Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T09:42:35.929Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of behavioral and psychological symptoms of dementia using transcranial magnetic stimulation: a systematic review

Published online by Cambridge University Press:  20 February 2023

Kayla Murphy Open the ORCID record for Kayla Murphy [Opens in a new window] ,
Amber Khan ,
Anil Bachu  and
Rajesh Tampi
Kayla Murphy
Affiliation:
University of Texas Southwestern Medical Center, Dallas, TX, USA
Amber Khan
Affiliation:
Montefiore Medical Center, Bronx, NY, USA
Anil Bachu
Affiliation:
Department of Psychiatry, Baptist Health-UAMS, North Little Rock, AR, USA
Rajesh Tampi*
Affiliation:
Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
*
Correspondence should be addressed to: Rajesh R. Tampi, Department of Psychiatry, Creighton University Education Building, 7710 Mercy Road, Suite 601, Omaha, NE 68124-2370, USA. Phone: (203) 809 5223; Fax: (402) 717 5792. Email: rajesh.tampi@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Behavioral and psychological symptoms of dementia (BPSD) are a group of noncognitive symptoms that occur commonly among individuals with dementia. These symptoms worsen the morbidity and mortality among individuals with dementia and significantly increase the cost of caring for these individuals. Transcranial magnetic stimulation (TMS) has been shown to have some benefits in the treatment of BPSD. This review provides an updated summary of the effect of TMS on BPSD.

Methods:

We conducted a systematic review of PubMed, Cochrane, and Ovid databases on the use of TMS to treat BPSD.

Results:

We found 11 randomized controlled studies that evaluated the use of TMS among individuals with BPSD. Three of these studies examined the effect of TMS on apathy, two of which showed significant benefit. Seven studies showed that TMS significantly improves BPSD: six using repetitive transcranial magnetic stimulation (rTMS) and one using transcranial direct current stimulation (tDCS). Four studies, two evaluating tDCS, one evaluating rTMS, and one evaluating intermittent theta-burst stimulation (iTBS) showed a nonsignificant impact of TMS on BPSD. Adverse events were predominantly mild and transitory in all studies.

Conclusion:

Available data from this review indicate that rTMS is beneficial for individuals with BPSD, especially among individuals with apathy, and is well tolerated. However, more data are needed to prove the efficacy of tDCS and iTBS. Additionally, more randomized controlled trials with longer treatment follow-up and standardized use of BPSD assessments are needed to determine the best dose, duration, and modality for effective treatment of BPSD.

Keywords

Transcranial magnetic stimulation (TMS)dementiabehavioral and psychological symptoms of dementia (BPSD)
Type
Review Article
Information
International Psychogeriatrics , Volume 35 , Special Issue 11: Issue Theme: Neuropsychiatric Symptoms of Mild and Major Neurocognitive Disorders , November 2023 , pp. 611 - 622
Copyright
© International Psychogeriatric Association 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

Kayla Murphy and Amber Khan are co-first authors of this paper.

References

Abraha, I., et al. (2017). Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open, 7, e012759.CrossRefGoogle ScholarPubMed
Alcala-Lozano, R., Morelos-Santana, E., Cortes-Sotres, J. F., Garza-Villarreal, E. A., Sosa-Ortiz, A. L. and Gonzalez-Olvera, J. J. (2018). Similar clinical improvement and maintenance after rTMS at 5 Hz using a simple vs. complex protocol in Alzheimer’s disease. Brain Stimulation, 11, 625–627.CrossRefGoogle ScholarPubMed
Aparício, L. V. M., Guarienti, F., Razza, L. B., Carvalho, A. F., Fregni, F. and Brunoni, A. R. (2016). A systematic review on the acceptability and tolerability of transcranial direct current stimulation treatment in neuropsychiatry trials. Brain Stimulation, 9, 671–681.CrossRefGoogle ScholarPubMed
Bahji, A., Meyyappan, A. C. and Hawken, E. R. (2020). Cannabinoids for the neuropsychiatric symptoms of dementia: a systematic review and meta-analysis. Canadian Journal of Psychiatry, 65, 365–376.CrossRefGoogle ScholarPubMed
Benussi, A., et al. (2020). Transcranial stimulation in frontotemporal dementia: A randomized, double-blind, sham-controlled trial. Alzheimer’s and Dementia (New York, N.Y.), 6, e12033.CrossRefGoogle ScholarPubMed
Bessey, L. J. and Walaszek, A. (2019). Management of behavioral and psychological symptoms of dementia. Current Psychiatry Reports, 21, 66.CrossRefGoogle ScholarPubMed
Blumberger, D. M., et al. (2018). Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet, 391, 1683–1692.CrossRefGoogle ScholarPubMed
Boes, A. D., Kelly, M. S., Trapp, N. T., Stern, A. P., Press, D. Z. and Pascual-Leone, A. (2018). Noninvasive brain stimulation: challenges and opportunities for a new clinical specialty. The Journal of Neuropsychiatry and Clinical Neurosciences, 30, 173–179.CrossRefGoogle ScholarPubMed
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73.CrossRefGoogle ScholarPubMed
Dyer, S. M., Harrison, S. L., Laver, K., Whitehead, C. and Crotty, M. (2018). An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia. International Psychogeriatrics, 30, 295–309.CrossRefGoogle ScholarPubMed
Elder, G. J., Colloby, S. J., Firbank, M. J., McKeith, I. G. and Taylor, J. P. (2019). Consecutive sessions of transcranial direct current stimulation do not remediate visual hallucinations in Lewy body dementia: a randomised controlled trial. Alzheimer’s Research & Therapy, 11, 9.CrossRefGoogle Scholar
Gerlach, L. B. and Kales, H. C. (2020). Managing behavioral and psychological symptoms of dementia. Clinics in Geriatric Medicine, 36, 315–327.CrossRefGoogle ScholarPubMed
Hejzlar, M., Novak, T. and Bares, M. (2021). Neurostimulation methods in the treatment of depression: a comparison of rTMS, tDCS, and Venlafaxine using a pooled analysis of two studies. Neuropsychiatric Disease and Treatment, 17, 1713–1722.CrossRefGoogle ScholarPubMed
Jadad, A. R., et al. (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials, 17, 1–12.CrossRefGoogle ScholarPubMed
Kales, H. C., Gitlin, L. N., Lyketsos, C. G., Detroit Expert Panel on, A. and Management of Neuropsychiatric Symptoms of, D. (2014). Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, 62, 762–769.CrossRefGoogle ScholarPubMed
Kales, H. C., Lyketsos, C. G., Miller, E. M. and Ballard, C. (2019). Management of behavioral and psychological symptoms in people with Alzheimer’s disease: an international Delphi consensus. International Psychogeriatrics, 31, 83–90.CrossRefGoogle ScholarPubMed
Magierski, R., Sobow, T., Schwertner, E. and Religa, D. (2020). Pharmacotherapy of behavioral and psychological symptoms of dementia: state of the art and future progress. Frontiers in Pharmacology, 11, 1168.CrossRefGoogle ScholarPubMed
Maidment, I. D., Fox, C. G., Boustani, M., Rodriguez, J., Brown, R. C. and Katona, C. L. (2008). Efficacy of memantine on behavioral and psychological symptoms related to dementia: a systematic meta-analysis. Annals of Pharmacotherapy, 42, 32–38.CrossRefGoogle ScholarPubMed
Padala, P. R., et al. (2020). Neuromodulation for apathy in Alzheimer’s disease: a double-blind, randomized, Sham-Controlled pilot study. Journal of Alzheimer’s Disease, 77, 1483–1493.CrossRefGoogle ScholarPubMed
Padala, P. R., et al. (2018). Repetitive transcranial magnetic stimulation for apathy in mild cognitive impairment: a double-blind, randomized, sham-controlled, cross-over pilot study. Psychiatry Research, 261, 312–318.CrossRefGoogle ScholarPubMed
Pytel, V., et al. (2021). Personalized repetitive transcranial magnetic stimulation for primary progressive aphasia. Journal of Alzheimer’s Disease, 84, 151–167.CrossRefGoogle ScholarPubMed
Rabey, J. M., Dobronevsky, E., Aichenbaum, S., Gonen, O., Marton, R. G. and Khaigrekht, M. (2013). Repetitive transcranial magnetic stimulation combined with cognitive training is a safe and effective modality for the treatment of Alzheimer’s disease: a randomized, double-blind study. Journal of Neural Transmission (Vienna), 120, 813–819.CrossRefGoogle ScholarPubMed
Savva, G. M., et al. (2009). Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. British Journal of Psychiatry, 194, 212–219.CrossRefGoogle ScholarPubMed
Seitz, D. P., Adunuri, N., Gill, S. S., Gruneir, A., Herrmann, N. and Rochon, P. (2011). Antidepressants for agitation and psychosis in dementia. Cochrane Database of Systematic Reviews, 16, CD008191.Google Scholar
Suemoto, C. K., et al. (2014). Effects of a non-focal plasticity protocol on apathy in moderate Alzheimer’s disease: a randomized, double-blind, sham-controlled trial. Brain Stimulation, 7, 308–313.CrossRefGoogle ScholarPubMed
Tampi, R. R. (2022). Paired associative stimulation (PAS) and Alzheimer’s disease (AD). International Psychogeriatrics, 1–7.Google ScholarPubMed
Trinh, N. H., Hoblyn, J., Mohanty, S. and Yaffe, K. (2003). Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis. Jama, 289, 210–216.CrossRefGoogle ScholarPubMed
Vacas, S. M., Stella, F., Loureiro, J. C., Simoes do Couto, F., Oliveira-Maia, A. J. and Forlenza, O. V. (2019). Noninvasive brain stimulation for behavioural and psychological symptoms of dementia: a systematic review and meta-analysis. International Journal of Geriatric Psychiatry, 34, 1336–1345.CrossRefGoogle ScholarPubMed
van den Berg, J. F., Kruithof, H. C., Kok, R. M., Verwijk, E. and Spaans, H. P. (2018). Electroconvulsive therapy for agitation and aggression in dementia: a systematic review. American Journal of Geriatric Psychiatry, 26, 419–434.CrossRefGoogle ScholarPubMed
Wu, X., et al. (2022). Accelerated intermittent theta-burst stimulation broadly ameliorates symptoms and cognition in Alzheimer’s disease: a randomized controlled trial. Brain Stimulation, 15, 35–45.CrossRefGoogle ScholarPubMed
Wu, Y., Xu, W., Liu, X., Xu, Q., Tang, L. and Wu, S. (2015). Adjunctive treatment with high frequency repetitive transcranial magnetic stimulation for the behavioral and psychological symptoms of patients with Alzheimer’s disease: a randomized, double-blind, sham-controlled study. Shanghai Archives of Psychiatry, 27, 280–288.Google ScholarPubMed
Zhang, F., Qin, Y., Xie, L., Zheng, C., Huang, X. and Zhang, M. (2019). High-frequency repetitive transcranial magnetic stimulation combined with cognitive training improves cognitive function and cortical metabolic ratios in Alzheimer’s disease. Journal of Neural Transmission (Vienna), 126, 1081–1094.CrossRefGoogle ScholarPubMed
Zhao, Q. F., et al. (2016). The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: systematic review and meta-analysis. Journal of Affective Disorders, 190, 264–271.CrossRefGoogle ScholarPubMed