Novel neurostimulation approaches: Focus on neuropsychiatric symptoms

Abstract

Neuropsychiatric symptoms (NPS) such as depression, apathy and agitation are common in neurocognitive disorders such as Alzheimer's disease (AD) and its prodrome, Mild Cognitive Impairment (MCI). Importantly, the presence of NPS is a prognostic indicator of future decline in MCI and AD and reduces quality of life in both patients and caregivers. Pharmacological interventions for NPS in neurocognitive disorders have not been shown to be effective and moreover, often have unfavourable side effect profiles for older adults due to age-related changes in pharmacokinetics and pharmacodynamics and the presence of comorbid medical conditions. Non-pharmacological approaches such as neurostimulation are increasingly being applied to treat primary psychiatric and neuropsychiatric conditions and hold promise for treatment of NPS in neurocognitive conditions, both from a symptom management point of view, and as a potential disease-modifying intervention for neurocognitive disorders. In this session, we will review novel neurostimulation modalities including transcranial direct current stimulation (tDCS), deep transcranial magnetic stimulation (dTMS), and photobiomodulation and their application to treatment of NPS in MCI and AD. Preliminary findings will be reviewed from ongoing clinical trials of neurostimulation for NPS in neurocognitive disorders: 1) Transcranial direct current stimulation (tDCS) combined with exercise for treatment of apathy in AD (Dr. Krista Lanctôt); 2) TDCS for treatment of agitation in AD (Dr. Sanjeev Kumar); 3) Deep transcranial magnetic stimulation (dTMS) for depression in MCI or AD [ClinicalTrials.gov Identifier: NCT03665831] (Dr. Linda Mah); 4) Photobiomodulation therapy for AD and as a potential treatment for NPS in neurocognitive disorders (Dr. Corinne Fischer).