Enhancing Cognition in Older Persons with Depression or Anxiety with a Combination of Mindfulness-Based Stress Reduction (MBSR) and Transcranial Direct Current Stimulation (tDCS): Results of a Pilot Randomized Clinical Trial

Using Electroencephalography to Advance Mindfulness Science: A Survey of Emerging Methods and Approaches

Throughout the brief history of contemplative neuroscience, electroencephalography (EEG) has been a valuable and enduring methodology used to elucidate the neural correlates and mechanisms of mindfulness. In this review, we provide a reminder that longevity should not be conflated with obsoletion and that EEG continues to offer exceptional promise for addressing key questions and challenges that pervade the field today. Toward this end, we first outline the unique advantages of EEG from a research strategy and experimental design perspective, then highlight an array of new sophisticated data analytic approaches and translational paradigms. Along the way, we provide illustrative examples from our own work and the broader literature to showcase how these innovations can be leveraged to spark new insights and stimulate progress across both basic science and translational applications of mindfulness. Ultimately, we argue that EEG still has much to contribute to contemplative neuroscience, and we hope to solicit the interest of other investigators to make full use of its capabilities in service of maximizing its potential within the field.

Enhancing Equanimity With Noninvasive Brain Stimulation: A Novel Framework for Mindfulness Interventions

Mindfulness has gained widespread recognition for its benefits for mental health, cognitive performance, and well-being. However, the multifaceted nature of mindfulness, which encompasses elements such as attentional focus, emotional regulation, and present-moment awareness, complicates its definition and measurement. A key component that may underlie its broad benefits is equanimity-the ability to maintain an open and nonreactive attitude toward all sensory experiences. Empirical research suggests that mindfulness works through a combination of top-down attentional control and bottom-up sensory and emotional processes and that equanimity's role in regulating those bottom-up processes drives the psychological and physiological benefits, making it a promising target for both theoretical and practical exploration. Given these findings, the development of interventions that specifically augment equanimity could improve the impact of mindfulness practices. Research into noninvasive brain stimulation (NIBS) suggests that it is a potential tool for altering neural circuits involved in mindfulness. However, most NIBS studies reported to date have focused on improving cognitive control systems and have left equanimity relatively unexplored. Preliminary findings from focused ultrasound interventions targeting the posterior cingulate cortex suggest that NIBS can directly facilitate equanimity by inhibiting self-referential processing in the default mode network to promote a more present-centered state of awareness. Future research should prioritize the integration of NIBS with well-defined mindfulness training protocols, focusing on equanimity as a core target. This approach could provide a novel framework for advancing both contemplative neuroscience and clinical applications, offering new insights into the mechanisms of mindfulness and refining NIBS methodologies to support individualized, precision wellness interventions.

The effectiveness of non-invasive brain stimulation in treatment of major depressive disorder (MDD): a systematic review and transfer analysis

This study aimed to analyze the transferability of non-invasive brain stimulation (NIBS) interventions in individuals with major depressive disorder (MDD) based on the FIELD model (Function, Implementation, Ecology, Level, and Duration), encompassing function, implement, ecology, level, and duration. A systematic search of electronic databases yielded a total of 21 eligible studies, comprising 12 transcranial direct current stimulation (tDCS) and 9 transcranial magnetic stimulation (TMS) trials, involving 1029 individuals with MDD. The meta-analysis of effect sizes revealed positive transfer effects across all domains of the FIELD model, suggesting that NIBS interventions have potential efficacy in improving various facets of MDD. The subgroup analysis highlighted that bilateral dlPFC stimulation exhibited the highest effect size for transferability, indicating greater transferability for rTMS, a higher dose of stimulation, and the integration of additional interventions. Additionally, the study discusses the implications of bilateral dorsolateral prefrontal cortex (dlPFC) stimulation and the integration of complementary therapies for optimizing treatment efficacy.

The Effect of Mindfulness-Based Interventions on Mental Health and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

To assess whether mindfulness-based interventions (MBIs) affect mental health and cognitive abilities in older adults.

METHODS

A systematic search was performed in PubMed, SCOPUS, Web of Science, and Google Scholar up to June 2023. Weight mean difference and 95% confidence intervals were provided as summary statistics.

RESULTS

In total, 26 articles were eligible. Overall, MBIs showed a statistically significant improvement in depression, anxiety, quality of life, and working memory compared to controls. However, no significant effects of MBIs on other cognitive parameters were found. In moderator analysis, less than eight weeks of MBIs showed greater improvement in anxiety and quality of life than longer periods. There was no evidence for publication bias.

DISCUSSION

Mindfulness-based interventions can be an encouraging alternative in place of conventional treatments in improving depression, anxiety, quality of life and working memory in cognition among older adults. However, findings strongly recommend future research to have definite conclusion.

An Educational Program for Remote Training and Supervision of Home-Based Transcranial Electrical Stimulation: Feasibility and Preliminary Effectiveness

OBJECTIVES

There has been recent interest in the administration of transcranial electrical stimulation (tES) by a caregiver, family member, or patient themselves while in their own homes (HB-tES). The need to properly train individuals in the administration of HB-tES is essential, and the lack of a uniform training approach across studies has come to light. The primary aim of this paper is to present the HB-tES training and supervision program, a tele-supervised, instructional, and evaluation program to teach laypersons how to administer HB-tES to a participant and to provide a standardized framework for remote monitoring of participants by teaching staff. The secondary aim is to present early pilot data on the feasibility and effectiveness of the training portion of the program based on its implementation in 379 sessions between two pilot clinical trials.

MATERIALS AND METHODS

The program includes instructional materials, standardized tele-supervised hands-on practice sessions, and a system for remote supervision of participants by teaching staff. Nine laypersons completed the training program. Data on the feasibility and effectiveness of the program were collected.

RESULTS

No adverse events were reported during the training or any of the HB-tES sessions after the training. All laypersons successfully completed the training. The nine laypersons reported being satisfied with the training program and confident in their tES administration capabilities. This was consistent with laypersons requiring technical assistance from teaching staff very infrequently during the 379 completed sessions. The average adherence rate between all administrators was >98%, with seven of nine administrators having 100% adherence to the scheduled sessions.

CONCLUSIONS

These findings indicate that the HB-tES program is effective and is associated with participant satisfaction.

SIGNIFICANCE

We hope that the remote nature of this training program will facilitate increased accessibility to HB-tES research for participants of different demographics and locations. This program, designed for easy adaptation to different HB-tES research applications and devices, also is accessible online. The adoption of this program is expected to facilitate uniformity of study methods among future HB-tES studies and thereby accelerate the pace of tES intervention discovery.

The influence of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life of patients with sarcopenia receiving haemodialysis: a randomised controlled trial

OBJECTIVE

To study the effect of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life in patients with sarcopenia receiving maintenance haemodialysis (MHD).

METHODS

Eligible patients with sarcopenia in our hospital were randomly assigned to a control group (n = 24) and an intervention group (n = 25). The control group received conventional dialysis treatment, while the intervention group underwent mindfulness meditation combined with progressive muscle relaxation training during the interdialysis period in addition to conventional dialysis treatment. The effect of the intervention was evaluated after 12 weeks.

RESULTS

There were no significant differences in the baseline values of various parameters between the two groups. Exercise capacity (sit-to-stand test,handgrip,time to 10 sit-ups) significantly improved in the intervention group after 12 weeks (32.68 ± 8.32 vs 26.50 ± 6.83; 37.42 ± 10.12 vs 28.12 ± 8.51; 19.8 ± 5.40 vs 25.29 ± 7.18) (p < 0.05). In terms of the kidney disease quality of life (KDQOLTM) score, all other dimensions except sexual function, social functioning, burden of kidney disease and work status dimensions showed significant improvement compared to the baseline (p < 0.05). In the control group, only the dialysis staff encouragement (DSE) and patient satisfaction (PS) dimensions showed slight improvements compared to the baseline (p > 0.05). When compared with the control group, the intervention group showed significant improvements in 10 dimensions of exercise capacity and KDQOLTM scores for physical function, role-physical, general health, energy, symptom/problem list, sleep, DSE, pain, cognitive function, emotional well-being and patient PS after 12 weeks (61.30 ± 5.38 vs 42.98 ± 5.73; 57.50 ± 3.55 vs 50.70 ± 3.62) (p < 0.05). Some inflammatory markers, such as the levels of interleukin-6 and high-sensitivity C-reactive protein (30.29 ± 2.96 vs 17.65 ± 3.22; 8.93 ± 0.99 vs 3.02 ± 0.34), showed a decrease during the intervention, while albumin and prealbumin levels were significantly increased compared with the baseline (30.62 ± 1.65 vs 35.60 ± 1.68; 0.32 ± 0.05 vs 0.44 ± 0.07) (p < 0.05).

CONCLUSION

Combined intervention training can improve the motor ability and quality of life of patients with sarcopenia within a short period of time.

A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression

LEARNING OBJECTIVES

After participating in this CME activity, the psychiatrist should be better able to:• Compare and contrast therapies used in combination with transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for treating MDD.

BACKGROUND

Noninvasive neuromodulation, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has emerged as a major area for treating major depressive disorder (MDD). This review has two primary aims: (1) to review the current literature on combining TMS and tDCS with other therapies, such as psychotherapy and psychopharmacological interventions, and (2) to discuss the efficacy, feasibility, limitations, and future directions of these combined treatments for MDD.

METHOD

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three databases: PubMed, PsycInfo, and Cochrane Library. The last search date was December 5, 2023.

RESULTS

The initial search revealed 2,519 records. After screening and full-text review, 58 studies (7 TMS plus psychotherapy, 32 TMS plus medication, 7 tDCS plus psychotherapy, 12 tDCS plus medication) were included.

CONCLUSIONS

The current literature on tDCS and TMS paired with psychotherapy provides initial support for integrating mindfulness interventions with both TMS and tDCS. Adding TMS or tDCS to stable doses of ongoing medications can decrease MDD symptoms; however, benzodiazepines may interfere with TMS and tDCS response, and antipsychotics can interfere with TMS response. Pairing citalopram with TMS and sertraline with tDCS can lead to greater MDD symptom reduction compared to using these medications alone. Future studies need to enroll larger samples, include randomized controlled study designs, create more uniform protocols for combined treatment delivery, and explore mechanisms and predictors of change.

Stimulated brains and meditative minds: A systematic review on combining low intensity transcranial electrical stimulation and meditation in humans

Background

Low intensity transcranial electrical stimulation (tES) and meditation are two promising, yet variable, non-pharmacological interventions. Growing research is investigating combined effects of both techniques on one's cognitive, emotional, and physical health.

Objective

This article reviews the current research that combines tES and meditation interventions in healthy and diseased participants. The review considers the intervention parameters and their effects in a well-organized manner.

Method

A systematic search for clinical and experimental published studies was conducted in the PubMed, Cochrane, and transcranial direct current stimulation (tDCS) databases using common keywords for tES and for meditation techniques well defined by previous studies. Unpublished ongoing studies were identified with the ClinicalTrials.gov and DRKS.de clinical trial websites.

Results

20 published studies and 13 ongoing studies were included for qualitative analysis. 13 published articles studied patients with chronic pain, psychological disorders, cognitive impairment, and movement disorders. Anodal tDCS was the only tES technique while mindfulness meditation was the most common meditation type. Eight studies had a main group effect, with outcome improvement in the active combined intervention. However, most published studies showed improvements after at least one combined intervention with variable effects.

Conclusion

Pairing anodal tDCS with meditation shows promising improvements of the physical, mental, and emotional aspects of daily life. Further studies are required to confirm the relevance of this combination in the clinic.

A transdiagnostic meta-analysis of acute augmentations to psychological therapy

At least half of all patients with mental health disorders do not respond adequately to psychological therapy. Acutely enhancing particular biological or psychological processes during psychological therapy may improve treatment outcomes. However, previous studies are confined to specific augmentation approaches, typically assessed within single diagnostic categories. Our objective was to assess to what degree acute augmentations of psychological therapy reduce psychiatric symptoms and estimate effect sizes of augmentation types (for example, brain stimulation or psychedelics). We searched Medline, PsycINFO and Embase for controlled studies published between database inception and 25 May 2022. We conducted a preregistered random-effects meta-analysis (PROSPERO CRD42021236403). We identified 108 studies (N = 5,889). Acute augmentation significantly reduced the severity of mental health problems (Hedges' g = -0.27, 95% CI: [-0.36, -0.18]; P < 0.0001), particularly for the transdiagnostic dimensions 'Fear' and 'Distress'. This result survived a trim-and-fill analysis to account for publication bias. Subgroup analyses revealed that pharmacological, psychological and somatic augmentations were effective, but to varying degrees. Acute augmentation approaches are a promising route to improve outcomes from psychological therapy.

tDCS over the left prefrontal Cortex improves mental flexibility and inhibition in geriatric inpatients with symptoms of depression or anxiety: A pilot randomized controlled trial

BACKGROUND

Patients with depression and/or anxiety are commonly seen in inpatient geriatric settings. Both disorders are associated with an increased risk of cognitive impairments, notably in executive functioning. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, involves the administration of a low-dose electrical current to induce neuromodulation, which ultimately may act on downstream cognitive processing.

OBJECTIVE

The purpose of this study was to determine the effects of tDCS on executive functioning in geriatric inpatients with symptoms of depression and/or anxiety.

DESIGN

Pilot Randomized Controlled Trial.

SETTING

Specialized geriatric wards in a tertiary rehabilitation hospital.

METHODS

Thirty older-aged adults were recruited, of which twenty completed ten-to-fifteen sessions of 1.5 mA anodal or sham tDCS over the left dorsolateral prefrontal cortex. Cognitive assessments were administered at baseline and following the tDCS protocol; analyses examined the effects of tDCS on cognitive performance between groups (anodal or sham tDCS).

RESULTS

tDCS was found to increase inhibitory processing and cognitive flexibility in the anodal tDCS group, with significant changes on the Stroop test and Trail Making Test-Part B. No significant changes were observed on measures of attention or working memory.

DISCUSSION

These results provide preliminary evidence that tDCS-induced neuromodulation may selectively improve cognitive processing in older adults with symptoms of depression and/or anxiety.

CLINICAL TRIALS REGISTRATION

www.clinicaltrials.gov, NCT04558177.

Adjunctive accelerated repetitive transcranial magnetic stimulation for older patients with depression: A systematic review

OBJECTIVE

We performed this systemic review to investigate the therapeutic potential and safety of adjunctive accelerated repetitive transcranial magnetic stimulation (aTMS) for older patients with depression.

METHODS

We included published randomized clinical trials (RCTs) and observational studies targeting adjunctive aTMS for older patients with depression.

RESULTS

Two open-label self-controlled studies (n = 29) fulfilled the criteria for inclusion. The included studies reported significant improvements in depressive symptoms from baseline to post-aTMS (all Ps < 0.05). One study reported a dropout rate of 10.5% (2/19). Mild headache was the most common adverse reaction.

CONCLUSION

The currently available evidence from two open-label self-controlled studies indicates that adjunctive aTMS is a safe and effective therapy for older patients with depression.

Transcranial-Direct-Current-Stimulation Accelerates Motor Recovery After Cortical Infarction in Mice: The Interplay of Structural Cellular Responses and Functional Recovery

BACKGROUND

Transcranial direct current stimulation (tDCS) promotes recovery after stroke in humans. The underlying mechanisms, however, remain to be elucidated. Animal models suggest tDCS effects on neuroinflammation, stem cell proliferation, neurogenesis, and neural plasticity.

OBJECTIVE

In a longitudinal study, we employed tDCS in the subacute and chronic phase after experimental focal cerebral ischemia in mice to explore the relationship between functional recovery and cellular processes.

METHODS

Mice received photothrombosis in the right motor cortex, verified by Magnetic Resonance Imaging. A composite neuroscore quantified subsequent functional deficits. Mice received tDCS daily: either 5 sessions from day 5 to 9, or 10 sessions with days 12 to 16 in addition. TDCS with anodal or cathodal polarity was compared to sham stimulation. Further imaging to assess proliferation and neuroinflammation was performed by immunohistochemistry at different time points and Positron Emission Tomography at the end of the observation time of 3 weeks.

RESULTS

Cathodal tDCS at 198 kC/m² (220 A/m²) between days 5 and 9 accelerated functional recovery, increased neurogenesis, decreased microglial activation, and mitigated CD16/32-expression associated with M1-phenotype. Anodal tDCS exerted similar effects on neurogenesis and microglial polarization but not on recovery of function or microglial activation. TDCS on days 12 to 16 after stroke did not induce any further effects, suggesting that the therapeutic time window was closed by then.

CONCLUSION

Overall, data suggest that non-invasive neuromodulation by tDCS impacts neurogenesis and microglial activation as critical cellular processes influencing functional recovery during the early phase of regeneration from focal cerebral ischemia.

Safety and Feasibility of Tele-Supervised Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder

Major depressive disorder (MDD) is a worldwide cause of disability in older age, especially during the covid pandemic. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has shown encouraging efficacy for treatment of depression. Here, we investigate the feasibility of an innovative protocol where tDCS is administered within the homes of older adults with MDD (patient participants) with the help of a study companion (i.e. caregiver). We further analyze the feasibility of a remotely-hosted training program that provides the knowledge and skills to administer tDCS at home, without requiring them to visit the lab. We also employed a newly developed multi-channel tDCS system with real-time monitoring designed to guarantee the safety and efficacy of home-based tDCS. Patient participants underwent a total of 37 home-based tDCS sessions distributed over 12 weeks. The protocol consisted of three phases each lasting four weeks: an acute phase, containing 28 home-based tDCS sessions, a taper phase containing nine home-based tDCS sessions, and a follow up phase, with no stimulation sessions. We found that the home-based, remotely-supervised, study companion administered, multi-channel tDCS protocol for older adults with MDD was feasible and safe. Further, the study introduces a novel training program for remote instruction of study companions in the administration of tDCS. Future research is required to determine the translatability of these findings to a larger sample.

Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04799405?term=NCT04799405&amp;draw=2&amp;rank=1, identifier NCT04799405.

Application of tDCS in children with cerebral palsy: A mini review

Cerebral palsy (CP) refers to a group of diseases characterized by persistent central dyskinesia, postural development disorder and activity limitation syndromes caused by nonprogressive brain injury in the developing fetus or infant, which is often accompanied by sensory, cognitive and attention disorders. The routine rehabilitation methods for children with CP mainly include physical therapy, occupational therapy, speech therapy and other methods. In recent years, noninvasive brain stimulation (NIBS), as a relatively new intervention method, has been widely used because of its potential to regulate cortical excitability and plasticity. Transcranial direct current stimulation (tDCS) is an NIBS technique that is easier and more convenient to perform. It does not require patients to remain stationary for a long time or have a significant impact on treatment results due to children's frequent activities. Compared with other NIBS techniques, tDCS has greater flexibility and no strict restrictions on patients' activities; it also helps the therapist conduct occupational therapy or speech therapy while a child receives tDCS, which markedly reduces the treatment time and avoids burnout due to a long treatment duration. Thus, tDCS is a better and more convenient intervention for CP children and warrants further exploration. Accordingly, this article reviews tDCS application in children with CP and discusses tDCS application prospects for such children to promote its expansion in clinical practice.