Abstract
Purpose of Review
This article aims to review select applications of Transcranial Magnetic Stimulation (TMS) that have significant relevance in geriatric psychiatry.
Recent Findings
Small study sizes and parameter variability limit the generalizability of many TMS studies in geriatric patients. Additionally, geriatric patients have unique characteristics that can moderate the efficacy of TMS. Nonetheless, several promising experimental applications in addition to the FDA-approved indication for major depression have emerged. Cognitive impairment, neuropathic pain, and smoking cessation are experimental applications with special significance to the elderly. Cognitive impairment has been researched the most in this population and evidence thus far suggests that TMS has potential therapeutic benefit. There is also evidence to suggest benefit from TMS for neuropathic pain and smoking cessation in working age adults. TMS is consistently reported as a safe and well-tolerated treatment modality with no adverse cognitive side effects.
Summary
TMS is a safe treatment modality that can be effective for certain applications in the elderly. Additional research that specifically includes older subjects is needed to replicate findings and to optimize treatment protocols for this population.
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References
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Mantovani A, Lisanby S. In: George M, Belmaker R, editors. Transcranial magnetic stimulation in major depression, in transcranial magnetic stimulation in clinical psychiatry. Arlington: American Psychiatric Publihing; 2007.
Horvath JC, et al. The neuroStar TMS device: conducting the FDA approved protocol for treatment of depression. J Vis Exp. 2010;(45):2345. https://doi.org/10.3791/2345.
George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010;67(5):507–16. https://doi.org/10.1001/archgenpsychiatry.2010.46.
•• Perera T, George MS, Grammer G, Janicak PG, Pascual-Leone A, Wirecki TS. The clinical TMS Society consensus review and treatment recommendations for TMS therapy for major depressive disorder. Brain Stimul. 2016;9(3):336–46. https://doi.org/10.1016/j.brs.2016.03.010. Consensus review concludes that daily left prefrontal TMS has “substantial evidence of efficacy and safety for treating the acute phase of depression in patients who are treatment resistant or intolerant”.
• McClintock SM, Reti IM, Carpenter LL, McDonald WM, Dubin M, Taylor SF, et al. Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. J Clin Psychiatry. 2017. https://doi.org/10.4088/JCP.16cs10905. Provides recommendations for safe and effective clinical application of rTMS in treating depression.
Kaiser R. Physiological and clinical considerations of geriatric patient care. In: Steffens D, Blazer D, Thakur M, editors. Textbook of geriatric psychiatry. Arlington: American Psychiatric Publishing; 2015. https://doi.org/10.1176/appi.books.9781615370054.ds02.
Galvez V, et al. Neuromodulation therapies for geriatric depression. Curr Psychiatry Rep. 2015;17(7):59. https://doi.org/10.1007/s11920-015-0592-y.
O’Connell NE, et al. Non-invasive brain stimulation techniques for chronic pain. Cochrane Database Syst Rev. 2014;(4):Cd008208.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A, Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120(12):2008–39. https://doi.org/10.1016/j.clinph.2009.08.016.
Wani A, Trevino K, Marnell P, Husain MM. Advances in brain stimulation for depression. Ann Clin Psychiatry. 2013;25(3):217–24.
Riva-Posse P, Hermida AP, McDonald WM. The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression. Psychiatr Clin North Am. 2013;36(4):607–30. https://doi.org/10.1016/j.psc.2013.08.007.
Xia G, Gajwani P, Muzina DJ, Kemp DE, Gao K, Ganocy SJ, et al. Treatment-emergent mania in unipolar and bipolar depression: focus on repetitive transcranial magnetic stimulation. Int J Neuropsychopharmacol. 2008;11(1):119–30. https://doi.org/10.1017/S1461145707007699.
Liu AY, Rajji TK, Blumberger DM, Daskalakis ZJ, Mulsant BH. Brain stimulation in the treatment of late-life severe mental illness other than unipolar nonpsychotic depression. Am J Geriatr Psychiatry. 2014;22(3):216–40. https://doi.org/10.1016/j.jagp.2013.02.017.
Sabesan P, Lankappa S, Khalifa N, Krishnan V, Gandhi R, Palaniyappan L. Transcranial magnetic stimulation for geriatric depression: promises and pitfalls. World J Psychiatry. 2015;5(2):170–81. https://doi.org/10.5498/wjp.v5.i2.170.
George MS, Bohning DE, Lorberbaum JP, et al. Overview of transcranial magnetic stimulation: history, mechanisms, physics and safety. In: George MS, Belmaker R, editors. Transcranial magnetic stimulation in clinical psychiatry. VA: American Psychiatric Publishing; 2007.
Manes F, Jorge R, Morcuende M, Yamada T, Paradiso S, Robinson RG. A controlled study of repetitive transcranial magnetic stimulation as a treatment of depression in the elderly. Int Psychogeriatr. 2001;13(2):225–31. https://doi.org/10.1017/S1041610201007608.
Jorge RE, Moser DJ, Acion L, Robinson RG. Treatment of vascular depression using repetitive transcranial magnetic stimulation. Arch Gen Psychiatry. 2008;65(3):268–76. https://doi.org/10.1001/archgenpsychiatry.2007.45.
Nahas Z, Teneback CC, Kozel A, Speer AM, DeBrux C, Molloy M, et al. Brain effects of TMS delivered over prefrontal cortex in depressed adults: role of stimulation frequency and coil-cortex distance. J Neuropsychiatr Clin Neurosci. 2001;13(4):459–70. https://doi.org/10.1176/jnp.13.4.459.
Nahas Z, Li X, Kozel FA, Mirzki D, Memon M, Miller K, et al. Safety and benefits of distance-adjusted prefrontal transcranial magnetic stimulation in depressed patients 55-75 years of age: a pilot study. Depress Anxiety. 2004;19(4):249–56. https://doi.org/10.1002/da.20015.
Manenti R, Brambilla M, Petesi M, Miniussi C, Cotelli M. Compensatory networks to counteract the effects of ageing on language. Behav Brain Res. 2013;249:22–7. https://doi.org/10.1016/j.bbr.2013.04.011.
Cabeza R. Hemispheric asymmetry reduction in older adults: the HAROLD model. Psychol Aging. 2002;17(1):85–100. https://doi.org/10.1037/0882-7974.17.1.85.
Cherbuin N, et al. Mild cognitive disorders are associated with different patterns of brain asymmetry than normal aging: the PATH through life study. Front Psychiatry. 2010;1:11.
Long X, Zhang L, Liao W, Jiang C, Qiu B, the Alzheimer's Disease Neuroimaging Initiative. Distinct laterality alterations distinguish mild cognitive impairment and Alzheimer’s disease from healthy aging: statistical parametric mapping with high resolution MRI. Hum Brain Mapp. 2013;34(12):3400–10. https://doi.org/10.1002/hbm.22157.
Brodie SM, Borich MR, Boyd LA. Impact of 5-Hz rTMS over the primary sensory cortex is related to white matter volume in individuals with chronic stroke. Eur J Neurosci. 2014;40(9):3405–12. https://doi.org/10.1111/ejn.12717.
Pennisi G, Ferri R, Cantone M, Lanza G, Pennisi M, Vinciguerra L, et al. A review of transcranial magnetic stimulation in vascular dementia. Dement Geriatr Cogn Disord. 2011;31(1):71–80. https://doi.org/10.1159/000322798.
Lanza G, et al. Vascular cognitive impairment through the looking glass of transcranial magnetic stimulation. Behav Neurol. 2017;2017:1421326.
Johnson KA, Baig M, Ramsey D, Lisanby SH, Avery D, McDonald WM, et al. Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial. Brain Stimul. 2013;6(2):108–17. https://doi.org/10.1016/j.brs.2012.02.003.
Bersani FS, Minichino A, Enticott PG, Mazzarini L, Khan N, Antonacci G, et al. Deep transcranial magnetic stimulation as a treatment for psychiatric disorders: a comprehensive review. Eur Psychiatry. 2013;28(1):30–9. https://doi.org/10.1016/j.eurpsy.2012.02.006.
Kedzior KK, Gellersen HM, Brachetti AK, Berlim MT. Deep transcranial magnetic stimulation (DTMS) in the treatment of major depression: an exploratory systematic review and meta-analysis. J Affect Disord. 2015;187:73–83. https://doi.org/10.1016/j.jad.2015.08.033.
Lisanby SH, Husain MM, Rosenquist PB, Maixner D, Gutierrez R, Krystal A, et al. Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology. 2009;34(2):522–34. https://doi.org/10.1038/npp.2008.118.
Conelea CA, Philip NS, Yip AG, Barnes JL, Niedzwiecki MJ, Greenberg BD, et al. Transcranial magnetic stimulation for treatment-resistant depression: naturalistic treatment outcomes for younger versus older patients. J Affect Disord. 2017;217:42–7. https://doi.org/10.1016/j.jad.2017.03.063.
Drumond Marra HL, et al. Transcranial magnetic stimulation to address mild cognitive impairment in the elderly: a randomized controlled study. Behav Neurol. 2015;2015:287843.
Wu Y, Xu W, Liu X, Xu Q, Tang L, Wu S. Adjunctive treatment with high frequency repetitive transcranial magnetic stimulation for the behavioral and psychological symptoms of patients with Alzheimer’s disease: a randomized, double-blind, sham-controlled study. Shanghai Arch Psychiatry. 2015;27(5):280–8. https://doi.org/10.11919/j.issn.1002-0829.215107.
Rabey JM, Dobronevsky E, Aichenbaum S, Gonen O, Marton RG, Khaigrekht M. 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 (Vienna). 2013;120(5):813–9. https://doi.org/10.1007/s00702-012-0902-z.
Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014;125(11):2150–206. https://doi.org/10.1016/j.clinph.2014.05.021.
Ma SM, Ni JX, Li XY, Yang LQ, Guo YN, Tang YZ. High-frequency repetitive transcranial magnetic stimulation reduces pain in postherpetic neuralgia. Pain Med. 2015;16(11):2162–70. https://doi.org/10.1111/pme.12832.
Dinur-Klein L, Dannon P, Hadar A, Rosenberg O, Roth Y, Kotler M, et al. Smoking cessation induced by deep repetitive transcranial magnetic stimulation of the prefrontal and insular cortices: a prospective, randomized controlled trial. Biol Psychiatry. 2014;76(9):742–9. https://doi.org/10.1016/j.biopsych.2014.05.020.
O’Reardon JP, et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 62(11):1208–16.
Qin BY, Dai LL, Zheng Y. Efficacy of repetitive transcranial magnetic stimulation for alleviating clinical symptoms and suicidal ideation in elderly depressive patients: a randomized controlled trial. Nan Fang Yi Ke Da Xue Xue Bao. 2017;37(1):97–101.
• Gildengers AG, Houck PR, Mulsant BH, Dew MA, Aizenstein HJ, Jones BL, et al. Trajectories of treatment response in late-life depression: psychosocial and clinical correlates. J Clin Psychopharmacol. 2005;25(4 Suppl 1):S8–13. https://doi.org/10.1097/01.jcp.0000161498.81137.12. Identifies two subpopulations with different response trajectories to treatment of late-life depression.
Yip AG, George MS, Tendler A, et al. 61% of unmedicated treatment resistant depression patients who did not respond to acute TMS treatment responded after four weeks of twice weekly deep TMS in the Brainsway pivotal trial. Brain Stimul. 2017;10(4):847–849. https://doi.org/10.1016/j.brs.2017.02.013.
Siebner HR, Rothwell J. Transcranial magnetic stimulation: new insights into representational cortical plasticity. Exp Brain Res. 2003;148(1):1–16. https://doi.org/10.1007/s00221-002-1234-2.
Hoogendam JM, Ramakers GM, Di Lazzaro V. Physiology of repetitive transcranial magnetic stimulation of the human brain. Brain Stimul. 2010;3(2):95–118. https://doi.org/10.1016/j.brs.2009.10.005.
• Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review. J Neural Transm (Vienna). 2010;117(1):105–22. https://doi.org/10.1007/s00702-009-0333-7. Reviews cognitive effects of TMS and concludes that rTMS can produce significant cognitive improvement in patients with cognitive impairment.
•• Nardone R, Tezzon F, Höller Y, Golaszewski S, Trinka E, Brigo F. Transcranial magnetic stimulation (TMS)/repetitive TMS in mild cognitive impairment and Alzheimer’s disease. Acta Neurol Scand. 2014;129(6):351–66. https://doi.org/10.1111/ane.12223. Reviews cognitive effects of TMS and concludes that it is a promising application to reduce cognitive impairments, “but results of the initial studies have to be considered as still preliminary at the present time”.
• Bentwich J, Dobronevsky E, Aichenbaum S, Shorer R, Peretz R, Khaigrekht M, et al. 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 (Vienna). 2011;118(3):463–71. https://doi.org/10.1007/s00702-010-0578-1. Reports significant improvements in the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) and the Clinical Global Impression of Change (CGIC) after treatment with combined TMS and cognitive training.
The National Academies Collection: reports funded by National Institutes of Health. In: Relieving pain in America: a blueprint for transforming prevention, care, education, and research, C.a.E. Institute of Medicine Committee on Advancing Pain Research, editor. National Academies Press: Washington (DC); 2011.
Klein MM, Treister R, Raij T, Pascual-Leone A, Park L, Nurmikko T, et al. Transcranial magnetic stimulation of the brain: guidelines for pain treatment research. Pain. 2015;156(9):1601–14. https://doi.org/10.1097/j.pain.0000000000000210.
Schiller JS, Gulnur Freeman BWW. Early release of selected estimates based on data from the 2013 National Health Interview Survey. 2014 May 2017]; Available from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201406.pdf.
Rimer BK, Orleans CT, Keintz MK, Cristinzio S, Fleisher L. The older smoker. Status, challenges and opportunities for intervention. Chest. 1990;97(3):547–53. https://doi.org/10.1378/chest.97.3.547.
Cawkwell PB, Blaum C, Sherman SE. Pharmacological smoking cessation therapies in older adults: a review of the evidence. Drugs Aging. 2015;32(6):443–51. https://doi.org/10.1007/s40266-015-0274-9.
Taylor DH Jr, Hasselblad V, Henley SJ, Thun MJ, Sloan FA. Benefits of smoking cessation for longevity. Am J Public Health. 2002;92(6):990–6. https://doi.org/10.2105/AJPH.92.6.990.
Eichhammer P, Johann M, Kharraz A, Binder H, Pittrow D, Wodarz N, et al. High-frequency repetitive transcranial magnetic stimulation decreases cigarette smoking. J Clin Psychiatry. 2003;64(8):951–3. https://doi.org/10.4088/JCP.v64n0815.
Amiaz R, Levy D, Vainiger D, Grunhaus L, Zangen A. Repeated high-frequency transcranial magnetic stimulation over the dorsolateral prefrontal cortex reduces cigarette craving and consumption. Addiction. 2009;104(4):653–60. https://doi.org/10.1111/j.1360-0443.2008.02448.x.
Li X, et al. Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex reduces nicotine cue craving. Biol Psychiatry. 73(8):714–20.
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Ilva G. Iriarte and Mark S. George declare no conflict of interest.
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Iriarte, I.G., George, M.S. Transcranial Magnetic Stimulation (TMS) in the Elderly. Curr Psychiatry Rep 20, 6 (2018). https://doi.org/10.1007/s11920-018-0866-2
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DOI: https://doi.org/10.1007/s11920-018-0866-2