDCS dose on cognitive performance over time in patients with schizophrenia. Schizophr Res 155:96–100
Impey D, Knott V (2015) Effect of transcranial direct current stimulation (tDCS) on MMN-indexed auditory discrimination: a pilot study. J Neural Transm 122:1175–1185
Impey D, de la Salle S, Knott V (2016a) Assessment of anodal and cathodal transcranial direct current stimulation (tDCS) on MMN-indexed auditory sensory processing. Brain Cogn 105:46–54
Impey D, de la Salle S, Baddeley A, Knott V (2016b) Effects of an NMDA antagonist on the auditory mismatch negativity response to transcranial direct current stimulation. J Psychopharmacol 31(5):614–624
Iyer MB, Mattu U, Grafman J, Lomarev M, Sato S, Wassermann EM (2005) Safety and cognitive effect of frontal DC brain polarization in healthy individuals. Neurology 64:872–875
Javitt DC (1996) Glutamate receptors and schizophrenia: opportunities and caveats. Mol Psychiatry 1(1):16
Javitt DC (2004) Glutamate as a therapeutic target in psychiatric disorders. Mol Psychiatry 9(11):984–997
Javitt DC (2007) Glutamate and schizophrenia: phencyclidine N-Methyl-d-aspartate receptors and dopamine-glutamate interactions. Int Rev Neurobiol 78:69–108
Javitt DC (2010) Glutamatergic theories of schizophrenia. Isr J Psychiatry Relat Sci 47(1):4
Javitt DC, Doneshka P, Grochowski S, Ritter W (1995) Impaired mismatch negativity generation reflects widespread dysfunction of working memory in schizophrenia. Arch Gen Psychiatry 52(7):550–558
Javitt DC, Steinschneider M, Schroeder CE, Arezzo JC (1996) Role of cortical N-methyl-d-aspartate receptors in auditory sensory memory and mismatch negativity generation: implications for Sz. PNAS 93:11962–11967
Javitt DC, Shelley AM, Ritter W (2000) Associated deficits in mismatch negativity generation and tone matching in schizophrenia. Clin Neurophysiol 111(10):1733–1737
Javitt DC, Spencer KM, Thaker GK, Winterer G, Hajós M (2008) Neurophysiological biomarkers for drug development in Sz. Nat Rev Drug Discov 7(1):68–83
Jo JM, Kim Y, Ko M, Ohn S, Joen B, Lee KH (2009) Enhancing the Working Memory of Stroke Patients Using tDCS. Am J Phys Med Rehabil 88:404–409
Jurcak V, Tsuzuki D, Dan I (2007) 10/20, 10/10, and 10/5 systems revisited: their validity as relative head-surface-based positioning systems. Neuroimage 34(4):1600–1611
Kawakubo Y, Kamio S, Nose T, Iwanami A, Nakagome K, Fukuda M, Kato N, Rogers MA, Kasai K (2007) Phonetic mismatch negativity predicts social skills acquisition in schizophrenia. Psychiatry Res 152(2): 261–265
Kay SR, Opler LA, Lindenmeyer JP (1989) The positive and negative syndrome scale (PANSS): rationale and standardization. Br J Psychiatr 155(Suppl 7):59–65
Knechtel L, Thienel R, Cooper G, Case V, Schall U (2014) Transcranial direct current stimulation of prefrontal cortex: an auditory event-related potential study in schizophrenia. Neurol Psychiatry Brain Res 20(4):102–106
Korostenskaja M, Dapsys K, Siurkute A, Maciulis V, Ruksenas O, Kähkönen S (2005) Effects of olanzapine on auditory P300 and mismatch negativity (MMN) in schizophrenia spectrum disorders. Prog Neuropsychopharmacol Biol Psychiatry 29(4):543–548
Kuo MF, Paulus W, Nitsche MA (2014) Therapeutic effects of non-invasive brain stimulation with direct currents (tDCS) in neuropsychiatric diseases. Neuroimage 85:948–960
Li LM, Uehara K, Hanakawa T (2015) The contribution of interindividual factors to variability of response in transcranial direct current stimulation studies. Front Cell Neurosci 9:181
Liebetanz D, Nitsche MA, Tergau F, Paulus W (2002) Pharmacological approach to the mechanisms of transcranial DC-stimulation-induced after-effects of human motor cortex excitability. Brain 125:2238–2247
Light GA, Näätänen R (2013) Mismatch negativity is a breakthrough biomarker for understanding and treating psychotic disorders. Proc Natl Acad Sci 110(38):15175–15176
Light GA, Swerdlow NR (2014) Neurophysiological biomarkers informing the clinical neuroscience of schizophrenia: mismatch negativity and prepulse inhibition of startle In: Kumari V, Bob P, Boutros N (eds) Electrophysiology and psychophysiology in psychiatry and psychopharmacology. Springer International Publishing, Switzerland, pp 293–314
Light GA, Swerdlow NR, Rissling AJ, Radant A, Sugar CA, Sprock J, Braff DL (2012) Characterization of neurophysiologic and neurocognitive biomarkers for use in genomic and clinical outcome studies of schizophrenia. PLoS One 7(7):e39434
Michie PT (2001) What has MMN revealed about the auditory system in schizophrenia? Int J Psychophys 42:177–194
Mondino M, Brunelin J, Palm UR, Brunoni A, Poulet E, Fecteau S (2015a) Transcranial direct current stimulation for the treatment of refractory symptoms of schizophrenia. Curr Evid Future Dir Curr Pharm Des 21(23):3373–3383
Mondino M, Haesebaert F, Poulet E, Suaud-Chagny MF, Brunelin J (2015b) Fronto-temporal transcranial direct current stimulation (tDCS) reduces source-monitoring deficits and auditory hallucinations in patients with schizophrenia. Schizophr Res 161(2):515–516
Mondino M, Jardri R, Suaud-Chagny MF, Saoud M, Poulet E, Brunelin J (2015c) Effects of fronto-temporal transcranial direct current stimulation on auditory verbal hallucinations and resting-state functional connectivity of the left temporo-parietal junction in patients with schizophrenia. Schizophr Bull 42(2):318–326
Näätänen R, Kähkönen S (2009) Central auditory dysfunction in Sz as revealed by the mismatch negativity (MMN) and its magnetic equivalent MMNm: a review. Int J Neuropsychopharmacol 12:125–135
Näätänen R, Jacobsen T, Winkler I (2005) Memory-based or afferent processes in mismatch negativity (MMN): a review of the evidence. Int J Psychophysiol 42:25–32
Näätänen R, Paavilainen P, Rinne T, Alho K (2007) The mismatch negativity (MMN) in basic research of central auditory processing: a review. Clin Neurophysiol 118(12):2544–2590
Näätänen R, Kujala T, Escera C, Baldeweg T, Kreegipuu K, Carlson S, Ponton C (2012) The mismatch negativity (MMN)—a unique window to disturbed central auditory processing in ageing and different clinical conditions. Clin Neurophysiol 123(3):424–458
Näätänen R, Shiga T, Asano S, Yabe H (2015a) Mismatch negativity (MMN) deficiency: a break-through biomarker in predicting psychosis onset. Int J Psychophysiol 95(3):338–344
Näätänen R, Todd J, Schall U (2015b) Mismatch negativity (MMN) as biomarker predicting psychosis in clinically at-risk individuals. Biol Psychol 116:36–40
Nawani H, Kalmady SV, Bose A, Shivakumar V, Rakesh G, Subramaniam A, Venkatasubramanian G (2014) Neural basis of tDCS effects on auditory verbal hallucinations in schizophrenia: a case report evidence for cortical neuroplasticity modulation. J ECT 30(1):e2–e4
Neuling T, Rach S, Herrmann CS (2013) Orchestrating neuronal networks: sustained after-effects of transcranial alternating current stimulation depend upon brain states. Front Hum Neurosci 7:161
Nitsche MA, Liebetanz D, Antal A, Lang N, Tergau F, Paulus W (2003a) Modulation of cortical excitability by weak direct current stimulation—technical safety and functional aspects. Suppl Clin Neurophysiol 56:255–276
Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W (2003b) Safety criteria for transcranial direct current stimulation (tDCS) in humans. Clin Neurophysiol 114:2220–2222
Nitsche MA, Jaussi W, Liebetanz D, Lang N, Tergau F, Paulus W (2004) Consolidation of human motor cortical neuroplasticity by d-cycloserine. Neuropsychopharmacology 29:1573–1578
Nitsche MA, Seeber A, Frommann K, Klein CC, Rochford C, Nitsche MS, Fricke K, Liebetanz D, Lang N, Antal A, Paulus W, Tergau F (2005) Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex. J Physiol 568:291–303
Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, Pascual-Leone A (2008) Transcranial direct current stimulation: state of the art 2008. Brain Stimul 1(3):206–223
Nitsche MA, Polania R, Kuo MF (2015) Transcranial direct current stimulation: modulation of brain pathways and potential clinical applications. In: Reti IM (ed) Brain stimulation, methodologies and interventions. John Wiley & Sons, Inc, Hoboken, NJ, USA, pp 233–254
Opitz B, Rinne T, Mecklinger A, Von Cramon DY, Schröger E (2002) Differential contribution of frontal and temporal cortices to auditory change detection: fMRI and ERP results. Neuroimage 15(1):167–174
Pascual-Leone A, Amedi A, Fregni F, Merabet LB (2005) The plastic human brain cortex. Annu Rev Neurosci 28:377–401
Rosburg T, Kreitschmann-Andermahr I (2015) The effects of ketamine on the mismatch negativity (MMN) in humans—a meta-analysis. Clin Neurophysiol 127(2):1387–1394
Sommer IE, Clos M, Meijering AL, Diederen KM, Eickhoff SB (2012) Resting state functional connectivity in patients with chronic hallucinations. PLoS One 7(9):e43516
Turetsky BI, Dress EM, Braff DL, Calkins ME, Green MF, Greenwood TA, Radant AD (2015) The utility of P300 as a schizophrenia endophenotype and predictive biomarker: clinical and socio-demographic modulators in COGS-2. Schizophr Res 163(1):53–62
Umbricht D, Krljes S (2005) Mismatch negativity in schizophrenia: a meta-analysis. Schizophr Res 76(1): 1–23
Umbricht D, Javitt D, Novak G, Bates J, Pollack S, Lieberman J, Kane J (1998) Effects of clozapine on auditory event-related potentials in schizophrenia. Biol Psychiatry 44(8):716–725
Umbricht D, Koller R, Vollenweider FX, Schmid L (2002) Mismatch negativity predicts psychotic experiences induced by NMDA receptor antagonist in healthy volunteers. Biol Psychiatry 51(5):400–406
Vercammen A, Rushby JA, Loo C, Short B, Weickert CS, Weickert TW (2011) Transcranial direct current stimulation influences probabilistic association learning in Sz. Sz Res 131(1):198–205
Vines BW, Schnider NM, Schlaug G (2006) Testing for causality with transcranial direct current stimulation: pitch memory and the left supramarginal gyrus. Neuroreport 17:1047–1050
Weigl M, Mecklinger A, Rosburg T (2016) Transcranial direct current stimulation over the left dorsolateral prefrontal cortex modulates auditory mismatch negativity. Clin Neurophysiol 127(5):2263–2272
Wood JN, Grafman J (2003) Human prefrontal cortex: processing and representational perspectives. Nat Rev Neurosci 4:139–147
Youn T, Park HJ, Kim JJ, Kim MS, Kwon JS (2003) Altered hemispheric asymmetry and positive symptoms in schizophrenia: equivalent current dipole of auditory mismatch negativity. Schizophr Res 59(2):253–260
Zaehle T, Beretta M, Jancke L, Herrmann CS, Sandmann P (2001) Excitability changes induced in the human auditory cortex by transcranial direct current stimulation: direct electrophysiological evidence. Exp Brain Res 215:135–140
Acknowledgements
Thank you to Dr. Alain Labelle for participant referrals and to Ashley Baddeley, Renee Nelson, Sara De La Salle and Adam Belair for the help with data collection.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There is no conflict of interest including any financial or personal relationships to report.
Funding
This study was funded by a Natural Sciences and Engineering Research Council of Canada (NSERC) Grant (210572-152799-2001) awarded to V. Knott.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Rights and permissions
About this article
Cite this article
Impey, D., Baddeley, A., Nelson, R. et al. Effects of transcranial direct current stimulation on the auditory mismatch negativity response and working memory performance in schizophrenia: a pilot study. J Neural Transm 124, 1489–1501 (2017). https://doi.org/10.1007/s00702-017-1783-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00702-017-1783-y