Efficacy of Repetitive Transcranial Magnetic Stimulation for Improvement of Memory in Older Adults with TBI
Abstract
About 1.7 million people sustain a traumatic brain injury (TBI) every year in the US while approximately 5.3 million cope with chronic TBI symptoms with large impacts on the quality of life they lead. A single blow to the head classified as a moderate or severe TBI can lead to cognitive decline or dementia. The recent attention given to chronic traumatic encephalopathy (CTE) in military personnel and those who participate in contact sports has raised much public concern. Current advances in Alzheimer’s disease (AD) and TBI test therapeutic treatments that target symptom improvement, especially on aspects of cognition that impact everyday function. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation treatment that is now Food and Drug Administration (FDA)-approved for depression. Research within the Department of Veterans Affairs (VA) is currently testing rTMS as a treatment for pain, post-traumatic stress disorder (PTSD), anxiety, and improvement of executive function in TBI. The military and Veteran populations with TBI are particularly at risk for accelerated cognitive decline and dementia as they grow older due to multiple health problems, and we believe it is important to understand how such treatments influence aging and other dementia-related processes in TBI populations. In order to fully comprehend the TBI-AD link, a bridge must be made between the two such that outcomes and tools are adapted from AD into the TBI research domain. Moreover, many of the biological properties that characterize memory and dementia may be linked to chronic symptoms post-TBI, but associated risk factors are yet to be determined. This proposal provides a TBI-AD bridge by applying previously established measures in AD population to older patients with mild and moderate TBI in an rTMS treatment study. That is, this proposal adapts the current rTMS study design that stimulates the frontal lobe in TBI patients (active group vs. a control group) but tests its beneficial effects on a memory measure dependent on the temporal lobe. This is done so as to capture symptoms of preclinical cognitive decline. We believe that stimulation of the frontal lobe will enhance brain repair specifically through network connections of established brain circuits resulting in improved memory performance. Current VA/Department of Defense guidelines for treatment of acute mild TBI do not include any neuroimaging and/or assessment of other biological biomarkers. Considering that chronic symptoms of TBI may occur later in time, it is important to uncover biological targets for better assessment and treatment. Therefore, we propose to measure functional brain activity at rest as that may be the best way to monitor change before and after this rTMS treatment. We will primarily focus on the “connectivity” within brain networks previously shown to be modulated by rTMS to demonstrate their change in the context of TBI and memory problems. This proposal does not only test the efficacy of an intervention to improve quality of life in population with TBI at risk for dementia, an additional purpose is to fully characterize those patients with TBI who may have certain risk factors for developing cognitive decline or even AD. In other words, we want to better understand the mechanisms of action underlying the rTMS treatment so as to provide better targets for research and create patient profiles. A large amount of research in AD and TBI suggests that, at the cell level, a decrease in neuronal connections occurs in TBI and in AD leading to decreased connectivity, possibly due to neuronal injury (TBI) or particular brain protein malfunctions (AD). We propose to collect measures that capture these biological insults, e.g., glucose uptake by the brain, genetic information that may add more risk, temporal dynamics of brain activity and brain volume. We will pay special attention to factors such as age, depression, PTSD, type of
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710508
Entities
People
- Maheen Adamson
Organizations
- Palo Alto Veterans Institute for Research
- United States Army