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Webler RD, Fox J, McTeague LM, Burton PC, Dowdle L, Short EB, Borckardt JJ, Li X, George MS, Nahas Z. DLPFC stimulation alters working memory related activations and performance: An interleaved TMS-fMRI study. Brain Stimul 2022; 15:823-832. [DOI: 10.1016/j.brs.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 12/31/2022] Open
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Gordon PC, Belardinelli P, Stenroos M, Ziemann U, Zrenner C. Prefrontal theta phase-dependent rTMS-induced plasticity of cortical and behavioral responses in human cortex. Brain Stimul 2022; 15:391-402. [PMID: 35182810 DOI: 10.1016/j.brs.2022.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prefrontal theta oscillations are involved in neuronal information transfer and retention. Phases along the theta cycle represent varied excitability states, whereby high-excitability states correspond to high-frequency neuronal activity and heightened capacity for plasticity induction, as demonstrated in animal studies. Human studies corroborate this model and suggest a core role of prefrontal theta activity in working memory (WM). OBJECTIVE/HYPOTHESIS We aimed at modulating prefrontal neuronal excitability and WM performance in healthy humans, using real-time EEG analysis for triggering repetitive transcranial magnetic stimulation (rTMS) theta-phase synchronized to the left dorsomedial prefrontal cortex. METHODS 16 subjects underwent 3 different rTMS interventions on separate days, with pulses triggered according to the individual's real-time EEG activity: 400 rTMS gamma-frequency (100 Hz) triplet bursts applied during either the negative peak of the prefrontal theta oscillation, the positive peak, or at random phase. Changes in cortical excitability were assessed with EEG responses following single-pulse TMS, and behavioral effects by using a WM task. RESULTS Negative-peak rTMS increased single-pulse TMS-induced prefrontal theta power and theta-gamma phase-amplitude coupling, and decreased WM response time. In contrast, positive-peak rTMS decreased prefrontal theta power, while no changes were observed after random-phase rTMS. CONCLUSION Findings point to the feasibility of EEG-TMS technology in a theta-gamma phase-amplitude coupling mode for effectively modifying WM networks in human prefrontal cortex, with potential for therapeutic applications.
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Affiliation(s)
- Pedro Caldana Gordon
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Paolo Belardinelli
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; CIMeC, Center for Mind/Brain Sciences, University of Trento, Italy
| | - Matti Stenroos
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Ulf Ziemann
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
| | - Christoph Zrenner
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Beynel L, Dannhauer M, Palmer H, Hilbig SA, Crowell CA, Wang JE, Michael AM, Wood EA, Luber B, Lisanby SH, Peterchev AV, Cabeza R, Davis SW, Appelbaum LG. Network-based rTMS to modulate working memory: The difficult choice of effective parameters for online interventions. Brain Behav 2021; 11:e2361. [PMID: 34651464 PMCID: PMC8613413 DOI: 10.1002/brb3.2361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Online repetitive transcranialmagnetic stimulation (rTMS) has been shown to modulate working memory (WM) performance in a site-specific manner, with behavioral improvements due to stimulation of the dorsolateral prefrontal cortex (DLPFC), and impairment from stimulation to the lateral parietal cortex (LPC). Neurobehavioral studies have demonstrated that subprocesses of WM allowing for the maintenance and manipulation of information in the mind involve unique cortical networks. Despite promising evidence of modulatory effects of rTMS on WM, no studies have yet demonstrated distinct modulatory control of these two subprocesses. The current study therefore sought to explore this possibility through site-specific stimulation during an online task invoking both skills. METHODS Twenty-nine subjects completed a 4-day protocol, in which active or sham 5Hz rTMS was applied over the DLPFC and LPC in separate blocks of trials while participants performed tasks that required either maintenance alone, or both maintenance and manipulation (alphabetization) of information. Stimulation targets were defined individually based on fMRI activation and structural network properties. Stimulation amplitude was adjusted using electric field modeling to equate induced current in the target region across participants. RESULTS Despite the use of advanced techniques, no significant differences or interactions between active and sham stimulation were found. Exploratory analyses testing stimulation amplitude, fMRI activation, and modal controllability showed nonsignificant but interesting trends with rTMS effects. CONCLUSION While this study did not reveal any significant behavioral changes in WM, the results may point to parameters that contribute to positive effects, such as stimulation amplitude and functional activation.
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Affiliation(s)
- Lysianne Beynel
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Moritz Dannhauer
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Hannah Palmer
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Susan A. Hilbig
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Courtney A. Crowell
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Joyce E‐H. Wang
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Andrew M. Michael
- Duke Institute for Brain SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Eleanor A. Wood
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Bruce Luber
- Noninvasive Neuromodulation UnitExperimental Therapeutics and Pathophysiology BranchNational Institute of Mental HealthBethesdaMarylandUSA
| | - Sarah H. Lisanby
- Noninvasive Neuromodulation UnitExperimental Therapeutics and Pathophysiology BranchNational Institute of Mental HealthBethesdaMarylandUSA
| | - Angel V. Peterchev
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Electrical and Computer EngineeringDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of NeurosurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Roberto Cabeza
- Center for Cognitive NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychology & NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Simon W. Davis
- Center for Cognitive NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of NeurologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Lawrence G. Appelbaum
- Department of Psychiatry and Behavioral ScienceDuke University School of MedicineDurhamNorth CarolinaUSA
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Stimulating Memory: Reviewing Interventions Using Repetitive Transcranial Magnetic Stimulation to Enhance or Restore Memory Abilities. Brain Sci 2021; 11:brainsci11101283. [PMID: 34679348 PMCID: PMC8533697 DOI: 10.3390/brainsci11101283] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022] Open
Abstract
Human memory systems are imperfect recording devices that are affected by age and disease, but recent findings suggest that the functionality of these systems may be modifiable through interventions using non-invasive brain stimulation such as repetitive transcranial magnetic stimulation (rTMS). The translational potential of these rTMS interventions is clear: memory problems are the most common cognitive complaint associated with healthy aging, while pathological conditions such as Alzheimer's disease are often associated with severe deficits in memory. Therapies to improve memory or treat memory loss could enhance independence while reducing costs for public health systems. Despite this promise, several important factors limit the generalizability and translational potential of rTMS interventions for memory. Heterogeneity of protocol design, rTMS parameters, and outcome measures present significant challenges to interpretation and reproducibility. However, recent advances in cognitive neuroscience, including rTMS approaches and recent insights regarding functional brain networks, may offer methodological tools necessary to design new interventional studies with enhanced experimental rigor, improved reproducibility, and greater likelihood of successful translation to clinical settings. In this review, we first discuss the current state of the literature on memory modulation with rTMS, then offer a commentary on developments in cognitive neuroscience that are relevant to rTMS interventions, and finally close by offering several recommendations for the design of future investigations using rTMS to modulate human memory performance.
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Liu M, Nie ZY, Li RR, Zhang W, Huang LH, Wang JQ, Xiao WX, Zheng JC, Li YX. Neural Mechanism of Repeated Transcranial Magnetic Stimulation to Enhance Visual Working Memory in Elderly Individuals With Subjective Cognitive Decline. Front Neurol 2021; 12:665218. [PMID: 34335441 PMCID: PMC8320844 DOI: 10.3389/fneur.2021.665218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Visual working memory (VWM), the core process inherent to many advanced cognitive processes, deteriorates with age. Elderly individuals usually experience defects in the processing of VWM. The dorsolateral prefrontal cortex is a key structure for the top-down control of working memory processes. Many studies have shown that repeated transcranial magnetic stimulation (rTMS) improves VWM by modulating the excitability of neurons in the target cortical region, though the underlying neural mechanism has not been clarified. Therefore, this study sought to assess the characteristics of brain memory function post-rTMS targeting the left dorsolateral prefrontal cortex. The study stimulated the left dorsolateral prefrontal cortex in elderly individuals by performing a high-frequency rTMS protocol and evaluated behavioral performance using cognitive tasks and a VWM task. Based on the simultaneously recorded electroencephalogram signals, event-related potential and event-related spectral perturbation analysis techniques were used to investigate the variation characteristics of event-related potential components' (N2PC and CDA) amplitudes and neural oscillations in elderly individuals to elucidate the effect of high-frequency rTMS. The results found that rTMS enhanced VWM performance and significantly improved attention and executive function in elderly individuals with subjective cognitive decline. We therefore speculate that rTMS enhances VWM by increasing the N2PC and CDA amplitude, alongside increasing β oscillation activity. This would improve the attention and allocation of resources in elderly individuals such as to improve an individual's VWM.
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Affiliation(s)
- Meng Liu
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Zhi-Yu Nie
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Ren-Ren Li
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Wei Zhang
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Li-He Huang
- Research Center for Ageing Language and Care, School of Foreign Languages, Tongji University, Shanghai, China
| | - Jie-Qun Wang
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Wei-Xin Xiao
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jialin C Zheng
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Yun-Xia Li
- Department of Neurology, Tongji University School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
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Impact of Repetitive Transcranial Magnetic Stimulation (rTMS) on Theory of Mind and Executive Function in Major Depressive Disorder and Its Correlation with Brain-Derived Neurotrophic Factor (BDNF): A Randomized, Double-Blind, Sham-Controlled Trial. Brain Sci 2021; 11:brainsci11060765. [PMID: 34207545 PMCID: PMC8228992 DOI: 10.3390/brainsci11060765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies have implicated hypofrontality in the pathogenesis of impaired theory of mind (ToM) and executive function (EF) in major depressive disorder (MDD). These symptoms are usually resistant to treatment. Repetitive transcranial magnetic stimulation (rTMS) has been shown to reverse hypofrontality. Moreover, BDNF is an effective biomarker of antidepressant effects, but there have been very few studies on the correlation between BDNF and rTMS. We aimed to evaluate the efficacy of 20 sessions of a 10 Hz unilateral rTMS intervention over the left dorsolateral prefrontal cortex (DLPFC) in improving ToM and EF in patients with MDD and its correlation with BDNF. METHODS A total of 120 MDD patients were enrolled in this randomized, sham-controlled, double-blind trial. Each participant received 20 sessions of rTMS at 10 Hz frequency through the active or the sham coil over 4 weeks. ToM was assessed with the facial emotion identification test (FEIT) and hinting task (HT). EF was assessed with the Wisconsin card sorting test (WCST). BDNF assessments were carried out at baseline and 2-, 4-, 12-, and 24-week follow-ups. RESULTS The improvement in the ToM (FEIT, HT) in the active rTMS group was significantly different from that in the sham rTMS group (F = 18.09, p < 0.001; F = 5.02, p = 0.026). There were significant differences in the WCST (categories completed, response errors, response perseverative errors, non-response perseverative errors) after logarithmic transformation at different time points in the active rTMS group (F = 14.71, p < 0.001; F = 5.99, p = 0.046; F = 8.90, p = 0.031; F = 2.31, p = 0.048). However, there was no significant difference in log transformed BDNF concentration between the two groups (t = 0.07 to t = 1.29, p > 0.05). BDNF was negatively correlated with WCST categories completed at the 24th week (r = -0.258, p = 0.046). CONCLUSIONS The results show that rTMS may improve the ToM and EF of patients with MDD and there was no significant correlation with serum BDNF concentration. RTMS can not only be used for treatment of patients with MDD but also has a positive effect on ToM and EF.
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Brambilla M, Dinkelbach L, Bigler A, Williams J, Zokaei N, Cohen Kadosh R, Brem AK. The Effect of Transcranial Random Noise Stimulation on Cognitive Training Outcome in Healthy Aging. Front Neurol 2021; 12:625359. [PMID: 33767658 PMCID: PMC7985554 DOI: 10.3389/fneur.2021.625359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/09/2021] [Indexed: 12/20/2022] Open
Abstract
Background and Objective: Aging is associated with a decline in attentional and executive abilities, which are linked to physiological, structural, and functional brain changes. A variety of novel non-invasive brain stimulation methods have been probed in terms of their neuroenhancement efficacy in the last decade; one that holds significant promise is transcranial random noise stimulation (tRNS) that delivers an alternate current at random amplitude and frequency. The aim of this study was to investigate whether repeated sessions of tRNS applied as an add-on to cognitive training (CT) may induce long-term near and far transfer cognitive improvements. Methods: In this sham-controlled, randomized, double-blinded study forty-two older adults (age range 60-86 years) were randomly assigned to one of three intervention groups that received 20 min of 0.705 mA tRNS (N = 14), 1 mA tRNS (N = 14), or sham tRNS (N = 19) combined with 30 min of CT of executive functions (cognitive flexibility, inhibitory control, working memory). tRNS was applied bilaterally over the dorsolateral prefrontal cortices for five sessions. The primary outcome (non-verbal logical reasoning) and other cognitive functions (attention, memory, executive functions) were assessed before and after the intervention and at a 1-month follow-up. Results: Non-verbal logical reasoning, inhibitory control and reaction time improved significantly over time, but stimulation did not differentially affect this improvement. These changes occurred during CT, while no further improvement was observed during follow-up. Performance change in logical reasoning was significantly correlated with age in the group receiving 1 mA tRNS, indicating that older participants profited more from tRNS than younger participants. Performance change in non-verbal working memory was significantly correlated with age in the group receiving sham tRNS, indicating that in contrast to active tRNS, older participants in the sham group declined more than younger participants. Interpretation: CT induced cognitive improvements in all treatment groups, but tRNS did not modulate most of these cognitive improvements. However, the effect of tRNS depended on age in some cognitive functions. We discuss possible explanations leading to this result that can help to improve the design of future neuroenhancement studies in older populations.
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Affiliation(s)
- Michela Brambilla
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Biomedical and Clinical Sciences Department, Center for Research and Treatment on Cognitive Dysfunctions, “Luigi Sacco” Hospital, University of Milan, Milan, Italy
| | - Lars Dinkelbach
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Duesseldorf, Germany
| | - Annelien Bigler
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Joseph Williams
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Nahid Zokaei
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Roi Cohen Kadosh
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Anna-Katharine Brem
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation and Division for Cognitive Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Cross-modal involvement of the primary somatosensory cortex in visual working memory: A repetitive TMS study. Neurobiol Learn Mem 2020; 175:107325. [PMID: 33059033 DOI: 10.1016/j.nlm.2020.107325] [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: 04/21/2020] [Revised: 09/01/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
Recent literature suggests that the primary somatosensory cortex (S1), once thought to be a low-level area only modality-specific, is also involved in higher-level, cross-modal, cognitive functions. In particular, electrophysiological studies have highlighted that the cross-modal activation of this area may also extend to visual Working Memory (WM), being part of a mnemonic network specific for the temporary storage and manipulation of visual information concerning bodies and body-related actions. However, the causal recruitment of S1 in the WM network remains speculation. In the present study, by taking advantage of repetitive Transcranial Magnetic Stimulation (rTMS), we look for causal evidence that S1 is implicated in the retention of visual stimuli that are salient for this cortical area. To this purpose, in a first experiment, high-frequency (10 Hz) rTMS was delivered over S1 of the right hemisphere, and over two control sites, the right lateral occipital cortex (LOC) and the right dorsolateral prefrontal cortex (dlPFC), during the maintenance phase of a high-load delayed match-to-sample task in which body-related visual stimuli (non-symbolic hand gestures) have to be retained. In a second experiment, the specificity of S1 recruitment was deepened by using a version of the delayed match-to-sample task in which visual stimuli depict geometrical shapes (non-body related stimuli). Results show that rTMS perturbation of S1 activity leads to an enhancement of participants' performance that is selective for body-related visual stimuli; instead, the stimulation of the right LOC and dlPFC does not affect the temporary storage of body-related visual stimuli. These findings suggest that S1 may be recruited in visual WM when information to store (and recall) is salient for this area, corroborating models which suggest the existence of a dedicated mnemonic system for body-related information in which also somatosensory cortices play a key role, likely thanks to their cross-modal (visuo-tactile) properties.
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