Repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer's disease.
OBJECTIVE
To assess the efficacy of a combination of cognitive training (COG) and repetitive transcranial magnetic stimulation (rTMS), on cognitive performance, locomotor activity, apathy, caregiver burden and dependence of patients with Alzheimer's disease (AD).


METHODS
A combination of COG and rTMS was performed in 10 patients with AD (NeuroAD procedure) for a period of 5weeks (one session per day, 5days a week), without maintenance sessions. Patients were evaluated at the end of the treatment (D45) and 6months later (M6) by the Mini Mental State Examination (MMSE), the Alzheimer disease assessment scale - cognitive subscale (ADAS-Cog), various neuropsychological tests and clinical scores specific for locomotor activity, apathy, caregiver burden, and dependence, recorded before the study (baseline).


RESULTS
The primary endpoint was the improvement of the ADAS-Cog score at D45, which was reached. Six months after the end of the treatment, the ADAS-Cog score returned to baseline value, except for the best responders who remained significantly improved. The other main result was the improvement of apathy and dependence scores at both D45 and M6 for the entire series of patients. No serious adverse events occurred and all patients completed the study.


CONCLUSIONS
The results of this open-label study confirm the feasibility of the rTMS-COG procedure in AD patients, and suggest that these patients can benefit from the procedure, in terms of cognitive performances, apathy and dependence, even in the long term. These promising results remain to be confirmed in controlled studies based on a larger population size, which could also help identify the prognostic factors associated with good outcome, in order to optimize patient selection.
Multidisciplinary Pain Center, clinique Bretéché, groupe Elsan, 44000 Nantes, France; UIC22 and EA2826, Multidisciplinary Pain, Palliative and Support Care Center, University Hospital, 44093 Nantes cedex 1, France.
Jean-Paul
JP
Nguyen
Multidisciplinary Pain Center, clinique Bretéché, groupe Elsan, 44000 Nantes, France.
Alcira
A
Suarez
EA6314, Laboratory MOVE, Faculty of Sports Sciences, University Hospital, groupe Elsan, 86000 Poitiers, France.
Gilles
G
Kemoun
Multidisciplinary Pain Center, clinique Bretéché, groupe Elsan, 44000 Nantes, France.
Michel
M
Meignier
Multidisciplinary Pain Center, clinique Bretéché, groupe Elsan, 44000 Nantes, France.
Estelle
E
Le Saout
Inserm U913, Neurology Department, University Hospital, 44093 Nantes cedex, France.
Philippe
P
Damier
UIC22 and EA2826, Multidisciplinary Pain, Palliative and Support Care Center, University Hospital, 44093 Nantes cedex 1, France. Electronic address: julien.nizard@univ-nantes.fr.
Julien
J
Nizard
EA4391, Clinical Neurophysiology Department, Henri Mondor University Hospital, University Paris-Est Créteil, 94010 Créteil cedex, France.
Jean-Pascal
JP
Lefaucheur
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology / Q000628:therapy*; D057565:Apathy; D017028:Caregivers / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
Alzheimer's disease; Cognitive training; Entraînement cognitif; Maladie d’Alzheimer; RTMS; Repetitive transcranial magnetic stimulation; Stimulation magnétique transcrânienne répétitive; Traitement; Treatment; rTMS