Neuroimaging mechanisms of high-frequency repetitive transcranial magnetic stimulation for treatment of amnestic mild cognitive impairment: a double-blind randomized sham-controlled trial - PubMed (original) (raw)

Neuroimaging mechanisms of high-frequency repetitive transcranial magnetic stimulation for treatment of amnestic mild cognitive impairment: a double-blind randomized sham-controlled trial

Li-Qiong Yuan et al. Neural Regen Res. 2021 Apr.

Abstract

Individuals with amnestic mild cognitive impairment (aMCI) have a high risk of developing Alzheimer's disease. Although repetitive transcranial magnetic stimulation (rTMS) is considered a potentially effective treatment for cognitive impairment in patients with aMCI, the neuroimaging mechanisms are poorly understood. Therefore, we performed a double-blind randomized sham-controlled trial in which rTMS was applied to the left dorsolateral prefrontal cortex of aMCI patients recruited from a community near the Third Hospital Affiliated to Sun Yat-sen University, China. Twenty-four patients with aMCI were randomly assigned to receive true rTMS (treatment group, n = 12, 6 men and 6 women; age 65.08 ± 4.89 years) or sham stimulation (sham group, n = 12, 5 men and 7 women; age 64.67 ± 4.77 years). rTMS parameters included a stimulation frequency of 10 Hz, stimulation duration of 2 seconds, stimulation interval of 8 seconds, 20 repetitions at 80% of the motor threshold, and 400 pulses per session. rTMS/sham stimulation was performed five times per week over a period of 4 consecutive weeks. Our results showed that compared with baseline, Montreal Cognitive Assessment scores were significantly increased and the value of the amplitude of low-frequency fluctuation (ALFF) was significantly increased at the end of treatment and 1 month after treatment. Compared with the sham group, the ALFF values in the right inferior frontal gyrus, triangular part of the inferior frontal gyrus, right precuneus, left angular gyrus, and right supramarginal gyrus were significantly increased, and the ALFF values in the right superior frontal gyrus were significantly decreased in the treatment group. These findings suggest that high-frequency rTMS can effectively improve cognitive function in aMCI patients and alter spontaneous brain activity in cognitive-related brain areas. This study was approved by the Ethics Committee of Shenzhen Baoan Hospital of Southern Medical University, China (approval No. BYL20190901) on September 3, 2019, and registered in the Chinese Clinical Trials Registry (registration No. ChiCTR1900028180) on December 14, 2019.

Keywords: Alzheimer’s disease; clinical trial; cognitive function; cognitive impairment; functional magnetic resonance imaging; neurological function; repetitive transcranial magnetic stimulation.

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Conflict of interest statement

None

Figures

Figure 1

Figure 1

Flow chart of the study procedure. fMRI: Functional magnetic resonance imaging; MoCA: Montreal Cognitive Assessment; rTMS: repetitive transcranial magnetic stimulation.

Figure 2

Figure 2

MoCA scores of amnestic mild cognitive impairment patients after repetitive transcranial magnetic stimulation or sham stimulation. Data are expressed as the mean ± SD (n = 12 per group). All data were analyzed via a two-sample _t_-test. *P < 0.05, vs. pre-intervention; #P < 0.05, vs. sham group. MoCA: Montreal Cognitive Assessment; Day1: 1 day after the intervention; Day30: 1 month after the intervention.

Figure 3

Figure 3

ALFF analysis of amnestic mild cognitive impairment patients after rTMS or sham stimulation. (A, B) The ALFF values in the different brain regions in the rTMS treatment (A) and sham groups (B). (C) Differences in ALFF values between the treatment and sham groups after the rTMS intervention. Red represents an increase and blue represents a decrease. The _P_-value, corrected by topological FDR, was set to P < 0.05. ALFF: Amplitude of low-frequency fluctuation; FDR: false discovery rate; rTMS: repetitive transcranial magnetic stimulation.

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