Abstract
Repetitive Transcranial Magnetic Stimulation (rTMS) can be used to modulate brain plasticity and may enhance the effects of cognitive intervention methods when administered in combination.e planned to look at efficacy of rTMS with cognitive training on cognition and gait in persons with Alzheimer disease. We applied rTMS together with cognitive training in persons with 6 mild to moderate Alzheimer disease for 1 hour daily sessions, 5 days per week, for 6 weeks (30 sessions). Three controlled subjects with mild to moderate AD received only cognitive training without magnetic stimulation (sham). All AD patients had stably been on AChEIs for 2 months. Six ROIs were targeted by the rTMS procedure concurrently with cognitive training: 1. left inferior frontal gyrus (Broca's area); 2. left superior temporal gyrus (Wernicke's area); 3 & 4. left and right dorsolateral prefrontal cortices (DLPFCs); and 5 & 6. left and right parietal somatosensory association cortices (R-PSAC and L-PSAC). TMSE, MOCA, Thai ADL (including basic and instrumental ADL), FAQ, NPI, VOSP test, Rey visual memory test, digit symbol, finger tapping test, BNT, color trail, and dual task gait analysis were measured pre- and post- stimulation at 6 months. The primary outcome was improvement of the cognitive score. The secondary outcome included improvement in Thai ADL score, Neuropsychiatric Inventory (NPI), and dual task gait performance. There was a trend to improve in TMSE and MOCA at M6 from M0 in treatment arm (p=0.05). There was a statistical significant improvement in logical memory, visual memory, BNT, and digit symbol tests in treatment arm at M6. At M6, there was an improvement in finger tapping scores between 2 arms (p=0.047). On dual task gait performance, there was improvement in foot rotation in both feet between treatment and placebo arm at M6 (p=0.05). No effect on NPI was found. There were no side effects during the study. The rTMS with cognitive training of NeuroAD System is an innovative, safe, and effective medical device for the treatment of AD.
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