Cognitive functioning after repetitive transcranial magnetic stimulation in patients with cerebrovascular disease without dementia: a pilot study of seven patients.
OBJECTIVE
Examine whether one session of high frequency repetitive transcranial magnetic stimulation (rTMS) applied over the left dorsolateral prefrontal cortex (DLPFC) would induce any measurable cognitive changes in patients with cerebrovascular disease and mild cognitive deficits.


METHODS
Seven patients with cerebrovascular disease and mild executive dysfunction entered the randomised, controlled, blinded study with a crossover design. rTMS was applied either over the left DLPFC (an active stimulation site) or over the left motor cortex (MC; a control stimulation site) in one session. Each patient participated in both stimulation sessions (days 1 and 4) and the order of stimulation sites (DLPFC or MC) was randomised. A short battery of neuropsychological tests was performed by a blinded psychologist prior to and after each rTMS session. Psychomotor speed, executive function, and memory were evaluated.


RESULTS
The only mild but significant stimulation site-specific effect of rTMS was observed in the Stroop interference results (i.e. improvement) after the stimulation of DLPFC but not MC in comparison with the baseline scores (Wilcoxon, Z=-2.03, p=0.04). Patients improved in the digit symbols subtest of the Wechsler adult intelligence scale-revised after both rTMS sessions regardless of the stimulation site (DLPFC or MC; Z=-2.06, p=0.04 and Z=-2.06, p=0.04, respectively). There was no measurable effect of rTMS in any other neuropsychological test.


CONCLUSIONS
Our pilot study results showed that one session of the high frequency rTMS applied over the left DLPFC was safe in patients with cerebrovascular disease and mild executive deficits, and may induce measurable positive effects on executive functioning.
Rektorova
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First Department of Neurology, Masaryk University, Teaching Hospital sv. Anna, Pekarska 53, 656 91, Brno, Czech Republic. irena.rektorova@fnusa.cz
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Bares
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Rektor
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D000368:Aged; D002561:Cerebrovascular Disorders / Q000523:psychology* / Q000628:therapy*; D003071:Cognition / Q000502:physiology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004574:Electromagnetic Fields / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D009044:Motor Cortex / Q000502:physiology; D009483:Neuropsychological Tests; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000502:physiology; D014888:Wechsler Scales