Authors: Kalpana P. Padala, Shelly Lensing, Christopher Parkes, Kim Dean, Lillian Orr, Tracy Holder, Prasad R. Padala
Abstract
Background: Alzheimer’s Dementia (AD) is a major public health problem. Although the cognitive symptoms of AD garner the most attention, non-cognitive symptoms such as neuropsychiatric symptoms (NPS) and motor abnormalities contribute most to the functional decline seen in AD. Unfortunately, both NPS and gait and balance problems are common in AD and may share a common neurobiological etiology. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique with the potential to enhance dopamine, is used to improve NPS particularly apathy. The objective was to study the effects of rTMS to the dorsolateral prefrontal cortex (DLPFC) on gait speed in AD.
Methods: A prospective randomized double-blind sham-controlled study was conducted in community dwelling older Veterans (N=20) with AD and apathy. Subjects received rTMS or sham treatments daily for four weeks for a total of 20 treatments. Treatment parameters were set at 10Hz stimulation, 120% Motor threshold (MT), and 3000 pulses per treatment although MT was lowered if necessary. Gait speed was assessed at baseline and 4 weeks.
Results: All subjects except one completed the study. Mean age was 77.3 (±7.2) years, 80% were Caucasian and 10% were female. After adjusting for baseline, there was a significantly greater improvement from baseline in the gait speed with rTMS treatment compared to sham treatment after four weeks of treatment (average between-group difference 0.10, (95% CI, 0.05-0.14) m/s, p<0.001). Treatment site discomfort was the most common adverse event.
Conclusions: rTMS may be used safely in patients with AD and may improve gait speed. Improved gait speed enhances physical function and decreases risk of falls, which may result in improved survival.
Conference/Symposium/Course name, dates and location where the work was supposed to be presented:
American Geriatrics Society, May 2020, Long Beach, CA