tDCS-Induced Effects on Executive Functioning and Their Cognitive Mechanisms: a Review

The cognitive and neural bases of creative thought: A cross-domain systematic review and meta-analysis of transcranial direct current stimulation studies

Creative thought enables humans to flexibly generate, evaluate and select novel and adaptive ideas across different contexts. Decades of research indicates that it involves two key aspects: retrieval of previously acquired knowledge and manipulation of that knowledge. However, the cognitive processes underpinning these aspects remain underspecified. The broader clinical-cognitive neuroscience literature suggests these functions rely on general-purpose cognitive mechanisms supporting semantic cognition, controlled episodic memory retrieval, and executive mechanisms. Transcranial direct current stimulation (tDCS) is a neuromodulation technique widely used in creativity and cognitive neuroscience research to examine causal brain-behaviour relationships. To identify converging evidence toward a unifying neurocognitive account of creative thought, we reviewed and meta-analysed 145 sham-controlled tDCS studies (involving 8399 healthy participants aged 18-40), drawn from electronic databases and previous reviews, across creativity and relevant cognitive neuroscience literatures. The results revealed that, only left lateral frontal anodal tDCS promotes creativity (p < .01). In parallel, anodal tDCS over the same region also promotes improvement in many other cognitive processes, including more efficient processing of semantic knowledge (p < .05), more accurate episodic memory retrieval (p < .05), better and more efficient manipulation of buffered knowledge (all p < .001), better self-initiated response generation (i.e., energization; p < .05), and more efficient response selection amongst competing options (i.e., task-setting; p < .01). By merging these previously separate literatures, tDCS studies - although heavily biased toward frontal montages - support the notion that creative thought arises from general-purpose cognitive mechanisms including controlled retrieval and temporary storage of semantic and episodic information, as well as executive mechanisms.

Mitochondria and Cognition: An [18F]BCPP-EF Positron Emission Tomography Study of Mitochondrial Complex I Levels and Brain Activation During Task Switching

BACKGROUND

Mitochondrial complex I is the largest enzyme complex in the respiratory chain and can be noninvasively measured using [18F]BCPP-EF positron emission tomography (PET). Neurological conditions associated with mitochondria complex I pathology are also associated with altered blood oxygen level-dependent (BOLD) response and impairments in cognition. In this study, we aimed to investigate the relationship between mitochondrial complex I levels, cognitive function, and associated neural activity during task switching in healthy humans.

METHODS

Cognitively healthy adults (N = 23) underwent [18F]BCPP-EF PET scans and functional magnetic resonance imaging (fMRI) while performing a task-switching exercise. Task performance metrics included switch cost and switching accuracy. Data were analyzed using linear mixed-effects models and partial least squares regression (PLS-R).

RESULTS

We found significant positive associations between [18F]BCPP-EF volume of distribution (VT) and the task-switching fMRI response (β = 3.351, SE = 1.01, z = 3.249, p = .001). Positive Pearson's correlations between [18F]BCPP-EF VT and the fMRI response were observed in the dorsolateral prefrontal cortex (r = 0.61, p = .0019), insula (r = 0.46, p = .0264), parietal precuneus (r = 0.51, p = .0139), and anterior cingulate cortex (r = 0.45, p = .0293). [18F]BCPP-EF VT across task-relevant regions was associated with task switching accuracy (PLS-R, R2 = 0.48, root mean square error [RMSE] = 0.154, p = .011) and with switch cost (PLS-R, R2 = 0.38, RMSE = 0.07, p = .048).

CONCLUSIONS

Higher mitochondrial complex I levels may underlie an individual's ability to exhibit a stronger BOLD response during task switching and are associated with better task-switching performance. This provides the first evidence linking the BOLD response with mitochondrial complex I and suggests a possible biological mechanism for the aberrant BOLD response in conditions associated with mitochondrial complex I dysfunction that should be tested in future studies.

The effect of transcranial Direct Current Stimulation on the Iowa Gambling Task: a scoping review

Introduction

Among the tasks employed to investigate decisional processes, the Iowa Gambling Task (IGT) appears to be the most effective since it allows for deepening the progressive learning process based on feedback on previous choices. Recently, the study of decision making through the IGT has been combined with the application of transcranial direct current stimulation (tDCS) to understand the cognitive mechanisms and the neural structures involved. However, to date no review regarding the effects of tDCS on decisional processes assessed through the IGT is available. This scoping review aims to provide a comprehensive exploration of the potential effects of tDCS in enhancing decisional processes, assessed with the IGT, through the evaluation of the complete range of target cases.

Methods

The existing literature was analyzed through the PRISMA approach.

Results

Results reported that tDCS can enhance performance in the IGT and highlighted a pivotal role of the dorsolateral prefrontal cortex and the orbitofrontal cortex in risky and ambiguous decisions.

Discussion

Thus, tDCS over the brain regions identified improves the decisional processes in healthy subjects and patients, confirming its potential to enhance decision making in everyday contexts and deepen the neural correlates. Suggestions for further studies are provided to delve into decisional mechanisms and how to better support them.

Cognitive Remediation in Patients With Bipolar Disorder: A Randomized Trial by Sequential tDCS and Navigated rTMS Targeting the Primary Visual Cortex

BACKGROUND

Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), has emerged as a promising alternative in the precise treatment of clinical symptoms, such as the cognitive impairment of bipolar disorder (BD). Optimizing the neurocognitive effects by combining tDCS and rTMS to strengthen the clinical outcome is a challenging research issue.

OBJECTIVE

In this randomized, controlled trial, we first combined tDCS and neuronavigated rTMS targeting the V1 region to explore the efficacy on neurocognitive function in BD patients with depressive episodes.

METHODS

Eligible individuals (n = 105) were assigned into three groups, Group A (active tDCS-active rTMS), Group B (sham tDCS-active rTMS), and Group C (active tDCS-sham rTMS). All participants received 3-week treatment in which every participant received 15 sessions of stimulation through the study, 5 sessions every week, with tDCS treatment followed by neuronavigated rTMS every session. We evaluated the cognitive, emotional, and safety outcomes at week-0 (w0, baseline), week-3 (w3, immediately post-treatment), and week-8 (w8, follow-up period). The THINC-integrated tool (THINC-it), 17-item Hamilton Depression Rating Scale, and Young Mania Rating Scale were applied for evaluating the cognitive function and emotional state, respectively. Data were analyzed by repeated measure ANOVA and paired t-test.

RESULTS

Eventually, 32 patients in Group A, 27 in Group B, and 23 in Group C completed the entire treatment. Compared to Groups B and C, Group A showed greater improvement in Symbol Check items (Time and Accuracy) at W3 and Symbol Check Accuracy at W8 (p < 0.01). The W0-W3 analysis indicated a significant improvement in depressive symptoms in both Group A and Group B (p < 0.01). Additionally, neuroimaging data revealed increased activity in the calcarine sulcus in Group A, suggesting potential neuroplastic changes in the visual cortex following the electromagnetic stimulation.

CONCLUSIONS

These findings provide preliminary evidence that the combination of navigated rTMS with tDCS targeting V1 region may serve as a potential treatment strategy for improving cognitive impairment and depressive symptoms in BD patients.

TRIAL REGISTRATION

Clinical Trial Registry number: NCT05596461.

Non-invasive brain stimulation enhances motor and cognitive performances during dual tasks in patients with Parkinson's disease: a systematic review and meta-analysis

BACKGROUND

Parkinson's disease (PD) induces progressive deficits in motor and cognitive functions as well as impaired dual-task performance requiring both motor and cognitive functions. This systematic review and meta-analysis evaluated the effects of non-invasive brain stimulation (NIBS) on dual-task performance in patients with PD.

METHODS

11 studies met the following inclusion criteria: (a) patients with PD, (b) NIBS intervention, (c) comparison with the sham stimulation group, (d) motor and cognitive performance outcomes during dual tasks, and (e) randomized controlled trials with parallel or crossover designs. Individual effect size (i.e., comparison) was quantified by comparing motor and cognitive performances changes during dual tasks between active NIBS and sham stimulation conditions. Thus, higher values of the overall effect size indicate more improvements in either motor or cognitive performances after NIBS. Moreover, moderator variable analyses determined whether NIBS effects on dual-task performances differed depending on targeted brain regions. Finally, meta-regression analyses determined whether NIBS effects on dual-task performances were associated with demographic characteristics.

RESULTS

The random-effects model meta-analysis revealed that NIBS significantly improved motor (73 comparisons from 11 studies) and cognitive (12 comparisons from four studies) performances during dual tasks in patients with PD. Specifically, anodal transcranial direct current stimulation protocols on the dorsolateral prefrontal cortex were effective. Moreover, greater improvements in motor performance during dual tasks significantly correlated with decreased age and increased proportion of females, respectively.

CONCLUSION

This meta-analysis suggests that excitatory stimulation on the dorsolateral prefrontal cortex may be effective for improving dual-task performance in patients with PD.

Suppressing contextually irrelevant meanings of homophonic versus heterophonic homographs: A tDCS study targeting LIFG

Readers frequently encounter homographs (e.g., bank) whose resolution requires selection-suppression processes: selecting the contextually relevant meaning, while suppressing the irrelevant one. In two experiments, we investigated how these processes are modulated by the phonological status of the homograph (homographs with one vs. two possible pronunciations); and what is the involvement of the left inferior frontal gyrus (LIFG, including Broca's area) in these processes. To these ends, Experiment 1 utilized the context verification task with two types of Hebrew homographs: homophonic (e.g., bank) and heterophonic (e.g., tear). In the task, participants read sentences ending either with a homograph (e.g., bank) or an unambiguous word (e.g., shore). The sentences were biased towards the homograph's subordinate meaning (e.g., The fisherman sat on the bank/shore), and were followed by a target word related to the homograph's dominant meaning (e.g., MONEY). The participants were asked to judge whether the target was related to the overall meaning of the sentence. An ambiguity effect was observed for both types of homographs, reflecting interference from the irrelevant dominant meaning. However, this ambiguity effect was larger for heterophonic than for homophonic homographs, indicating that dominant meanings of heterophonic homographs are more difficult to suppress. Experiment 2 was identical, except that the procedure was coupled with transcranial direct current stimulation (tDCS) over the LIFG (including Broca's area). We found that stimulating the LIFG abolished the ambiguity effect, but only in the case of heterophonic homographs. Together, these findings highlight the distinction between phonological and semantic levels of selection-suppression processes, and the involvement of the LIFG in the phonological level of these processes.

Effects of high-intensity interval training combined with dual-site transcranial direct current stimulation on inhibitory control and working memory in healthy adults

Transcranial direct current stimulation (tDCS) and high-intensity interval training (HIIT) have been demonstrated to enhance inhibitory control and working memory (WM) performance in healthy adults. However, the potential benefits of combining these two interventions have been rarely explored and remain largely speculative. This study aimed to explore the effects of acute HIIT combined with dual-site tDCS over the dorsolateral prefrontal cortex (DLPFC, F3 and F4) on inhibitory control and WM in healthy young adults. Twenty-five healthy college students (20.5 ± 1.3 years; 11 females) were recruited to complete HIIT + tDCS, HIIT + sham-tDCS, rest + tDCS, and rest + sham-tDCS (CON) sessions in a randomized crossover design. tDCS or sham-tDCS was conducted after completing HIIT or a rest condition of the same duration. The Stroop and 2-back tasks were used to evaluate the influence of this combined intervention on cognitive tasks involving inhibitory control and WM performance in post-trials, respectively. Response times (RTs) of the Stroop task significantly improved in the HIIT + tDCS session compared to the CON session across all conditions (all p values <0.05), in the HIIT + tDCS session compared to the rest + tDCS session in the congruent and neutral conditions (all p values <0.05), in the HIIT + sham-tDCS session compared to the CON session in the congruent and neutral conditions (all p values <0.05), in the HIIT + sham-tDCS session compared to the rest + tDCS session in the congruent condition (p = 0.015). No differences were found between sessions in composite score of RT and accuracy in the Stroop task (all p values >0.05) and in the 2-back task reaction time and accuracy (all p values >0.05). We conclude that acute HIIT combined with tDCS effectively improved inhibitory control but it failed to yield cumulative benefits on inhibitory control and WM in healthy adults. These preliminary findings help to identify beneficial effects of combined interventions on cognitive performance and might guide future research with clinical populations.

Neurocognitive effects of transcranial direct current stimulation in obsessive-compulsive disorder: a systematic review

Transcranial direct current stimulation (tDCS) has been used with increasing frequency as a therapeutic tool to alleviate clinical symptoms of obsessive compulsive-disorder (OCD). However, little is known about the effects of tDCS on neurocognitive functioning among OCD patients. The aim of this review was to provide a comprehensive overview of the literature examining the effects of tDCS on specific neurocognitive functions in OCD. A literature search following PRISMA guidelines was conducted on the following databases: PubMed, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. The search yielded 4 results: one randomized, sham-controlled study (20 patients), one randomized, controlled, partial crossover trial (12 patients), one open-label study (5 patients), and one randomized, double-blind, sham-controlled, parallel-group trial (37 patients). A total of 51 patients received active tDCS with some diversity in electrode montages targeting the dorsolateral prefrontal cortex, the pre-supplementary motor area, or the orbitofrontal cortex. tDCS was associated with improved decision-making in study 1, enhanced attentional monitoring and response inhibition in study 2, improved executive and inhibitory control in study 3, and reduced attentional bias and improved response inhibition and working memory in study 4. Limitations of this review include its small sample, the absence of a sham group in half of the studies, and the heterogeneity in tDCS parameters. These preliminary results highlight the need for future testing in randomized, sham-controlled trials to examine whether and how tDCS induces relevant cognitive benefits in OCD.

The Effects of Transcranial Direct Current Stimulation (tDCS) in HIV Patients-A Review

Introduction: HIV is a severe and incurable disease that has a devastating impact worldwide. It affects the immune system and negatively affects the nervous system, leading to various cognitive and behavioral problems. Scientists are actively exploring different therapeutic approaches to combat these issues. One promising method is transcranial direct current stimulation (tDCS), a non-invasive technique that stimulates the brain. Methods: This review aims to examine how tDCS can help HIV patients. Searches were conducted in the Pubmed/Medline, Research Gate, and Cochrane databases. Results: The literature search resulted in six articles focusing on the effects of tDCS on cognitive and behavioral measures in people with HIV. In some cases, tDCS showed positive improvements in the measures assessed, improving executive functions, depression, attention, reaction time, psychomotor speed, speed of processing, verbal learning and memory, and cognitive functioning. Furthermore, the stimulation was safe with no severe side effects. However, the included studies were of low quality, had small sample sizes, and did not use any relevant biomarkers that would help to understand the mechanisms of action of tDCS in HIV. Conclusions: tDCS may help patients with HIV; however, due to the limited number of studies and the diversity of protocols used, caution should be exercised when recommending this treatment option in clinical settings. More high-quality research, preferably involving neurophysiological and neuroimaging measurements, is necessary to better understand how tDCS works in individuals with HIV.

Relationship Between the Parietal Cortex and Task Switching: Transcranial Direct Current Stimulation Combined with an Event-related Potential Study

Task switching refers to a set of cognitive processes involved in shifting attention from one task to another. In recent years, researchers have applied transcranial direct current stimulation (tDCS) to investigate the causal relationship between the parietal cortex and task switching. However, results from available studies are highly inconsistent. This may be due to the unclear understanding of the underlying mechanisms. Therefore, the current study utilized event-related potential (ERP) analysis to investigate the modulatory effects of tDCS on task-switching processes. Twenty-four subjects were recruited to perform both predictable and unpredictable parity/magnitude tasks under anodal (RA) and sham conditions. The results showed no significant changes in behavioral performance. However, marked tDCS-induced ERP changes were observed. Specifically, for the predictable task switching, compared with the sham condition, the target-N2 component occurred significantly earlier for switch trials than repeat trials under the RA condition in males, while no difference was found in females. For unpredictable task switching, under the sham condition, the P2 peak was significantly larger for switch trials compared with repeat trials, whereas this difference was not observed under the RA condition. These results indicated the causal relationship between the right parietal cortex and exogenous adjustment processes involved in task switching. Moreover, anodal tDCS over the right parietal cortex may lead to the manifestation of gender differences.

Targeting right orbitofrontal cortex (OFC) with transcranial direct current stimulation (tDCS) can improve cognitive executive function in a major depressive episode, but not depressive mood: A Double-blind Randomized Controlled Pilot Trial

Transcranial direct current stimulation (tDCS) has emerged as a potential treatment for major depressive episodes (MDE). This study aimed to evaluate the efficacy of targeting the right orbitofrontal cortex (rOFC) with tDCS in improving depressed mood and cognitive function in patients with depression. A double-blind, randomized sham-controlled trial was conducted in which 70 patients with depression were randomly assigned to receive rOFC-tDCS (n = 24), left dorsolateral prefrontal cortex (lDLPFC) tDCS (n = 23), or SHAM (n = 23). The treatment course consisted of ten treatments (2 mA, 20 min) delivered over two weeks. Participants were then given once-a-week interventions for the next two weeks. The Hamilton Depression Scale 17 evaluated the severity of depressive symptoms, while the cognitive function was assessed using the Stroop Color-Word Test (SCWT) and the Wisconsin Card Sorting Test (WCST). The primary outcomes were evaluated following ten interventions, with the assessment additionally conducted after maintenance treatment and 4-week follow-up visits. Analyses were performed using linear mixed models. The trial was registered with ChiCTR2000034671. The study did not reveal antidepressant efficacy for rOFC-tDCS or lDLPFC-tDCS over SHAM. Cognitive performance improved for rOFC -tDCS and lDLPFC-tDCS compared to sham for response time on the SWCT and non-perseverative errors in the WCST. However, no statistically significant difference was observed between the two active stimulation groups concerning cognitive performance-enhancing effects. No serious adverse events were noted. In conclusion, while rOFC-tDCS did not present advantages for mood outcomes over lDLPFC-tDCS and SHAM, it may have promising effectiveness in cognitive executive function compared to SHAM.

Effects of anodal tDCS stimulation in predictable and unpredictable task switching performance: The possible involvement of the parietal cortex

Transcranial direct current stimulation (tDCS) has been used to explore the causal relationship between specific brain regions and task switching. However, most studies have focused on the frontal cortex, and only few have examined other related cortices, e.g., the parietal cortex. However, no prior study has systematically explored the tDCS-induced effect of the parietal cortex in different task switching types. Therefore, the current study mainly used the unilateral anodal-tDCS (a-tDCS) stimulation setting to investigate the possible involvement of the parietal cortex in predictable and unpredictable task switching. It was noted that compared with sham group, significantly higher switch cost reaction time of right anode tDCS (RA) group was found in predictable task but not unpredictable task. No interaction effect was observed between congruence and tDCS groups in predictable task. These findings suggested that a-tDCS over right parietal cortex could markedly decrease the predictable task-switching performance in both congruent and incongruent trials, and indicated that parietal cortex is more likely to be involved in the proactive cognitive processes, such as endogenous preparation.

The effect of transcranial direct current stimulation of dorsolateral prefrontal cortex on performing a sequential dual task: a randomized experimental study

When it comes to simultaneous processing of two tasks, information processing capacity is usually below par and not desirable. Therefore, this preliminary study aimed to investigate the effect of transcranial direct-current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) on performing dual tasks. Twenty-six students (average age 25.2 ± 2.43 years) were selected and then randomly divided into experimental and sham groups. All of the participants conducted the Stroop effect test in a dual task situation before and after the tDCS. This test included two intervals between the stimuli of 100 and 900 ms. The results of mixed-ANOVA showed that the average second reaction time of the experimental stimulated group was reduced (in both dual tasks with congruent and incongruent stimuli) significantly after the tDCS. Therefore, it can be stated that the tDCS of the DLPFC increases the information processing speed and the capacity of attention and, as a result, decreases the effect of the psychological refractory period.

Enhancement of task-switching performance with transcranial direct current stimulation over the right lateral prefrontal cortex

Switching between two or more tasks is a key component in our modern world. Task switching, however, requires time-consuming executive control processes and thus produces performance costs when compared to task repetitions. While executive control during task switching has been associated with activation in the lateral prefrontal cortex (lPFC), only few studies so far have investigated the causal relation between lPFC activation and task-switching performance by modulating lPFC activation. In these studies, the results of lPFC modulation were not conclusive or limited to the left lPFC. In the present study, we aimed to investigate the effect of non-invasive transcranial direct current stimulation [tDCS; anodal tDCS (1 mA, 20 min) vs. cathodal tDCS (1 mA, 20 min) vs. sham tDCS (1 mA, 30 s)] over the right inferior frontal junction on task-switching performance in a well-established task-switching paradigm. In response times, we found a significant effect of tDCS Condition (atDCS, ctDCS vs. sham) on task-switching costs, indicating the modulation of task-switching performance by tDCS. In addition, we found a task-unspecific tDCS Condition effect in the first experimental session, in which participants were least familiar with the task, indicating a general enhancement of task performance in both task repetitions and task-switching trials. Taken together, our study provides evidence that the right lPFC is involved in task switching as well as in general task processing. Further studies are needed to investigate whether these findings can be translated into clinically relevant improvement in older subjects or populations with executive function impairment.

Investigating the interaction between white matter and brain state on tDCS-induced changes in brain network activity

Background

Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation whose potential as a cognitive therapy is hindered by our limited understanding of how participant and experimental factors influence its effects. Using functional MRI to study brain networks, we have previously shown in healthy controls that the physiological effects of tDCS are strongly influenced by brain state. We have additionally shown, in both healthy and traumatic brain injury (TBI) populations, that the behavioral effects of tDCS are positively correlated with white matter (WM) structure.

Objectives

In this study we investigate how these two factors, WM structure and brain state, interact to shape the effect of tDCS on brain network activity.

Methods

We applied anodal, cathodal and sham tDCS to the right inferior frontal gyrus (rIFG) of healthy (n = 22) and TBI participants (n = 34). We used the Choice Reaction Task (CRT) performance to manipulate brain state during tDCS. We acquired simultaneous fMRI to assess activity of cognitive brain networks and used Fractional Anisotropy (FA) as a measure of WM structure.

Results

We find that the effects of tDCS on brain network activity in TBI participants are highly dependent on brain state, replicating findings from our previous healthy control study in a separate, patient cohort. We then show that WM structure further modulates the brain-state dependent effects of tDCS on brain network activity. These effects are not unidirectional - in the absence of task with anodal and cathodal tDCS, FA is positively correlated with brain activity in several regions of the default mode network. Conversely, with cathodal tDCS during CRT performance, FA is negatively correlated with brain activity in a salience network region.

Conclusions

Our results show that experimental and participant factors interact to have unexpected effects on brain network activity, and that these effects are not fully predictable by studying the factors in isolation.

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We replicated the brain state and polarity dependent effects of tDCS.

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White matter structure influences tDCS's state-dependent changes in neural activity

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The parameters of tDCS may operate under a hierarchy of influence.

Prefrontal high definition cathodal tDCS modulates executive functions only when coupled with moderate aerobic exercise in healthy persons

Transcranial direct current stimulation (tDCS) is a promising tool to enhance cognitive performance. However, its effectiveness has not yet been unequivocally shown. Thus, here we tested whether coupling tDCS with a bout of aerobic exercise (AE) is more effective in modulating cognitive functions than tDCS or AE alone. One hundred twenty-two healthy participants were assigned to five randomized controlled crossover experiments. Two multimodal target experiments (EXP-4: anodal vs. sham tDCS during AE; EXP-5: cathodal vs. sham tDCS during AE) investigated whether anodal (a-tDCS) or cathodal tDCS (c-tDCS) applied during AE over the left dorsolateral prefrontal cortex (left DLPFC) affects executive functioning (inhibition ability). In three unimodal control experiments, the participants were either stimulated (EXP-1: anodal vs. sham tDCS, EXP-2: cathodal vs. sham tDCS) or did AE (EXP-3: AE vs. active control). Participants performed an Eriksen flanker task during ergometer cycling at moderate intensity (in EXP. 3-5). Only c-tDCS during AE had a significant adverse effect on the inhibition task, with decreased accuracy. This outcome provides preliminary evidence that c-tDCS during AE over the left DLPFC might effectively modulate inhibition performance compared to c-tDCS alone. However, more systematic research is needed in the future.

Challenging control over emotions in borderline personality disorder - a tDCS study

BACKGROUND

Deficient cognitive control (CC) over emotional distraction is a central characteristic of borderline personality disorder (BPD). Reduced activation of the left dorsolateral prefrontal cortex (dlPFC) has been linked to this deficit. This study investigates whether it is possible to ameliorate CC deficits via anodal tDCS over the left dlPFC in BPD. Furthermore, we investigate whether the extent of CC impairment influences how well one responds to tDCS.

METHODS

The effect of a single-session tDCS (1 mA for 20 min, reference electrode on the contralateral mastoid bone) to the left dlPFC (F3) on the CC of patients with BPD (N = 20) and healthy control participants (HCs, N = 20) was examined in a double-blinded, balanced randomized, sham-controlled crossover trial. A delayed response working memory task with negative, neutral and positive pictures presented during the delay period was conducted to assess CC. Stimulation was applied simultaneously with the task.

RESULTS

Negative pictures caused prolonged response times as compared to a control condition in patients with BPD and HCs. Anodal tDCS to the left dlPFC did not significantly reduce this interference effect in the overall sample. Further analyses showed, however, that participants with impaired CC profited the most from anodal tDCS. In the subgroup of participants who actually showed an interference effect we found the expected significant amelioration of CC under tDCS.

CONCLUSIONS

The present study demonstrates that anodal tDCS applied to the left dlPFC improves deficient CC. Thereby, base-level performance moderates tDCS effects. Hence, tDCS might be suitable to support behavioral trainings to enhance CC specifically in people whose impairments in CC are comparably high.

The Effects of Transcranial Direct Current Stimulation on Dual-Task Interference Depend on the Dual-Task Content

Recently, some studies revealed that transcranial direct current stimulation (tDCS) reduces dual-task interference. Since there are countless combinations of dual-tasks, it remains unclear whether stable effects by tDCS can be observed on dual-task interference. An aim of the present study was to investigate whether the effects of tDCS on dual-task interference change depend on the dual-task content. We adopted two combinations of dual-tasks, i.e., a word task while performing a tandem task (word-tandem dual-task) and a classic Stroop task while performing a tandem task (Stroop-tandem dual-task). We expected that the Stroop task would recruit the dorsolateral prefrontal cortex (DLPFC) and require involvement of executive function to greater extent than the word task. Subsequently, we hypothesized that anodal tDCS over the DLPFC would improve executive function and result in more effective reduction of dual-task interference in the Stroop-tandem dual-task than in the word-tandem dual-task. Anodal or cathodal tDCS was applied over the DLPFC or the supplementary motor area using a constant current of 2.0 mA for 20 min. According to our results, dual-task interference and the task performances of each task under the single-task condition were not changed after applying any settings of tDCS. However, anodal tDCS over the left DLPFC significantly improved the word task performance immediately after tDCS under the dual-task condition. Our findings suggested that the effect of anodal tDCS over the left DLPFC varies on the task performance under the dual-task condition was changed depending on the dual-task content.

Anodal Transcranial Direct Current Stimulation-Induced Effects Over the Right Dorsolateral Prefrontal Cortex: Differences in the Task Types of Task Switching

Transcranial direct current stimulation (tDCS) has been previously used to investigate the causal relationships between the dorsolateral prefrontal cortex (DLPFC) and task switching but has delivered inconclusive results that may be due to different switching tasks involving different cognitive control processes. In the current study, we manipulated task types and task predictability to investigate the role of DLPFC in task-switching performances. Notably, we distinguished the specific effects of anodal-tDCS on two types of tasks (parity/magnitude and parity/vowel-consonant tasks). Forty-eight participants were randomly assigned to four task groups as follows; Group I who was assigned right anode (RA) parity/magnitude tasks, Group II who were assigned sham parity/magnitude tasks, Group III who were assigned RA parity/vowel-consonant tasks, and Group IV who were assigned sham parity/vowel-consonant tasks. Participants were asked to complete both predictable and unpredictable tasks. In the parity/magnitude task, we demonstrated a lower switch cost for the RA group compared to the sham group for unpredictable tasks. In contrast, in the parity/vowel-consonant task, the switch cost was higher for the RA group compared to the sham group for unpredictable and predictable tasks. These findings confirmed an anodal-tDCS-induced effect over the right DLPFC both in the parity/magnitude and parity/vowel-consonant tasks. Our data indicated that anodal tDCS may have a stronger influence on task-switching performance over the right DLPFC by changing the irrelevant task-set inhibition process. Also, the right DLPFC is unlikely to act by performing exogenous adjustment of predictable task switching.

Combining transcranial direct current stimulation with a motor-cognitive task: the impact on dual-task walking costs in older adults

Background

The performance of a secondary task while walking increases motor-cognitive interference and exacerbates fall risk in older adults. Previous studies have demonstrated that transcranial direct current stimulation (tDCS) may improve certain types of dual-task performance, and, that tDCS delivered during the performance of a task may augment the benefits of stimulation, potentially reducing motor-cognitive interference. However, it is not yet known if combining multi-target tDCS with the simultaneous performance of a task related to the tDCS targets reduces or increases dual-task walking costs among older adults. The objectives of the present work were (1) To examine whether tDCS applied during the performance of a task that putatively utilizes the brain networks targeted by the neuro-stimulation reduces dual-task costs, and (2) to compare the immediate after-effects of tDCS applied during walking, during seated-rest, and during sham stimulation while walking, on dual-task walking costs in older adults. We also explored the impact on postural sway and other measures of cognitive function.

Methods

A double-blind, ‘within-subject’ cross-over pilot study evaluated the effects of 20 min of anodal tDCS targeting both the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (lDLPFC) in 25 healthy older adults (73.9 ± 5.2 years). Three stimulation conditions were assessed in three separate sessions: (1) tDCS while walking in a complex environment (tDCS + walking), (2) tDCS while seated (tDCS + seated), and (3) walking in a complex environment with sham tDCS (sham + walking). The complex walking condition utilized virtual reality to tax motor and cognitive abilities. During each session, usual-walking, dual-task walking, quiet standing sway, and cognitive function (e.g., Stroop test) were assessed before and immediately after stimulation. Dual-task costs to gait speed and other measures were computed.

Results

The dual-task cost to gait speed was reduced after tDCS + walking (p = 0.004) as compared to baseline values. Neither tDCS + seated (p = 0.173) nor sham + walking (p = 0.826) influenced this outcome. Similar results were seen for other gait measures and for Stroop performance. Sway was not affected by tDCS.

Conclusions

tDCS delivered during the performance of challenging walking decreased the dual-task cost to walking in older adults when they were tested just after stimulation. These results support the existence of a state-dependent impact of neuro-modulation that may set the stage for a more optimal neuro-rehabilitation.

Trial registration: Clinical Trials Gov Registrations Number: NCT02954328.

Effect of Repeated Anodal HD-tDCS on Executive Functions: Evidence From a Pilot and Single-Blinded fNIRS Study

Executive functions are of vital importance in the process of active cognition, which is thought to be associated with the dorsolateral prefrontal cortex (DLPFC). As a valid brain stimulation technology, high-definition transcranial direct current stimulation (HD-tDCS) has been used to optimize cognitive function in healthy adults. Substantial evidence indicates that short-term or single anodal tDCS sessions over the left DLPFC will enhance the performance of executive functions. However, the changes in performance and cortical activation of executive functions after modulation by repeated anodal HD-tDCS is as yet unexplored. This study aims to examine changes in three core components of executive functions (inhibitory control, working memory, and cognitive flexibility) produced by nine HD-tDCS sessions (1.5 mA, over left DLPFC, 20 min per session), and to use functional near-infrared spectroscopy (fNIRS) to bilaterally record DLPFC neural activity. A total of 43 participants were divided randomly into two study groups (anodal group vs. sham group) to complete nine interventions. Our results demonstrate that the enhancement of cognitive flexibility in the anodal group was significantly better than that in the sham group. Additionally, a Stroop effect-related decrease in oxygenated hemoglobin (HbO) concentration in the DLPFC was observed in the anodal group but not the sham group. In conclusion, our study found that repeated anodal HD-tDCS sessions can significantly promote cognitive flexibility, one of the core components of executive function, and that alterations in DLPFC activation can enhance our understanding of the neuroplastic modifications modulated by HD-tDCS.

Anodal transcranial direct current stimulation over the posterior parietal cortex enhances three-dimensional mental rotation ability

Prior neuroimaging and neurophysiological studies have found that the right posterior parietal cortex (PPC) plays an important role in mental rotation ability. Transcranial direct-current stimulation (tDCS) has been shown the potential to enhance cognitive ability by delivering a low current to the brain cortex of interest, via electrodes on the scalp. Here, we tested whether stimulating the PPC with tDCS can improve three-dimensional mental rotation performance and narrow gender difference. The classic three-dimensional Shepard-Metzler task was measured after three stimulation conditions (right PPC, left PPC, sham stimulation). The results indicated that stimulating the right PPC induced an improvement in accuracy and response time of mental rotation relative to sham stimulation. Stimulating the left PPC caused an enhancement in the accuracy but not in the response time. Gender difference during mental rotation was diminished after stimulation. These findings indicated that the PPC regions played a causal role in mental rotation ability. tDCS could be used as a promising non-invasive method to improve mental rotation skills in individuals with lower ability and to provide an effective therapeutic tool for neurological disorder rehabilitation.

Dorsolateral Prefrontal Cortex and Task-Switching Performance: Effects of Anodal Transcranial Direct Current Stimulation

Task switching refers to the process by which an individual transfers focus from one cognitive task to another. In recent years, transcranial direct current stimulation (tDCS) technology had been used to investigate the causal relationship between the dorsolateral prefrontal cortex (DLPFC) and task-switching performance. However, the effects of anodal-tDCS (a-tDCS) on task switching remain unclear, and the relationship between DLPFC and various task predictabilities have not yet been studied. Therefore, this study mainly investigated the effects of left anode tDCS (LA) and right anode tDCS (RA) in predictable and unpredictable task-switching performance. Thirty-six participants were randomly assigned to three tDCS groups (including LA, RA, and sham) and were asked to complete both the predictable and unpredictable tasks. Compared with LA and sham tDCS, increasing the activity of the right DLPFC improved task-switching performance (switch cost) of unpredictable but not predictable tasks. The results suggested there is a causal association between DLPFC and unpredictable task switching and implied a task-specific effect in task switching. We concluded that the DLPFC is not essential for exogenous adjustment in predictable task switching.

Neither Cathodal nor Anodal Transcranial Direct Current Stimulation on the Left Dorsolateral Prefrontal Cortex alone or Applied During Moderate Aerobic Exercise Modulates Executive Function

There is converging evidence that both aerobic exercise (AE) and transcranial direct current stimulation (tDCS) can acutely modulate executive functions (EF). In addition, recent studies have proposed the beneficial effects of applying tDCS during AE on physical performance. This study aimed to investigate whether tDCS applied during an AE session additionally or differently effects EF. Therefore, five experiments were conducted in a counterbalanced pre-post-retention crossover design to explore the acute effects of tDCS and AE on EF (inhibition and updating) once in isolation (i.e., either cathodal, anodal tDCS or AE alone as controls) and once in a combined application (i.e., anodal and cathodal tDCS during AE versus sham tDCS during AE). No differences were found in any experiment in the cognitive test parameters. However, in the case of anodal tDCS vs. sham during AE, heart rate was significantly affected. For cathodal tDCS vs. sham during AE, a significant Anova interaction indicated that cathodal tDCS during AE slightly reduced ratings of perceived exertion. The nonsignificant effects of tDCS on EFs are in contrast to previous studies, as no replication of existing observations could be achieved. Thus, the protocol applied in this study does not provide any strong evidence that a combination of AE and tDCS has any effects on EFs, but indicates effects on physiological parameters and subjective exhaustion ratings. Further research should consider changes in AE and tDCS parameters (e.g., intensity or exercise mode) and sequence of applications (online vs. offline).

Testing the role of cognitive inhibition in physical endurance using high-definition transcranial direct current stimulation over the prefrontal cortex

The aim of this study was to clarify the role of the prefrontal cortex (PFC) in physical effort regulation. We hypothesized that the PFC would be progressively involved in physical endurance through the engagement of cognitive inhibition, which would be necessary to maintain effort by inhibiting fatigue-related cues. This hypothesis was examined using a double-blind, sham-controlled, within-subjects study (N = 20) using high-definition (HD) transcranial direct current stimulation (tDCS) over the right dorsolateral prefrontal cortex (dlPFC). Participants had to maintain a knee extensor contraction at 30% of their maximal force while simultaneously performing an Eriksen flanker task to evaluate their inhibition performance during the task. Anodal stimulation of the dlPFC influenced response to the cognitive task during exercise, as seen by slower response times and better accuracy. However, it did not lead to any measureable improvement in cognitive inhibition and did not influence endurance time. There was no correlation between cognitive inhibition and the maintenance of physical effort. This result does not indicate a relationship between cognitive inhibition and endurance performance. The contribution of the PFC in physical endurance could be explained through its involvement on decisional processes.

Enhancing neural efficiency of cognitive processing speed via training and neurostimulation: An fNIRS and TMS study

Speed of Processing (SoP) represents a fundamental limiting step in cognitive performance which may underlie General Intelligence. The measure of SoP is particularly sensitive to aging, neurological or cognitive diseases, and has become a benchmark for diagnosis, cognitive remediation, and enhancement. Neural efficiency of the Dorsolateral Prefrontal Cortex (DLPFC) is proposed to account for individual differences in SoP. However, the mechanisms by which DLPFC efficiency is shaped by training and whether it can be enhanced remain elusive. To address this, we monitored the brain activity of sixteen healthy participants using functional Near Infrared Spectroscopy (fNIRS) while practicing a common SoP task (Symbol Digit Substitution Task) across 4 sessions. Furthermore, in each session, participants received counterbalanced excitatory repetitive transcranial magnetic stimulation (rTMS) during mid-session breaks. Results indicate a significant involvement of the left-DLPFC in SoP, whose neural efficiency is consistently increased through task practice. Active neurostimulation, but not Sham, significantly enhanced the neural efficiency. These findings suggest a common mechanism by which neurostimulation may aid to accelerate learning.

Modulating Applied Task Performance via Transcranial Electrical Stimulation

Basic and applied research are increasingly adopting transcranial electrical stimulation (tES) for modulating perceptual, cognitive, affective, and motor processes. Industry and defense applications of tES hold potential for accelerating training and knowledge acquisition and sustaining work-related performance in the face of fatigue, workload, and stress. This mini-review article describes the promises and perils of tES, and reviews research testing its influence on two broad applied areas: sustaining and dividing attention, and operating in virtual environments. Also included is a discussion of challenges related to viable mechanistic explanations for tES effectiveness, attempts at replication and consideration of null results, and the potential importance of individual differences in predicting tES influences on human performance. Finally, future research directions are proposed to address these challenges and help develop a fuller understanding of tES viability for enhancing real-world performance.

Anodal Transcranial Direct Current Stimulation Induces High Gamma-Band Activity in the Left Dorsolateral Prefrontal Cortex During a Working Memory Task: A Double-Blind, Randomized, Crossover Study

Transcranial direct current stimulation (tDCS) has been shown to have mixed effects on working memory (WM) capacity in healthy individuals. Different stimulation paradigms may account for these discrepancies, with certain features being favored. To determine the effect in the context of anodal tDCS, we investigated whether anodal tDCS induced cortical oscillatory changes during a WM task. Specifically, we tested whether anodal offline tDCS over the left prefrontal cortex (PFC) enhances WM capacity by modulating the oscillatory activity in the left dorsolateral PFC (DLPFC) using magnetoencephalography (MEG). This study employed a double-blind, randomized, crossover design, in which 24 healthy right-handed participants conducted MEG recordings during a 3-back task after administration of 2 mA tDCS or sham stimulation as a placebo. Our results showed that the effect of tDCS did not appear in the behavioral indices—WM accuracy (d′) or reaction time (RT). From the results of the time-frequency analysis, significant event-related synchronization (ERS) in the high-gamma band (82–84 Hz) of the left DLPFC was found under the tDCS condition; however, ERS was not correlated with WM capacity. Furthermore, we calculated the modulation index (MI), which indicates the strength of phase-amplitude coupling (PAC). tDCS significantly decreased MI of the left DLPFC, representing the theta-gamma PAC during the n-back task using color names as verbal stimuli. Our results suggest that although tDCS increased the gamma-band oscillation indicating greater neural activity in the left DLPFC, it did not lead to an improvement of WM capacity; this may be due to the inability of gamma-band oscillation to couple with the task-induced theta wave. WM capacity might not increase unless theta-gamma PAC is not enhanced by tDCS.

A Review of Acute Aerobic Exercise and Transcranial Direct Current Stimulation Effects on Cognitive Functions and Their Potential Synergies

Today, several pharmaceutic and non-pharmaceutic approaches exist to treat psychiatric and neurological diseases. Because of the lack of treatment procedures that are medication free and without severe side effects, transcranial direct current stimulation (tDCS) and aerobic exercise (AE) have been tested to explore the potential for initiating and modulating neuroplasticity in the human brain. Both tDCS and AE could support cognition and behavior in the clinical and non-clinical context to improve the recovery process within neurological or psychiatric conditions or to increase performance. As these techniques still lack meaningful effects, although they provide multiple beneficial opportunities within disease and health applications, there is emerging interest to find improved tDCS and AE protocols. Since multimodal approaches could provoke synergetic effects, a few recent studies have begun to combine tDCS and AE within different settings such as in cognitive training in health or for treatment purposes within clinical settings, all of which show superior effects compared to single technique applications. The beneficial outcomes of both techniques depend on several parameters and the understanding of neural mechanisms that are not yet fully understood. Recent studies have begun to directly combine tDCS and AE within one session, although their interactions on the behavioral, neurophysiological and neurochemical levels are entirely unclear. Therefore, this review: (a) provides an overview of acute behavioral, neurophysiological, and neurochemical effects that both techniques provoke within only one single application in isolation; (b) gives an overview regarding the mechanistic pathways; and (c) discusses potential interactions and synergies between tDCS and AE that might be provoked when directly combining both techniques. From this literature review focusing primarily on the cognitive domain in term of specific executive functions (EFs; inhibition, updating, and switching), it is concluded that a direct combination of tDCS and AE provides multiple beneficial opportunities for synergistic effects. A combination could be useful within non-clinical settings in health and for treating several psychiatric and neurologic conditions. However, there is a lack of research and there are several possibly interacting moderating parameters that must be considered and more importantly must be systematically investigated in the future.

Role of Sensorimotor Cortex in Gestural-Verbal Integration

Action comprehension that is related to language or gestural integration has been shown to engage the motor system in the brain, thus providing preliminary evidence for the gestural-verbal embodiment concept. Based on the involvement of the sensorimotor cortex (M1) in language processing, we aimed to further explore its role in the cognitive embodiment necessary for gestural-verbal integration. As such, we applied anodal (excitatory) and sham transcranial direct current stimulation (tDCS) over the left M1 (with reference electrode over the contralateral supraorbital region) during a gestural-verbal integration task where subjects had to make a decision about the semantic congruency of the gesture (prime) and the word (target). We used a cross-over within-subject design in young subjects. Attentional load and simple reaction time (RT) tasks served as control conditions, applied during stimulation (order of three tasks was counterbalanced). Our results showed that anodal (atDCS) compared to sham tDCS (stDCS) reduced RTs in the gestural-verbal integration task, specifically for incongruent pairs of gestures and verbal expressions, with no effect on control task performance. Our findings provide evidence for the involvement of the sensorimotor system in gestural-verbal integration performance. Further, our results suggest that functional modulation induced by sensorimotor tDCS may be specific to gestural-verbal integration. Future studies should now evaluate the modulatory effect of tDCS on semantic congruency by using tDCS over additional brain regions and include assessments of neural connectivity.