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74 A Phase I Trial of Accelerated, HighDose Repetitive Transcranial Magnetic Stimulation to Improve Cognition in Amnestic MCI
- Stephanie Fountain-Zaragoza, James Lopez, Katrina Rbeiz, Holly H Fleischmann, Olivia Horn, Katrina Madden, Michael Antonucci, Gonzalo Revuelta, Lisa M McTeague
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 479-480
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- Article
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Objective:
Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation therapy most widely used in depression, has shown evidence of secondary benefits for cognition in both neurologic and neuropsychiatric conditions. The recent development of more efficient stimulation protocols, such as accelerated high-dose intermittent theta burst (iTBS)-rTMS, has substantially reduced treatment burden by shortening the treatment course by >50%. This study aimed to establish the safety, feasibility, acceptability, and preliminary efficacy of iTBS-rTMS as a tool for bolstering cognition in individuals with amnestic mild cognitive impairment (aMCI).
Participants and Methods:Twenty-four patients with aMCI were enrolled in an open-label phase I trial of iTBS-rTMS; 2 withdrew prior to initiating treatment due to personal circumstances. All participants had received a diagnosis of MCI due to possible AD from a healthcare provider (i.e., neurologist or neuropsychologist) and met actuarial neuropsychological criteria for aMCI. This sample of older adults (range: 61.5-85.2 years, M = 74.1, SD = 5.71) was predominantly White/non-Hispanic (n = 23; Black/non-Hispanic: n = 1), roughly half female (n = 13), with a college education (range: 12-20 years, M = 15.9, SD = 2.5). Participants received 24 sessions of iTBS-rTMS to the left dorsolateral prefrontal cortex over 3 days (8 sessions each, lasting roughly 2 hours per day). Participants rated their perceptions and experience of common side effects during and after each treatment session as well as retrospectively at post-treatment and 4-week follow-up. They completed structural and functional brain MRI, neuropsychiatric evaluations, and neuropsychological assessments before and after treatment and were administered a subset of these measures at 4-week follow-up. MoCA scores were used to monitor for adverse neurocognitive effects, and the fluid cognition composite score from the NIH Toolbox Cognition Battery was used to test preliminary efficacy.
Results:We achieved a high retention rate (95%), with 21 of the 22 participants completing all study procedures. There were no clinically significant adverse neuroradiological, neuropsychiatric, or neurocognitive effects of treatment. Participant reports indicated high tolerability and acceptability, with a modal rating of 0 (on a scale from 0=not at all to 10=extremely) for six common side effects (i.e., headache, pain, scalp irritation, facial twitching, fatigue, fear/anxiety), assessed both during and after each treatment session. They reported very low desire to quit despite some participants rating the treatment as moderately tiring. We observed significant, large effect-size (d = 0.98) improvements in fluid cognition from pre- to post-treatment.
Conclusions:Our findings support the safety, feasibility, and acceptability of iTBS-rTMS treatment in patients with aMCI. Further, although not explicitly dosed for efficacy, we provide preliminary evidence of improved fluid cognition as a function of treatment, highlighting the potential of this treatment for improving trans-domain cognitive impairment. These promising results can directly inform future trials aimed at optimizing treatment parameters, broadening the indication to other MCI subtypes, and testing the augmentation of established cognitive rehabilitation interventions when combined with rTMS.
Assessing Effects of Treatment With Lisdexamfetamine Dimesylate for Pediatric ADHD Using a Parental Survey
- Donna Antonucci, Craig Kunins, Michael Manos, Frank A. López, Donna L. Kerney
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- Journal:
- CNS Spectrums / Volume 15 / Issue 4 / April 2010
- Published online by Cambridge University Press:
- 07 November 2014, pp. 248-256
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Introduction:
Lisdexamfetamine dimesylate (LDX) is a prodrug stimulant approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in adults and children 6–12 years of age. Parent surveys provide valuable information regarding the impact of ADHD treatments.
Methods:Parents of children with ADHD beginning treatment with LDX voluntarily completed surveys through an automated telephone system or the Internet before and 6 weeks after LDX treatment initiation. Prescribing physicians received individual reports of the responses for each survey completed by their patients' parents. All patients whose parents completed both baseline and 6 week surveys were included in the analyses. Subgroup analyses were conducted for those previously treated with medications to treat ADHD, including mixed amphetamine salts-extended release.
Results:LDX treatment was associated with a significant decrease in ADHD symptom interference with school activities, family interactions, homework, and social interactions (P<.01; N= 11,576). Parents rated satisfaction with LDX as significantly higher than with their child's previous treatment (P<.01). On average, global improvement, tolerability, convenience, and satisfaction with LDX were all highly rated.
Conclusion:Patients treated with LDX showed significant symptom improvement and parents reported significantly greater satisfaction than with prior treatment.
Contributors
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- By Isabella Aboderin, W. Andrew Achenbaum, Katherine R. Allen, Toni C. Antonucci, Sara Arber, Claudine Attias‐Donfut, Paul B. Baltes, Sandhi Maria Barreto, Vern L. Bengtson, Simon Biggs, Joanna Bornat, Julie B. Boron, Mike Boulton, Clive E. Bowman, Marjolein Broese van Groenou, Edna Brown, Robert N. Butler, Bill Bytheway, Neena L. Chappell, Neil Charness, Kaare Christensen, Peter G. Coleman, Ingrid Arnet Connidis, Neal E. Cutler, Sara J. Czaja, Svein Olav Daatland, Lia Susana Daichman, Adam Davey, Bleddyn Davies, Freya Dittmann‐Kohli, Glen H. Elder, Carroll L. Estes, Mike Featherstone, Amy Fiske, Alexandra Freund, Daphna Gans, Linda K. George, Roseann Giarrusso, Chris Gilleard, Jay Ginn, Edlira Gjonça, Elena L. Grigorenko, Jaber F. Gubrium, Sarah Harper, Jutta Heckhausen, Akiko Hashimoto, Jon Hendricks, Mike Hepworth, Charlotte Ikels, James S. Jackson, Yuri Jang, Bernard Jeune, Malcolm L. Johnson, Randi S. Jones, Alexandre Kalache, Robert L. Kane, Rosalie A. Kane, Ingrid Keller, Rose Anne Kenny, Thomas B. L. Kirkwood, Kees Knipscheer, Martin Kohli, Gisela Labouvie‐Vief, Kristina Larsson, Shu‐Chen Li, Charles F. Longino, Ariela Lowenstein, Erick McCarthy, Gerald E. McClearn, Brendan McCormack, Elizabeth MacKinlay, Alfons Marcoen, Michael Marmot, Tom Margrain, Victor W. Marshall, Elizabeth A. Maylor, Ruud ter Meulen, Harry R. Moody, Robert A. Neimeyer, Demi Patsios, Margaret J. Penning, Stephen A. Petrill, Chris Phillipson, Leonard W. Poon, Norella M. Putney, Jill Quadagno, Pat Rabbitt, Jennifer Reid Keene, Sandra G. Reynolds, Steven R. Sabat, Clive Seale, Merril Silverstein, Hannes B. Staehelin, Ursula M. Staudinger, Robert J. Sternberg, Debra Street, Philip Taylor, Fleur Thomése, Mats Thorslund, Jinzhou Tian, Theo van Tilburg, Fernando M. Torres‐Gil, Josy Ubachs‐Moust, Christina Victor, K. Warner Shaie, Anthony M. Warnes, James L. Werth, Sherry L. Willis, François‐Charles Wolff, Bob Woods
- Edited by Malcolm L. Johnson, University of Bristol
- Edited in association with Vern L. Bengtson, University of Southern California, Peter G. Coleman, University of Southampton, Thomas B. L. Kirkwood, University of Newcastle upon Tyne
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- Book:
- The Cambridge Handbook of Age and Ageing
- Published online:
- 05 June 2016
- Print publication:
- 01 December 2005, pp xii-xvi
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