TMS may slow Alzheimer’s progress, new evidence shows

Nov 17, 2022 - neurocare group

TMS slows Alzheimer's progress

Alzheimer's disease causes significant suffering in those affected and their caregivers. Currently, there is no known cure for the disease and the underlying causes are not fully understood. However new scientific research has made great strides especially in investigating non-pharmacological treatment options.

A new study conducted by the Fondazione Santa Lucia, Rome, in collaboration with the University of Ferrara, has found that magnetic stimulation, applied to the precuneus region of the brain over 24 weeks, slows cognitive and functional decline in patients with mild-to-moderate Alzheimer's disease. It was also found to improve their autonomy in performing daily activities. Dr. Marilena Minei of the neurocare group collaborated in the study as a psychologist expert in neuropsychology. This is an important finding that paves the way for new therapeutic perspectives for Alzheimer's disease.

Alzheimer's disease is on the rise and there is an urgent need for therapies to treat it 

Dementia is a syndrome that affects memory and other cognitive and behavioural functions, significantly interfering with the performance of daily activities. According to the World Health Organization (WHO), Alzheimer's disease is the most common form of neurodegenerative dementia and is the seventh leading cause of death worldwide.

There are currently more than 55 million people worldwide living with a form of dementia and this is projected to reach 78 million by 2030. In Italy, according to estimates by the Istituto Superiore di Sanità (ISS), over one million people suffer from dementia, more than half of whom have Alzheimer's disease.

Advances in scientific research on Alzheimer's therapies

Although advanced age is the most important known risk factor for Alzheimer's, it is not an inevitable consequence of aging. Currently, knowledge about the triggers of Alzheimer's is limited, and there is no known cure. Despite this, scientific research has made great strides over the past decade, on both preventive and diagnostic levels.

Scientific research on nonpharmacological therapeutic options for the treatment of Alzheimer's, such as non-invasive neuromodulation techniques, has grown significantly over the past decade. Key among these are Transcranial Magnetic Stimulation (TMS) and Transcranial Electrical Stimulation (TES).

What is Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation is a non-invasive, nonpharmacological neuromodulation technique that works by using a magnetic coil on the patient's head to stimulate specific areas of the brain in a localised manner. By stimulating impaired brain areas, it can intervene in the symptomatology of certain psychiatric or neurological conditions.

The therapy is also sometimes referred to as rTMS, or repetitive transcranial magnetic stimulation, because the protocols involve multiple sessions repeated over time.

Magnetic stimulation is a completely painless treatment and does not require anaesthesia or hospitalization. To date, no related side effects have been reported, apart from a mild focal headache. Unlike Electroconvulsive Therapy (ECT), better known as Electroshock, no seizures are induced and there is no risk of memory loss.

Precuneus stimulation to slow Alzheimer's disease, a study by the Santa Lucia Foundation in Rome

Patients with Alzheimer's disease experience deterioration mainly in the precuneus region of the brain, particularly in the earliest stages of the disease.

A recent study conducted by the Fondazione Santa Lucia IRCCS in Rome, in collaboration with the University of Ferrara, demonstrated that by applying transcranial stimulation to the precuneus region, it was possible to slow the cognitive and functional decline caused by deterioration in this brain region.

The study examined a sample of patients aged 50 to 85 years, of both sexes, with mild-to-moderate dementia due to Alzheimer's disease, who had been on medication for at least six months.

Patients were randomly divided into two groups. One half received precuneus stimulation, while the other received rTMS sham treatment, which is a simulated placebo treatment, allowing researchers to test the efficacy of the therapy.

Enrolment, cognitive assessments, recording, and analysis of neurophysiological data were performed by neurologists, neuropsychologists, and neurophysiologists blinded to treatment assignment, i.e., without knowing which patients received rTMS and which received sham treatment. 

Treatment was administered over 24 weeks. During the intensive phase, (the first two weeks), rTMS was administered daily, and in the maintenance phase (the subsequent 22 weeks), once a week. Patients were not engaged in any cognitive rehabilitation program during the research.

TMS found to slow cognitive decline and improve autonomy in patients with mild-to-moderate Alzheimer's disease

Patients who received rTMS showed almost no decline in the primary parameter used to assess the degree of dementia (Clinical Dementia Rating Scale-Sum of Boxes). In comparison, patients who received the sham treatment saw deterioration and advancement of dementia.

The effects of magnetic stimulation were also found to have a positive effect on cognitive function and functional decline with the study observing an improvement in the autonomy of rTMS-treated patients in performing daily actions. This suggests that, in the early stages of Alzheimer's disease, rTMS can be beneficial for both cognitive and functional disorders.

Patients involved in the study were all on standard medication for mild-to-moderate Alzheimer's disease indicating the application of magnetic stimulation could be a valuable therapeutic supplement to pharmacological treatment. 

Future prospects for TMS treatment on patients with mild-to-moderate Alzheimer's disease

The rate of treatment response was 68 percent in the group that received rTMS and 34 percent in the group that received sham treatment. This finding is similar to those reported in clinical trials of rTMS for depression, which is currently approved by the Food and Drug Administration (FDA) and covered by health insurers in the United States and other countries. 

rTMS applied to the precuneus brain area offers a new therapeutic approach for the disease that may reduce the progression of cognitive decline and delay the impairment of autonomy in performing daily activities.

Further personalisation of the treatment plan and longer interventions could pave the way for a new class of nonpharmacological treatments for Alzheimer's disease.

Koch et al. 2022
Koch et al. 2018







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