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De Smet S, Cohen N, Vanderhasselt MA. Boosting affective control with bifrontal transcranial direct current stimulation (tDCS): a proof-of-concept study in healthy individuals. Behav Res Ther 2023; 169:104401. [PMID: 37729689 DOI: 10.1016/j.brat.2023.104401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
Affective control refers to the ability to regulate emotions and is considered a marker of mental health. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, holds promise to enhance affective control. In this between-subjects study in healthy individuals, we investigated the effects of bifrontal tDCS on core processes and higher-level markers of affective control. As such, we assessed direct tDCS effects on emotional interference during an affective control task and indirect effects on an instructed reappraisal task afterward. Results showed that the affective control task combined with active tDCS, compared to sham, resulted in enhanced cognitive emotion regulation. Specifically, participants in the active tDCS condition showed an increased propensity to use reappraisal and were more successful in doing so. Moreover, there was reduced vagally mediated heart rate variability indicative of attenuated emotion and self-regulation, in the sham, but not in the active condition. Surprisingly, there were no effects of tDCS on emotional interference during the affective control task, with Bayesian analyses showing extreme evidence against these effects. Nevertheless, there was a positive association between the emotional interference during the affective control task and participants' reappraisal success afterward for the active, but not the sham tDCS condition. The study offers valuable insights to guide future work on combined tDCS with affective control tasks or training on the ability to regulate emotions.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Noga Cohen
- Faculty of Education, University of Haifa, Haifa, Israel; Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
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2
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Nawani H, Mittner M, Csifcsák G. Modulation of mind wandering using transcranial direct current stimulation: A meta-analysis based on electric field modeling. Neuroimage 2023; 272:120051. [PMID: 36965860 DOI: 10.1016/j.neuroimage.2023.120051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023] Open
Abstract
Mind wandering (MW) is a heterogeneous construct involving task-unrelated thoughts. Recently, the interest in modulating MW propensity via non-invasive brain stimulation techniques has increased. Single-session transcranial direct current stimulation (tDCS) in healthy controls has led to mixed results in modulating MW propensity, possibly due to methodological heterogeneity. Therefore, our aim was to conduct a systematic meta-analysis to examine the influence of left dorsolateral prefrontal cortex (lDLPFC) and right inferior parietal lobule (rIPL) targeted tDCS on MW propensity. Importantly, by computational modeling of tDCS-induced electric fields, we accounted for differences in tDCS-dose across studies that varied strongly in their applied methodology. Fifteen single-session, sham-controlled tDCS studies published until October 2021 were included. All studies involved healthy adult participants and used cognitive tasks combined with MW thought-probes. Heterogeneity in tDCS electrode placement, stimulation polarity and intensity were controlled for by means of electric field simulations, while overall methodological quality was assessed via an extended risk of bias (RoB) assessment. We found that RoB was the strongest predictor of study outcomes. Moreover, the rIPL was the most promising cortical area for influencing MW, with stronger anodal electric fields in this region being negatively associated with MW propensity. Electric field strength in the lDLPFC was not related to MW propensity. We identified several severe methodological problems that could have contributed to overestimated effect sizes in this literature, an issue that needs urgent attention in future research in this area. Overall, there is no reliable evidence for tDCS influencing MW in the healthy. However, the analysis also revealed that increasing neural excitability in the rIPL via tDCS might be associated with reduced MW propensity. In an exploratory approach, we also found some indication that targeting prefrontal regions outside the lDLPFC with tDCS could lead to increased MW propensity.
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Affiliation(s)
- Hema Nawani
- Institute for Psychology, UiT The Arctic University of Norway.
| | | | - Gábor Csifcsák
- Institute for Psychology, UiT The Arctic University of Norway.
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3
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Risk-Taking Behavior Among Male Adolescents: The Role of Observer Presence and Individual Self-Control. J Youth Adolesc 2022; 51:2161-2172. [PMID: 35861907 DOI: 10.1007/s10964-022-01659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
A number of studies have focused on the same-sex peer effect on and the developmental difference in adolescent risk-taking in terms of the dual systems model. Little research, however, addresses the effects of different observers, the role of different levels of individual self-control, and their interactions. To fill this gap, the present study examined the main and interactive effects of observer presence and individual self-control on male adolescents' risk-taking behavior with an experimental design. A total of 261 male adolescents (Mage = 15.79 ± 0.79, range = 14-18) completed an adapted Stoplight Task, which measures risk-taking behavior, in the presence of an observer, either peer or adult, either male or female. The results indicated that a same-sex peer's presence and low self-control were both risk factors of male adolescents' risk-taking, but did only low self-control male adolescents take serious risks when in the presence of a same-sex peer whereas those with high self-control consistently had low levels of risk-taking under any condition. An opposite-sex observer, particularly an opposite-sex adult's presence, played a similar protective role for male adolescents with low self-control. The findings suggest that a high level of self-control closely related to the cognitive control system may significantly buffer the negative effect of an adverse social stimulus which activates the social-emotional system on male adolescents' risk-taking; the findings also reveal that an opposite-sex adult's presence may contribute to a decrease in male adolescents' risk-taking by improving their cognitive control system.
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Lisoni J, Barlati S, Deste G, Ceraso A, Nibbio G, Baldacci G, Vita A. Efficacy and tolerability of Brain Stimulation interventions in Borderline Personality Disorder: state of the art and future perspectives - A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2022; 116:110537. [PMID: 35176417 DOI: 10.1016/j.pnpbp.2022.110537] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 12/28/2022]
Abstract
Treating Borderline Personality Disorder (BPD) is a major challenge for psychiatrists. As Brain Stimulation represents an alternative approach to treat psychiatric disorders, our systematic review is the first to focus on both invasive and Non-Invasive Brain Stimulation (NIBS) interventions in people living with BPD, examining clinical effects over core features and comorbid conditions. Following PRISMA guidelines, out of 422 original records, 24 papers were included regarding Deep Brain Stimulation (n = 1), Electroconvulsive therapy (n = 5), Transcranial Magnetic Stimulation (n = 13) and transcranial Direct Current Stimulation (n = 5). According to impulsivity and emotional dysregulated domain improvements, NIBS in BPD appears to restore frontolimbic network deficiencies. NIBS seems also to modulate depressive features. Safety and tolerability profiles for each technique are discussed. Despite encouraging results, definitive recommendations on Brain Stimulation in BPD are mitigated by protocols heterogeneity, lack of randomized controlled trials and poor quality of included studies, including high risk of methodological biases. To serve as guide for future systematic investigations, protocols optimization proposals are provided, focusing on alternative stimulation sites and suggesting a NIBS symptom-based approach.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Viale Europa 11, 25123 Brescia, Italy.
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Anna Ceraso
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Viale Europa 11, 25123 Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Viale Europa 11, 25123 Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Viale Europa 11, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy, Piazzale Spedali Civili 1, 25123 Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Viale Europa 11, 25123 Brescia, Italy.
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Nord CL, Garfinkel SN. Interoceptive pathways to understand and treat mental health conditions. Trends Cogn Sci 2022; 26:499-513. [PMID: 35466044 DOI: 10.1016/j.tics.2022.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 12/14/2022]
Abstract
An increasing recognition that brain and body are dynamically coupled has enriched our scientific understanding of mental health conditions. Peripheral signals interact centrally to influence how we think and feel, generating our sense of the internal condition of the body, a process known as interoception. Disruptions to this interoceptive system may contribute to clinical conditions, including anxiety, depression, and psychosis. After reviewing the nature of interoceptive disturbances in mental health conditions, this review focuses on interoceptive pathways of existing and putative mental health treatments. Emerging clinical interventions may target novel peripheral treatment mechanisms. Future treatment development requires forward- and back-translation to uncover and target specific interoceptive processes in mental health to elucidate their efficacy relative to interventions targeting other factors.
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Affiliation(s)
- Camilla L Nord
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Rd, Cambridge CB2 7EF, UK.
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, UCL, Alexandra House, 17-19 Queen Square, London WC1N 3AZ, UK.
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Andò A, Vasilotta ML, Zennaro A. The modulation of emotional awareness using non-invasive brain stimulation techniques: a literature review on TMS and tDCS. JOURNAL OF COGNITIVE PSYCHOLOGY 2021. [DOI: 10.1080/20445911.2021.1954013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Agata Andò
- Department of Psychology, University of Turin, Turin, Italy
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Nord CL. Predicting Response to Brain Stimulation in Depression: a Roadmap for Biomarker Discovery. Curr Behav Neurosci Rep 2021; 8:11-19. [PMID: 33708470 PMCID: PMC7904553 DOI: 10.1007/s40473-021-00226-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW Clinical response to brain stimulation treatments for depression is highly variable. A major challenge for the field is predicting an individual patient's likelihood of response. This review synthesises recent developments in neural predictors of response to targeted brain stimulation in depression. It then proposes a framework to evaluate the clinical potential of putative 'biomarkers'. RECENT FINDINGS Largely, developments in identifying putative predictors emerge from two approaches: data-driven, including machine learning algorithms applied to resting state or structural neuroimaging data, and theory-driven, including task-based neuroimaging. Theory-driven approaches can also yield mechanistic insight into the cognitive processes altered by the intervention. SUMMARY A pragmatic framework for discovery and testing of biomarkers of brain stimulation response in depression is proposed, involving (1) identification of a cognitive-neural phenotype; (2) confirming its validity as putative biomarker, including out-of-sample replicability and within-subject reliability; (3) establishing the association between this phenotype and treatment response and/or its modifiability with particular brain stimulation interventions via an early-phase randomised controlled trial RCT; and (4) multi-site RCTs of one or more treatment types measuring the generalisability of the biomarker and confirming the superiority of biomarker-selected patients over randomly allocated groups.
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Affiliation(s)
- Camilla L. Nord
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF UK
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Cl N, Dc H, N L, T L, S P, Jp R. The neural basis of hot and cold cognition in depressed patients, unaffected relatives, and low-risk healthy controls: An fMRI investigation. J Affect Disord 2020; 274:389-398. [PMID: 32663968 PMCID: PMC7369634 DOI: 10.1016/j.jad.2020.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/26/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Modern cognitive neuropsychological models of depression posit that negatively biased emotional ("hot") processing confers risk for depression, while preserved executive function ("cold") cognition promotes resilience. METHODS We compared neural responses during hot and cold cognitive tasks in 99 individuals: those at familial risk for depression (N = 30 unaffected first-degree relatives of depressed individuals) and those currently experiencing a major depressive episode (N = 39 unmedicated depressed patients) with low-risk healthy controls (N = 30). Primary analyses assessed neural activation on two functional magnetic resonance imaging tasks previously associated with depression: dorsolateral prefrontal cortex (DLPFC) responsivity during the n-back working memory task; and amygdala and subgenual anterior cingulate cortex (sgACC) responsivity during incidental emotional face processing. RESULTS Depressed patients exhibited significantly attenuated working memory-related DLPFC activation, compared to low-risk controls and unaffected relatives; unaffected relatives did not differ from low-risk controls. We did not observe a complementary pattern during emotion processing. However, we found preliminary support that greater DLPFC activation was associated with lower amygdala response during emotion processing. LIMITATIONS These findings require confirmation in a longitudinal study to observe each individual's risk of developing depression; without this, we cannot identify the true risk level of the first-degree relative or low-risk control group. CONCLUSIONS These findings have implications for understanding the neural mechanisms of risk and resilience in depression: they are consistent with the suggestion that preserved executive function might confer resilience to developing depression in first-degree relatives of depressed patients.
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Affiliation(s)
- Nord Cl
- Institute of Cognitive Neuroscience, University College London, London, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Halahakoon Dc
- Institute of Cognitive Neuroscience, University College London, London, UK; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lally N
- Institute of Cognitive Neuroscience, University College London, London, UK; Warwick Medical School, University of Warwick, Coventry, UK; Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Limbachya T
- Camden and Islington NHS Foundation Trust, London, UK
| | - Pilling S
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Roiser Jp
- Institute of Cognitive Neuroscience, University College London, London, UK
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Galli G, Miniussi C, Pellicciari MC. Transcranial electric stimulation as a neural interface to gain insight on human brain functions: current knowledge and future perspective. Soc Cogn Affect Neurosci 2020; 17:4-14. [PMID: 32756871 DOI: 10.1093/scan/nsaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/12/2020] [Accepted: 07/11/2020] [Indexed: 11/12/2022] Open
Abstract
The use of brain-stimulation approaches in social and affective science has greatly increased over the last two decades. The interest in social factors has grown along with technological advances in brain research. Transcranial electric stimulation (tES) is a research tool that allows scientists to establish contributory causality between brain functioning and social behaviour, therefore deepening our understanding of the social mind. Preliminary evidence is also starting to demonstrate that tES, either alone or in combination with pharmacological or behavioural interventions, can alleviate the symptomatology of individuals with affective or social cognition disorders. This review offers an overview of the application of tES in the field of social and affective neuroscience. We discuss issues and challenges related to this application and suggest avenue for future basic and translational research.
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Affiliation(s)
- Giulia Galli
- Department of Psychology, Kingston University, Penrhyn Road, Kingston Upon Thames, KT1 2EE, United Kingdom
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Corso Bettini, 31, 38068 Rovereto, TN Italy
| | - Maria Concetta Pellicciari
- UniCamillus - Saint Camillus International University of Health Sciences, via di Sant'Alessandro 8, 00131, Rome, Italy
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Cotelli M, Manenti R, Gobbi E, Enrici I, Rusich D, Ferrari C, Adenzato M. Theory of Mind Performance Predicts tDCS-Mediated Effects on the Medial Prefrontal Cortex: A Pilot Study to Investigate the Role of Sex and Age. Brain Sci 2020; 10:brainsci10050257. [PMID: 32353992 PMCID: PMC7288024 DOI: 10.3390/brainsci10050257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/16/2022] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) has become an increasingly promising tool for understanding the relationship between brain and behavior. The purpose of this study was to investigate whether the magnitude of sex- and age-related tDCS effects previously found in the medial prefrontal cortex (mPFC) during a Theory of Mind (ToM) task correlates with social cognition performance; in particular, we explored whether different patterns of activity would be detected in high- and low-performing participants. For this, young and elderly, male and female participants were categorized as a low- or high-performer according to their score on the Reading the Mind in the Eyes task. Furthermore, we explored whether sex- and age-related effects associated with active tDCS on the mPFC were related to cognitive functioning. We observed the following results: (i) elderly participants experience a significant decline in ToM performance compared to young participants; (ii) low-performing elderly females report slowing of reaction time when anodal tDCS is applied over the mPFC during a ToM task; and (iii) low-performing elderly females are characterized by lower scores in executive control functions, verbal fluency and verbal short-term memory. The relationship between tDCS results and cognitive functioning is discussed in light of the neuroscientific literature on sex- and age-related differences.
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Affiliation(s)
- Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, BS, Italy
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, BS, Italy
- Correspondence: ; Tel.: +39-030-3501457; Fax: +39-030-3533513
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, BS, Italy
| | - Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, 10124 Turin, TO, Italy
| | - Danila Rusich
- Department of Human Science, LUMSA University (Libera Università Maria Santissima Assunta), 00193 Rome, RM, Italy
| | - Clarissa Ferrari
- Statistics Service, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, BS, Italy
| | - Mauro Adenzato
- Department of Psychology, University of Turin, 10124 Turin, TO, Italy
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11
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Adenzato M, Manenti R, Gobbi E, Enrici I, Rusich D, Cotelli M. Aging, sex and cognitive Theory of Mind: a transcranial direct current stimulation study. Sci Rep 2019; 9:18064. [PMID: 31792263 PMCID: PMC6889494 DOI: 10.1038/s41598-019-54469-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Aging is accompanied by changes in cognitive abilities and a great interest is spreading among researchers about aging impact on social cognition skills, such as the Theory of Mind (ToM). Transcranial direct current stimulation (tDCS) has been used in social cognition studies founding evidence of sex-related different effects on cognitive ToM task in a young people sample. In this randomized, double-blind, sham-controlled study, we applied one active and one sham tDCS session on the medial prefrontal cortex (mPFC) during a cognitive ToM task, including both social (i.e., communicative) and nonsocial (i.e., private) intention attribution conditions, in sixty healthy aging individuals (30 males and 30 females). In half of the participants the anode was positioned over the mPFC, whereas in the other half the cathode was positioned over the mPFC. The results showed that: (i) anodal tDCS over the mPFC led to significant slower reaction times (vs. sham) for social intention attribution task only in female participants; (ii) No effects were found in both females and males during cathodal stimulation. We show for the first time sex-related differences in cognitive ToM abilities in healthy aging, extending previous findings concerning young participants.
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Affiliation(s)
- Mauro Adenzato
- Department of Psychology, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, Turin, Italy
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy
| | - Danila Rusich
- Department of Human Science, LUMSA University, Roma, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Neural predictors of treatment response to brain stimulation and psychological therapy in depression: a double-blind randomized controlled trial. Neuropsychopharmacology 2019; 44:1613-1622. [PMID: 31039579 PMCID: PMC6784995 DOI: 10.1038/s41386-019-0401-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 11/08/2022]
Abstract
Standard depression treatments, including antidepressant medication and cognitive behavioural therapy (CBT), are ineffective for many patients. Prefrontal transcranial direct current stimulation (tDCS) has been proposed as an alternative treatment, but has shown inconsistent efficacy for depression, and its mechanisms are poorly understood. We recruited unmedicated patients with major depressive disorder (N = 71 approached; N = 39 randomised) for a mechanistic, double-blind, randomized controlled trial consisting of eight weekly sessions of prefrontal tDCS administered to the left prefrontal cortex prior to CBT. We probed (1) whether tDCS improved the efficacy of CBT relative to sham stimulation; and (2) whether neural measures predicted clinical response. We found a modest and non-significant effect of tDCS on clinical outcome over and above CBT (active: 50%; sham: 31.6%; odds ratio: 2.16, 95% CI = 0.59-7.99), but a strong relationship, predicted a priori, between baseline activation during a working memory task in the stimulated prefrontal region and symptom improvement. Repeating our analyses of symptom outcome splitting the sample according to this biomarker revealed that tDCS was significantly superior to sham in individuals with high left prefrontal cortex activation at baseline; we also show 86% accuracy in predicting clinical response using this measure. Exploratory analyses revealed several other regions where activation at baseline was associated with subsequent response to CBT, irrespective of tDCS. This mechanistic trial revealed variable, but predictable, clinical effects of prefrontal tDCS combined with CBT for depression. We have discovered a potential explanation for this variability: individual differences in baseline activation of the region stimulated. Such a biomarker could potentially be used to pre-select patients for trials and, eventually, in the clinic.
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Li H, Zhu N, Klomparens EA, Xu S, Wang M, Wang Q, Wang J, Song L. Application of functional near-infrared spectroscopy to explore the neural mechanism of transcranial direct current stimulation for post-stroke depression. Neurol Res 2019; 41:714-721. [PMID: 31092142 DOI: 10.1080/01616412.2019.1612539] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hongyu Li
- Department of rehabilitation medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Zhu
- Department of rehabilitation medicine, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Eric A. Klomparens
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Shu Xu
- Capital Medical University, School of Rehabilitation Medicine, Beijing, China
- Beijing Bo‘ai Hospital, China Rehabilitation Research Center, Department of Neurological rehabilitation, Beijing, China
| | - Man Wang
- Capital Medical University, School of Rehabilitation Medicine, Beijing, China
- Beijing Bo‘ai Hospital, China Rehabilitation Research Center, Department of Neurological rehabilitation, Beijing, China
| | - Qiang Wang
- Capital Medical University, School of Rehabilitation Medicine, Beijing, China
- Beijing Bo‘ai Hospital, China Rehabilitation Research Center, Department of Neurological rehabilitation, Beijing, China
| | - Jing Wang
- Capital Medical University, School of Basic Medical Sciences, Beijing, China
| | - Luping Song
- Capital Medical University, School of Rehabilitation Medicine, Beijing, China
- Beijing Bo‘ai Hospital, China Rehabilitation Research Center, Department of Neurological rehabilitation, Beijing, China
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Nord CL, Popa T, Smith E, Hannah R, Doñamayor N, Weidacker K, Bays PM, Rothwell J, Voon V. The effect of frontoparietal paired associative stimulation on decision-making and working memory. Cortex 2019; 117:266-276. [PMID: 31009813 PMCID: PMC6664322 DOI: 10.1016/j.cortex.2019.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/29/2019] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
Previous single-site neurostimulation experiments have unsuccessfully attempted to shift decision-making away from habitual control, a fast, inflexible cognitive strategy, towards goal-directed control, a flexible, though computationally expensive strategy. We employed a dual-target neurostimulation approach in 30 healthy participants, using cortico-cortical paired associative stimulation (ccPAS) to target two key nodes: lateral prefrontal cortex (LPFC) and intraparietal sulcus (IPS), to test whether decision-making can be artificially shifted from habitual toward goal-directed control. Participants received three active stimulations, delivered at least six days apart (each involving 100 paired pulses over the IPS and LPFC, varying the interstimulus interval): two interventional, time-relevant ccPAS (10 msec interval) and one control, non-time-relevant ccPAS (100 msec interval). Following stimulation, participants completed a sequential learning task, measuring goal-directed/habitual control, and a working memory task. IPS→LPFC ccPAS (stimulating IPS, then LPFC with a 10 msec interval) shifted decision-making from habitual toward goal-directed control, compared to control ccPAS. There was no effect of LPFC→IPS ccPAS, nor an effect of any PAS condition on working memory. Previous studies have shown ccPAS effects outside the motor domain targeting prefrontal regions on response inhibition, attentional bias, and alpha asymmetry. The present study measures the behavioural effects of parietal-prefrontal PAS, focusing on a highly complex decision-making task and working memory. If confirmed in larger studies, this would be the first instance of neurostimulation successfully shifting decision-making from habitual to goal-directed control, putatively via inducing long-term potentiation between the IPS and LPFC. However, we found no effect in the other direction (LPFC→IPS ccPAS), and no effect on working memory overall. PAS is a relatively new neuromodulatory technique in the cognitive arsenal, and this study could help guide future approaches in healthy and disordered decision-making.
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Affiliation(s)
- Camilla L Nord
- Department of Psychiatry, University of Cambridge, Cambridge, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Traian Popa
- Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Switzerland; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Emma Smith
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ricci Hannah
- Sobell Centre for Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Nuria Doñamayor
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany
| | | | - Paul M Bays
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - John Rothwell
- Sobell Centre for Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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15
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Ironside M, Perlo S. Transcranial Direct Current Stimulation for the Treatment of Depression: a Review of the Candidate Mechanisms of Action. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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Liu W, Leng YS, Zou XH, Cheng ZQ, Yang W, Li BJ. Affective Processing in Non-invasive Brain Stimulation Over Prefrontal Cortex. Front Hum Neurosci 2017; 11:439. [PMID: 28936170 PMCID: PMC5595166 DOI: 10.3389/fnhum.2017.00439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022] Open
Abstract
The prefrontal cortex (PFC) is the most frequently targeted brain region by non-invasive brain stimulation (NBS) studies. Non-invasively stimulating the PFC has been shown to both modulate affective processing and improve the clinical symptoms of several psychiatric disorders, such as depression and schizophrenia. The magnitude of the modulation depends on several factors, including the stimulation frequency, the number of stimulation sessions, and the specific sub-region of the PFC that is stimulated. Although some of the potential underlying mechanisms have been identified, the exact mechanisms that underlie these cognitive and affective changes remain unclear. The present review aims to summarize recent advances in the study of affective processing using NBS over the PFC. We will provide a theoretical framework for better understanding how affective processing changes are induced by NBS, with the goal of providing testable hypotheses for future studies.
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Affiliation(s)
- Wei Liu
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin UniversityChangchun, China
| | - Ya Shu Leng
- Department of Anesthesiology, The Third Hospital of Jilin UniversityChangchun, China
| | - Xiao Han Zou
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin UniversityChangchun, China
| | - Zi Qian Cheng
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin UniversityChangchun, China
| | - Wei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin UniversityChangchun, China
| | - Bing Jin Li
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, The Second Hospital of Jilin UniversityChangchun, China
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