Enhancing Neuroplasticity and Frontal Lobe Function in Patients With Mild Alzheimer's Disease
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 49
- Locations
- 1
- Primary Endpoint
- Paired Associated Stimulation induced Long-term potentiation as a measure of neuroplasticity in the dorsolateral prefrontal cortex
Study Overview
Brief Summary
The purpose of this study is to determine if a novel brain stimulation approach using magnetic stimulation (Transcranial Magnetic Stimulation [TMS]) can improve memory and thinking processes in individuals with mild Alzheimer's disease (AD).
Detailed Description
In this study, the investigators aim at assessing and then enhancing neuroplasticity in the dorsolateral prefrontal cortex (DLPFC) and working memory - a key function of DLPFC - in patients with mild AD. The investigators will use a novel non-invasive brain stimulation approach, Paired Associative Stimulation (PAS). PAS simulates in humans the induction of long-term potentiation (LTP), a prototype of synaptic neuroplasticity. PAS involves the repetitive pairing of electrical stimulation of the median nerve with - 25 ms later - transcranial magnetic stimulation (TMS) of the contralateral DLPFC. As such, these two stimulations arrive simultaneously in the DLPFC and result in potentiation of TMS induced cortical evoked potential, analogous to in vitro LTP.
Specific Aim 1: To compare LTP in the DLPFC among patients with mild AD and healthy subjects.
Specific Aim 2: To assess the effect of a 2-week course of PAS (rPAS) as applied to the left DLPFC on LTP and performance on working memory in patients with mild AD in comparison with a 2-week course of PAS control condition (PAS-C, described below) (rPAS-C).
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •for patients:
- •Age 65 or above
- •Meet NINCDS-ADRDA and DSM-IV TR criteria for a current diagnosis of Alzheimer's Disease
- •Stable does of acetylcholinesterase inhibitors for at least 3 months
- •Willingness and ability to speak English
- •Willingness and ability to provide informed consent
- •Corrected visual ability that enables reading of newspaper headlines and corrected hearing capacity that is adequate to respond to a raised conversational voice.
Exclusion Criteria
- •for patients:
- •Meets criteria for an Axis I diagnosis within the past 12 months other than Dementia of the Alzheimer type.
- •Mini Mental Status Examination score of 16 or less as described above
- •Meets diagnostic criteria for current alcohol or other drug dependence within 6 months of testing
- •Electroconvulsive Therapy (ECT) within 6 months of testing.
- •Left handedness.
- •Incompetency to consent
- •Any contraindication for TMS
- •Inclusion Criteria for healthy controls:
- •Age 65 or above
- •Willingness and ability to speak English
- •Willingness and ability to provide informed consent
- •Corrected visual ability that enables reading of newspaper headlines and corrected hearing capacity that is adequate to respond to a raised conversational voice.
- •Exclusion Criteria for healthy controls:
- •Meets criteria for an Axis I diagnosis other than simple phobias or adjustment disorder.
- •Other neurological disorder affecting central nervous system.
- •Psychotropic medication except for sedative /hypnotics at a stable dose for at least 4 weeks.
- •Left handedness
- •Any contraindication for TMS
Arms & Interventions
Alzheimer's disease-rPAS-C
The intervention procedure being done with this group is PAS-C. This is a control Paired Associative Stimulation paradigm in which TMS to the left DLPFC follows the electrical stimulation of the right median nerve by 100 ms, and, thus, does not result in contemporaneous occurrence of the two stimulations in the cortex and consequently no LTP.
Intervention: Paired Associative Stimulation-Control (Procedure)
Alzheimer's disease-rPAS
The intervention procedure will done in this group is r-Paired Associative Stimulation. This involves the repetitive pairing of electrical stimulation of the median nerve with - 25 ms later - transcranial magnetic stimulation (TMS) of the contralateral DLPFC
Intervention: Paired Associative Stimulation (Procedure)
Control
Controls will have a one time Paired Associative Stimulation-Control (PAS-C) paradigm intervention in which TMS to the left DLPFC follows the electrical stimulation of the right median nerve by 100 ms, and, thus, does not result in contemporaneous occurrence of the two stimulations in the cortex and consequently no LTP.
Intervention: Paired Associative Stimulation-Control (Procedure)
Outcomes
Primary Outcomes
Paired Associated Stimulation induced Long-term potentiation as a measure of neuroplasticity in the dorsolateral prefrontal cortex
Time Frame: 14 days
We are using a novel technique of TMS- EEG as developed by our group. Through this technique, not only motor evoked potential (MEP) but also cortical evoked activity (CEA) is recorded continuously while TMS is being delivered to the cortex. Thus, PAS-induced LTP could be indexed through the potentiation of not only MEP but also of CEA. TMS-EEG has been used by our group and others. Our group has used TMS-EEG in healthy individuals and patients with severe mental illness to study several neurophysiological phenomena in M1 and DLPFC such as cortical inhibition, gamma oscillations, and recently LTP. In summary, we propose to combine PAS with TMS-EEG to assess DLPFC neuroplasticity in patients with mild AD and then deliver a 2-week course of daily repetitive PAS (rPAS) to enhance DLPFC neuroplasticity and function as indexed by the N-back task. This will be measured to see if there are any changes after 1 day, 7 days and 14 days of the intervention procedure.
Secondary Outcomes
- N-back Task(pre-intervention (baseline) and then 1, 7, 14 days after intervention)
Investigators
Tarek Rajji
Staff Psychiatrist and Clinician Researcher
Centre for Addiction and Mental Health