Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique able to modulate cortical excitability. This modulation may influence areas and networks responsible for specific cognitive processes, and the repetition of the induced temporary changes can produce long-lasting effects. TMS effectiveness may be enhanced when used in conjunction with cognitive training focused on specific cognitive functions. Playing video games can be an optimal cognitive training since it involves different cognitive components and high levels of engagement and motivation. The goal of this study is to assess the synergistic effects of TMS and video game training to enhance cognition, specifically, working memory and executive functions. We conducted a randomized 2 × 3 repeated measures (stimulation × time) study, randomly assigning 27 healthy volunteers to an active intermittent theta-burst stimulation or a sham stimulation group. Participants were assessed using a comprehensive neuropsychological battery before, immediately after, and 15 days after finishing the video game+TMS training. The training consisted of 10 sessions where participants played a 3D platform video game for 1.5 h. After each gaming session, TMS was applied over the right dorsolateral prefrontal cortex (DLPFC). All participants improved their video gaming performance, but we did not find a synergistic effect of stimulation and video game training. Neither had we found cognitive improvements related to the stimulation. We explored possible confounding variables such as age, gender, and early video gaming experience through linear regression. The early video gaming experience was related to improvements in working memory and inhibitory control. This result, although exploratory, highlights the influence of individual variables and previous experiences on brain plasticity.
Highlights
Non-invasive brain stimulation techniques have become a step forward in cognitive neuroscience due to their ability to establish causal links between cognition and its neural substrate
This study aimed to test the synergistic effect of the combination of non-invasive brain stimulation and video game training in cognitive enhancement
Our results did not support this hypothesis, showing an absence of combined effects on cognitive performance. Due to this observed lack of effect, we explored other variables that could have influenced our results showing that early video gaming experience had an impact on the improvement of certain cognitive functions
Summary
Non-invasive brain stimulation techniques have become a step forward in cognitive neuroscience due to their ability to establish causal links between cognition and its neural substrate. Among these techniques, transcranial magnetic stimulation (TMS) allows modulation of cortical excitability in highly specific target regions, inducing changes in the associated cognitive functions and even enhancing them (e.g., Luber and Lisanby, 2014). Its influence can be maximized when it is delivered after skill training This allows us to take advantage of the state-dependency effects in specific neural populations (Romei et al, 2016), and TMS can interact with their current, imbalanced state (Silvanto et al, 2018). Examples in animal studies, using hypothalamic intracranial self-stimulation have shown that, administering the stimulation immediately after a skill training produce higher retention rates for that skill than administering the stimulation before the training (Redolar-Ripoll et al, 2002)
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