title: Open-label, short-term, repetitive transcranial magnetic stimulation in patients with Alzheimer's disease with functional imaging correlates and literature review.
abstract: BACKGROUND
  Accumulating evidence suggests repetitive transcranial magnetic stimulation (rTMS) may be beneficial in ameliorating cognitive deficits in Alzheimer's disease (AD).
  
  
  METHODS
  AD patients received four high-frequency rTMS sessions over the bilateral dorsolateral prefrontal cortex (DLPFC) over two weeks. Structured cognitive assessments were administered at baseline, at 2 weeks after completion of rTMS, and at 4 weeks post treatment. At these same times, tolerant patients underwent functional magnetic resonance imaging (fMRI) while performing structured motor and cognitive tasks. We also reviewed literature regarding the effects of rTMS on cognitive function in AD.
  
  
  RESULTS
  A total of 12 patients were enrolled, eight of whom tolerated the fMRI. Improvement was seen in Boston Diagnostic Aphasia Examination tests of verbal and non-verbal agility 4 weeks post-treatment. The fMRI analysis showed trends for increased activation during cognitive performance tasks immediately after and at 4 weeks post-treatment. Our literature review revealed several double-blind, sham-controlled studies, all showing sustained improvement in cognition of AD patients with rTMS.
  
  
  CONCLUSIONS
  There was improvement in aspects of language after four rTMS treatments, sustained a month after treatment cessation. Our results are consistent with other studies and standardization of treatment protocols using functional imaging may be of benefit.
authors.affiliation: 1New York Memory and Healthy Aging Services, New York, NY, USA.
authors.forename: Gayatri
authors.initials: G
authors.lastname: Devi
authors.forename: Henning U
authors.initials: HU
authors.lastname: Voss
authors.forename: Dani
authors.initials: D
authors.lastname: Levine
authors.forename: Dana
authors.initials: D
authors.lastname: Abrassart
authors.forename: Linda
authors.initials: L
authors.lastname: Heier
authors.forename: James
authors.initials: J
authors.lastname: Halper
authors.forename: Leilanie
authors.initials: L
authors.lastname: Martin
authors.forename: Sandy
authors.initials: S
authors.lastname: Lowe
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology / Q000628:therapy*; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017397:Prefrontal Cortex / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Alzheimer’s disease; fMRI; rTMS