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Turrini S, Wong B, Eldaief M, Press DZ, Sinclair DA, Koch G, Avenanti A, Santarnecchi E. The multifactorial nature of healthy brain ageing: Brain changes, functional decline and protective factors. Ageing Res Rev 2023; 88:101939. [PMID: 37116664 DOI: 10.1016/j.arr.2023.101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 04/30/2023]
Abstract
As the global population faces a progressive shift towards a higher median age, understanding the mechanisms underlying healthy brain ageing has become of paramount importance for the preservation of cognitive abilities. The first part of the present review aims to provide a comprehensive look at the anatomical changes the healthy brain endures with advanced age, while also summarizing up to date findings on modifiable risk factors to support a healthy ageing process. Subsequently, we describe the typical cognitive profile displayed by healthy older adults, conceptualizing the well-established age-related decline as an impairment of four main cognitive factors and relating them to their neural substrate previously described; different cognitive trajectories displayed by typical Alzheimer's Disease patients and successful agers with a high cognitive reserve are discussed. Finally, potential effective interventions and protective strategies to promote cognitive reserve and defer cognitive decline are reviewed and proposed.
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Affiliation(s)
- Sonia Turrini
- Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Centro studi e ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Alma Mater Studiorum Università di Bologna, Campus di Cesena, Cesena, Italy
| | - Bonnie Wong
- Neuropsychology Program, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA , USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Eldaief
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Z Press
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David A Sinclair
- Blavatnik Institute, Department of Genetics, Paul F. Glenn Center for Biology of ageing Research, Harvard Medical School, Boston, MA, USA
| | - Giacomo Koch
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy; Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Alessio Avenanti
- Centro studi e ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia "Renzo Canestrari", Alma Mater Studiorum Università di Bologna, Campus di Cesena, Cesena, Italy; Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica del Maule, Talca, Chile
| | - Emiliano Santarnecchi
- Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Colella M, Press DZ, Laher RM, McIlduff CE, Rutkove SB, Cassarà AM, Apollonio F, Pascual-Leone A, Liberti M, Bonmassar G. A study of flex miniaturized coils for focal nerve magnetic stimulation. Med Phys 2023; 50:1779-1792. [PMID: 36502488 PMCID: PMC10033376 DOI: 10.1002/mp.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/01/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Peripheral magnetic stimulation (PMS) is emerging as a complement to standard electrical stimulation (ES) of the peripheral nervous system (PNS). PMS may stimulate sensory and motor nerve fibers without the discomfort associated with the ES used for standard nerve conduction studies. The PMS coils are the same ones used in transcranial magnetic stimulation (TMS) and lack focality and selectiveness in the stimulation. PURPOSE This study presents a novel coil for PMS, developed using Flexible technologies, and characterized by reduced dimensions for a precise and controlled targeting of peripheral nerves. METHODS We performed hybrid electromagnetic (EM) and electrophysiological simulations to study the EM exposure induced by a novel miniaturized coil (or mcoil) in and around the radial nerve of the neuro-functionalized virtual human body model Yoon-Sun, and to estimate the current threshold to induce magnetic stimulation (MS) of the radial nerve. Eleven healthy subjects were studied with the mcoil, which consisted of two 15 mm diameter coils in a figure-of-eight configuration, each with a hundred turns of a 25 μm copper-clad four-layer foil. Sensory nerve action potentials (SNAPs) were measured in each subject using two electrodes and compared with those obtained from standard ES. The SNAPs conduction velocities were estimated as a performance metric. RESULTS The induced electric field was estimated numerically to peak at a maximum intensity of 39 V/m underneath the mcoil fed by 70 A currents. In such conditions, the electrophysiological simulations suggested that the mcoil elicits SNAPs originating at 7 mm from the center of the mcoil. Furthermore, the numerically estimated latencies and waveforms agreed with those obtained during the PMS experiments on healthy subjects, confirming the ability of the mcoil to stimulate the radial nerve sensory fibers. CONCLUSION Hybrid EM-electrophysiological simulations assisted the development of a miniaturized coil with a small diameter and a high number of turns using flexible electronics. The numerical dosimetric analysis predicted the threshold current amplitudes required for a suprathreshold peripheral nerve sensory stimulation, which was experimentally confirmed. The developed and now validated computational pipeline will be used to improve the performances (e.g., focality and minimal currents) of new generations of mcoil designs.
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Affiliation(s)
- Micol Colella
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Daniel Z. Press
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rebecca M. Laher
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Courtney E. McIlduff
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Seward B. Rutkove
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Antonino M. Cassarà
- IT'IS Foundation for Research on Information Technologies in Society, 8004 Zurich, Switzerland
| | - Francesca Apollonio
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Micaela Liberti
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
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Curnin CB, Hayashi T, Smith MA, Press DZ. Utility of online cognitive test in cognitive neurology unit. Alzheimers Dement 2022. [DOI: 10.1002/alz.068010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Cotovio G, Boes AD, Press DZ, Oliveira-Maia AJ, Pascual-Leone A. In Older Adults the Antidepressant Effect of Repetitive Transcranial Magnetic Stimulation Is Similar but Occurs Later Than in Younger Adults. Front Aging Neurosci 2022; 14:919734. [PMID: 35928992 PMCID: PMC9343621 DOI: 10.3389/fnagi.2022.919734] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Treatment resistant depression is common in older adults and treatment is often complicated by medical comorbidities and polypharmacy. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for this group due to its favorable profile. However, early influential studies suggested that rTMS is less effective in older adults. This evidence remains controversial. Methods Here, we evaluated the rTMS treatment outcomes in a large international multicenter naturalistic cohort of >500 patients comparing older vs. younger adults. Results We show that older adults, while having similar antidepressant response to younger adults, respond more slowly, which may help to explain differences from earlier studies when the duration of a treatment course was shorter. Conclusions Such evidence helps to resolve a long-standing controversy in treating older depressed patients with rTMS. Moreover, these findings provide an important data point in the call to revise policy decisions from major insurance providers that have unfairly excluded older adults.
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Affiliation(s)
- Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Aaron D Boes
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, United States.,Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States.,Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Daniel Z Press
- Division of Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Deanna and Sidney Wolk Center for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States
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Buss SS, Ross J, Hagan B, Press DZ, Shafi M. TMS‐EEG as a measure of cortical hyperexcitability in motor and parietal cortex in Alzheimer’s disease: A pilot study. Alzheimers Dement 2021. [DOI: 10.1002/alz.055780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stephanie S. Buss
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Jessica Ross
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Brenna Hagan
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Daniel Z. Press
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Mouhsin Shafi
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
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Cotovio G, Oliveira-Maia AJ, Paul C, Viana FF, Rodrigues da Silva D, Seybert C, Stern AP, Pascual-Leone A, Press DZ. Reply: Variability in motor threshold. Brain Stimul 2021; 14:1523-1524. [PMID: 34619388 DOI: 10.1016/j.brs.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gonçalo Cotovio
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carter Paul
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francisco Faro Viana
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Carolina Seybert
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Adam P Stern
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Guttmann Brain Health Institute, Institut Guttmann, Barcelona, Spain
| | - Daniel Z Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Taylor JJ, Newberger NG, Stern AP, Phillips A, Feifel D, Betensky RA, Press DZ. Reply to Tendler et al. Brain Stimul 2021; 14:1216-1217. [PMID: 34400377 DOI: 10.1016/j.brs.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joseph J Taylor
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Adam P Stern
- Berenson Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Angela Phillips
- Department of Veterans Affairs, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - David Feifel
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Kadima Neuropsychiatry Institute, La Jolla, CA, USA
| | - Rebacca A Betensky
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Daniel Z Press
- Berenson Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Cotovio G, Oliveira-Maia AJ, Paul C, Faro Viana F, Rodrigues da Silva D, Seybert C, Stern AP, Pascual-Leone A, Press DZ. Day-to-day variability in motor threshold during rTMS treatment for depression: Clinical implications. Brain Stimul 2021; 14:1118-1125. [PMID: 34329797 DOI: 10.1016/j.brs.2021.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND When repetitive transcranial magnetic stimulation (rTMS) is used to treat medication refractory depression, the treatment pulse intensity is individualized according to motor threshold (MT). This measure is often acquired only on the first day of treatment, as per the protocol currently approved by Food and Drug Administration. OBJECTIVE Here, we aimed to assess daily MT variability across an rTMS treatment course and simulate the effects of different schedules of MT assessment on treatment intensity. METHODS We conducted a naturalistic retrospective study with 374 patients from a therapeutic rTMS program for depression that measures MT daily. RESULTS For each patient, in almost half the TMS sessions, MT varied on average more than 5% as compared to the baseline MT acquired in the first treatment day. Such variability was only minimally impacted by having different TMS technicians acquiring MT in different days. In a smaller cohort of healthy individuals, we confirmed that the motor hotspot localization method, a critical step for accurate MT assessment, was stable in different days, arguing that daily MT variability reflects physiological variability, rather than an artifact of measurement error. Finally, in simulations of the effect of one-time MT measurement, we found that half of sessions would have been 5% or more above or below target intensity, with almost 5% of sessions 25% above target intensity. The simulated effects of weekly MT measurements were significantly improved. CONCLUSIONS In conclusion, MT varies significantly across days, not fully dependent on methods of MT acquisition. This finding may have important implications for therapeutic rTMS practice regarding safety and suggests that regular MT assessments, daily or at least weekly, would ameliorate the effect.
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Affiliation(s)
- Gonçalo Cotovio
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA; Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carter Paul
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA
| | - Francisco Faro Viana
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Carolina Seybert
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Adam P Stern
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Institut Guttmann de Neurorehabilitación, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain
| | - Daniel Z Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA.
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Zadey S, Buss SS, McDonald K, Press DZ, Pascual-Leone A, Fried PJ. Higher motor cortical excitability linked to greater cognitive dysfunction in Alzheimer's disease: results from two independent cohorts. Neurobiol Aging 2021; 108:24-33. [PMID: 34479168 DOI: 10.1016/j.neurobiolaging.2021.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/19/2021] [Accepted: 06/10/2021] [Indexed: 11/27/2022]
Abstract
Prior studies have reported increased cortical excitability in people with Alzheimer's disease (AD), but findings have been inconsistent, and how excitability relates to dementia severity remains incompletely understood. The objective of this study was to investigate the association between a transcranial magnetic stimulation (TMS) measure of motor cortical excitability and measures of cognition in AD. A retrospective cross-sectional analysis tested the relationship between resting motor threshold (RMT) and the Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog) across two independent samples of AD participants (a discovery cohort, n=22 and a larger validation cohort, n=129) and a control cohort of cognitively normal adults (n=26). RMT was correlated with ADAS-Cog in the discovery-AD cohort (n=22, β=-.70, p<0.001) but not in the control cohort (n=26, β=-0.13, p=0.513). This relationship was confirmed in the validation-AD cohort (n=129, β=-.35, p<0.001). RMT can be a useful neurophysiological marker of progressive global cognitive dysfunction in AD. Future translational research should focus on the potential of RMT to predict and track individual pathophysiological trajectories of aging.
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Affiliation(s)
- Siddhesh Zadey
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Indian Institute of Science Education and Research, Pune, India; Duke Global Health Institute, Duke University, Durham, NC, USA; Association for Socially Applicable Research (ASAR), Pune, India
| | - Stephanie S Buss
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Katherine McDonald
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Cognitive and Brain Health, Northeastern University, Boston, MA, USA
| | - Daniel Z Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institute, Institut Guttmann de Neurorehabilitació, Universitat Autonoma de Barcelona, Badalona, Spain; Hinda and Arthur Marcus Institute for Aging Research, Center for Memory Health, Hebrew Senior Life, Harvard Medical School, Boston, Massachusetts, USA.
| | - Peter J Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Taylor JJ, Newberger NG, Stern AP, Phillips A, Feifel D, Betensky RA, Press DZ. Seizure risk with repetitive TMS: Survey results from over a half-million treatment sessions. Brain Stimul 2021; 14:965-973. [PMID: 34133991 DOI: 10.1016/j.brs.2021.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/24/2021] [Accepted: 05/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Seizures are rare during repetitive transcranial magnetic stimulation (rTMS) treatment, but estimating risk is difficult because of study heterogeneity and sampling limitations. Moreover, there are few studies comparing rates between device manufacturers. OBJECTIVE The objective of this study was to calculate rTMS seizure rates across various FDA-cleared devices in naturalistic clinical settings. METHODS In July and August 2018, approximately 500 members of the Clinical TMS Society (CTMSS) were electronically surveyed about seizures in their practices. Seizures were distinguished from non-seizures by a remote semi-structured interview with a Board-certified neurologist and Co-Chair of the CTMSS Standards Committee. Exact Poisson calculations were used to estimate seizure rates and confidence intervals across the four most widely used manufacturers. RESULTS The survey was completed by 134 members, with 9 responses excluded because of data inconsistencies. In total, 18 seizures were reported in 586,656 sessions and 25,526 patients across all device manufacturers. The overall seizure rate was 0.31 (95% CI: 0.18, 0.48) per 10,000 sessions, and 0.71 (95% CI: 0.42, 1.11) per 1000 patients. The Brainsway H-coil seizure rate of 5.56 per 1000 patients (95% CI: 2.77,9.95) was significantly higher (p < 0.001) than the three most widely used figure- 8 coil devices' combined seizure rate of 0.14 per 1000 patients (95% CI: 0.01, 0.51). CONCLUSION The absolute risk of a seizure with rTMS is low, but generic Brainsway H-coil treatment appears to be associated with a higher relative risk than generic figure- 8 coil treatment. Well-designed prospective studies are warranted to further investigate this risk.
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Affiliation(s)
- Joseph J Taylor
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Adam P Stern
- Berenson Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Angela Phillips
- Department of Veterans Affairs, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - David Feifel
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Kadima Neuropsychiatry Institute, La Jolla, CA, USA
| | - Rebecca A Betensky
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Daniel Z Press
- Berenson Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Baumgartner AJ, Press DZ, Simon DK. The Relationship Between Olfactory Dysfunction and Constipation in Early Parkinson's Disease. Mov Disord 2021; 36:781-782. [PMID: 33404111 DOI: 10.1002/mds.28483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Daniel Z Press
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - David K Simon
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Musaeus CS, Zhao L, Dai W, Breton J, Shafi M, Alsop DC, Press DZ. A randomized controlled trial measuring changes in cerebral blood flow after levetiracetam in patients with Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.045476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Li Zhao
- Children's National Medical Center Washington DC USA
| | | | | | - Mouhsin Shafi
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
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Buss SS, Macone J, Li G, McDonald K, Shafi M, Donohoe K, Press DZ, Pascual‐Leone A, Fried PJ. TMS‐measures of cortical excitability are abnormal in amyloid‐positive MCI, relate to amyloid burden, and predict faster cognitive decline. Alzheimers Dement 2020. [DOI: 10.1002/alz.045478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Stephanie S. Buss
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | - Joanna Macone
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | - Gongri Li
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Mouhsin Shafi
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | - Kevin Donohoe
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | - Daniel Z. Press
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | - Alvaro Pascual‐Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife; Department of Neurology Harvard Medical School Boston MA USA
- Guttmann Brain Health Institute Institut Guttmann Institut Universitari de Neurorehabilitació Adscrit a la UAB Badalona Spain
- Harvard University Boston MA USA
| | - Peter J. Fried
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
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Wells RE, Kerr C, Dossett ML, Danhauer SC, Sohl SJ, Sachs BC, Feeley JW, Wolkin J, Wall R, Kaptchuk T, Press DZ, Phillips RS, Yeh GY. Can Adults with Mild Cognitive Impairment Build Cognitive Reserve and Learn Mindfulness Meditation? Qualitative Theme Analyses from a Small Pilot Study. J Alzheimers Dis 2020; 70:825-842. [PMID: 31282418 DOI: 10.3233/jad-190191] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVE High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of mild cognitive impairment (MCI) and Alzheimer's disease. While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation. METHODS 14 adults with MCI were randomized 2:1 to Mindfulness Based Stress Reduction (MBSR) or a wait-list control group. We conducted qualitative interviews with those who completed MBSR. Transcribed interviews were: a) coded using an emergent themes inductive approach informed by grounded theory; b) rated 0-10, with higher scores reflecting greater perceived benefit from, and understanding of, mindfulness meditation. Ratings were correlated with daily home practice times and baseline level of cognitive function. RESULTS Seven themes emerged from the interviews: positive perceptions of class; development of mindfulness skills, including meta-cognition; importance of the group experience; enhanced well-being; shift in MCI perspective; decreased stress reactivity and increased relaxation; improvement in interpersonal skills. Ratings of perceived benefit and understanding ranged from 2-10 (mean = 7) and of 0-9.5 (mean = 6), respectively. Many participants experienced substantial benefit/understanding, some had moderate, and a few had minimal benefit/understanding. Understanding the key concepts of mindfulness was highly positively correlated with ≥20 minutes/day of home practice (r = 0.90) but not with baseline cognitive function (r = 0.13). CONCLUSIONS Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. Cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI.
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Affiliation(s)
- Rebecca Erwin Wells
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Catherine Kerr
- Department of Family Medicine and Mindfulness-Wellness Program, Brown University School of Medicine, Providence, RI, USA
| | - Michelle L Dossett
- Department of Medicine and Benson-Henry Institute for Mind Body Medicine, Division of General Internal Medicine, Massachusetts General Hospital; and Harvard Medical School, Boston, MA, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Stephanie J Sohl
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jacquelyn Walsh Feeley
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Robert Wall
- Mclean Hospital Borden Cottage, Camden, ME, USA
| | - Ted Kaptchuk
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Daniel Z Press
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Russell S Phillips
- Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gloria Y Yeh
- Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Zhao L, Taso M, Dai W, Press DZ, Alsop DC. Non-invasive measurement of choroid plexus apparent blood flow with arterial spin labeling. Fluids Barriers CNS 2020; 17:58. [PMID: 32962708 PMCID: PMC7510126 DOI: 10.1186/s12987-020-00218-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background The choroid plexus is a major contributor to the generation of cerebrospinal fluid (CSF) and the maintenance of its electrolyte and metabolite balance. Here, we sought to characterize the blood flow dynamics of the choroid plexus using arterial spin labeling (ASL) MRI to establish ASL as a non-invasive tool for choroid plexus function and disease studies. Methods Seven healthy volunteers were imaged on a 3T MR scanner. ASL images were acquired with 12 labeling durations and post labeling delays. Regions of the choroid plexus were manually segmented on high-resolution T1 weighted images. Choroid plexus perfusion was characterized with a dynamic ASL perfusion model. Cerebral gray matter perfusion was also quantified for comparison. Results Kinetics of the ASL signal were clearly different in the choroid plexus than in gray matter. The choroid plexus has a significantly longer T1 than the gray matter (2.33 ± 0.30 s vs. 1.85 ± 0.10 s, p < 0.02). The arterial transit time was 1.24 ± 0.20 s at the choroid plexus. The apparent blood flow to the choroid plexus was measured to be 39.5 ± 10.1 ml/100 g/min and 0.80 ± 0.31 ml/min integrated over the posterior lateral ventricles in both hemispheres. Correction with the choroid plexus weight yielded a blood flow of 80 ml/100 g/min. Conclusions Our findings suggest that ASL can provide a clinically feasible option to quantify the dynamic characteristics of choroid plexus blood flow. It also provides useful reference values of the choroid plexus perfusion. The long T1 of the choroid plexus may suggest the transport of water from arterial blood to the CSF, potentially providing a method to quantify CSF generation.
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Affiliation(s)
- Li Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Manuel Taso
- Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Weiying Dai
- Computer Science, State University of New York At Binghamton, Binghamton, NY, USA
| | - Daniel Z Press
- Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David C Alsop
- Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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16
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Colella M, Laher RM, Press DZ, McIlduff CE, Rutkove SB, Pascual-Leone A, Apollonio F, Liberti M, Bonmassar G. Ultra-focal Magnetic Stimulation Using a µTMS coil: a Computational Study. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:3987-3990. [PMID: 31946745 DOI: 10.1109/embc.2019.8857349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A new miniaturized figure-of-eight coil (μCoil) for TMS applications has been developed taking advantage of the Flex circuit technology. First experiments on volunteers demonstrated the ability of the μCoil to elicit sensorial action potentials of the peripheral nervous system. The necessity of reducing the size of standard TMS stimulator arises from the poor spatial resolution of the latter. This study aims to model the μCoil and study the electromagnetic fields induced inside the arm during peripheral nerve stimulation. Results confirmed that the μCoil is capable of inducing a focalized electric field inside the tissues with amplitudes up to 70V/m consistent with the observed peripheral nerve stimulation in healthy volunteers.
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Buss SS, Davila-Perez P, Press DZ, Pascual-Leone A, Fried PJ. P3-230: TRANSCRANIAL MAGNETIC STIMULATION REVEALS CORTICAL HYPEREXCITABILITY IN EARLY AD. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Stephanie S. Buss
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
| | - Paula Davila-Perez
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
- Neuroscience and Motor Control Group (NEUROcom), Institute for Biomedical Research (INIBIC); Universidade da Coruña; A Coruña Spain
| | - Daniel Z. Press
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
- Institut Guttmann; Badalona Spain
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston MA USA
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18
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Feifel D, Dunner DL, Press DZ. Roles and Qualifications of TMS Treatment Team Members. J Clin Psychiatry 2019; 79. [PMID: 29505183 DOI: 10.4088/jcp.17lr11887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- David Feifel
- .,Kadima Neuropsychiatry Institute and University of California San Diego, La Jolla, California, USA
| | - David L Dunner
- Center for Anxiety and Depression, Mercer Island, Washington, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Daniel Z Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Cognitive Neurology Unit, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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19
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Boes AD, Kelly MS, Trapp NT, Stern AP, Press DZ, Pascual-Leone A. Noninvasive Brain Stimulation: Challenges and Opportunities for a New Clinical Specialty. J Neuropsychiatry Clin Neurosci 2018; 30:173-179. [PMID: 29685065 DOI: 10.1176/appi.neuropsych.17110262] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noninvasive brain stimulation refers to a set of technologies and techniques with which to modulate the excitability of the brain via transcranial stimulation. Two major modalities of noninvasive brain stimulation are transcranial magnetic stimulation (TMS) and transcranial current stimulation. Six TMS devices now have approved uses by the U.S. Food and Drug Administration and are used in clinical practice: five for treating medication refractory depression and the sixth for presurgical mapping of motor and speech areas. Several large, multisite clinical trials are currently underway that aim to expand the number of clinical applications of noninvasive brain stimulation in a way that could affect multiple clinical specialties in the coming years, including psychiatry, neurology, pediatrics, neurosurgery, physical therapy, and physical medicine and rehabilitation. In this article, the authors review some of the anticipated challenges facing the incorporation of noninvasive brain stimulation into clinical practice. Specific topics include establishing efficacy, safety, economics, and education. In discussing these topics, the authors focus on the use of TMS in the treatment of medication refractory depression when possible, because this is the most widely accepted clinical indication for TMS to date. These challenges must be thoughtfully considered to realize the potential of noninvasive brain stimulation as an emerging specialty that aims to enhance the current ability to diagnose and treat disorders of the brain.
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Affiliation(s)
- Aaron D Boes
- From the Departments of Pediatrics, Neurology, and Psychiatry, Iowa Neuroimaging and Noninvasive Brain Stimulation Laboratory, University of Iowa Hospitals and Clinics, Iowa City, Iowa (ADB); the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa (NTT); the Department of Neurology, Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston (ADB, MSK, APS, DZP, AP-L); and the University of Rochester School of Medicine and Dentistry, Rochester, N.Y. (MSK)
| | - Michael S Kelly
- From the Departments of Pediatrics, Neurology, and Psychiatry, Iowa Neuroimaging and Noninvasive Brain Stimulation Laboratory, University of Iowa Hospitals and Clinics, Iowa City, Iowa (ADB); the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa (NTT); the Department of Neurology, Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston (ADB, MSK, APS, DZP, AP-L); and the University of Rochester School of Medicine and Dentistry, Rochester, N.Y. (MSK)
| | - Nicholas T Trapp
- From the Departments of Pediatrics, Neurology, and Psychiatry, Iowa Neuroimaging and Noninvasive Brain Stimulation Laboratory, University of Iowa Hospitals and Clinics, Iowa City, Iowa (ADB); the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa (NTT); the Department of Neurology, Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston (ADB, MSK, APS, DZP, AP-L); and the University of Rochester School of Medicine and Dentistry, Rochester, N.Y. (MSK)
| | - Adam P Stern
- From the Departments of Pediatrics, Neurology, and Psychiatry, Iowa Neuroimaging and Noninvasive Brain Stimulation Laboratory, University of Iowa Hospitals and Clinics, Iowa City, Iowa (ADB); the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa (NTT); the Department of Neurology, Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston (ADB, MSK, APS, DZP, AP-L); and the University of Rochester School of Medicine and Dentistry, Rochester, N.Y. (MSK)
| | - Daniel Z Press
- From the Departments of Pediatrics, Neurology, and Psychiatry, Iowa Neuroimaging and Noninvasive Brain Stimulation Laboratory, University of Iowa Hospitals and Clinics, Iowa City, Iowa (ADB); the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa (NTT); the Department of Neurology, Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston (ADB, MSK, APS, DZP, AP-L); and the University of Rochester School of Medicine and Dentistry, Rochester, N.Y. (MSK)
| | - Alvaro Pascual-Leone
- From the Departments of Pediatrics, Neurology, and Psychiatry, Iowa Neuroimaging and Noninvasive Brain Stimulation Laboratory, University of Iowa Hospitals and Clinics, Iowa City, Iowa (ADB); the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa (NTT); the Department of Neurology, Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston (ADB, MSK, APS, DZP, AP-L); and the University of Rochester School of Medicine and Dentistry, Rochester, N.Y. (MSK)
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20
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Paul C, Cotovio G, Oliveira-Maia AJ, Stern AP, Pascual-Leone A, Press DZ. Motor threshold variability and the frequency of determination. Brain Stimul 2018. [DOI: 10.1016/j.brs.2018.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Hinchman CA, Fried PJ, Pascual-Leone A, Press DZ, Stern AP. Modulation of corticomotor excitability following 10 Hz repetitive transcranial magnetic stimulation predicts clinical response in patients with treatment-resistant depression. Brain Stimul 2018. [DOI: 10.1016/j.brs.2018.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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22
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Welch ES, Weigand A, Hooker JE, Philip NS, Tyrka AR, Press DZ, Carpenter LL. Feasibility of Computerized Cognitive‐Behavioral Therapy Combined With Bifrontal Transcranial Direct Current Stimulation for Treatment of Major Depression. Neuromodulation 2018; 22:898-903. [DOI: 10.1111/ner.12807] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/20/2018] [Accepted: 06/04/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Emma S. Welch
- Mood Disorders Research ProgramButler Hospital Providence RI USA
| | - Anne Weigand
- Department of Neurology, Berenson‐Allen Center for Noninvasive Brain StimulationHarvard Medical School and Beth Israel Deaconess Medical Center Boston MA USA
| | - Julia E. Hooker
- Department of Neurology, Berenson‐Allen Center for Noninvasive Brain StimulationHarvard Medical School and Beth Israel Deaconess Medical Center Boston MA USA
| | - Noah S. Philip
- Center for Neurorestoration and NeurotechnologyProvidence VA Medical CenterProvidenceRIUSA
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University Providence RI USA
| | - Audrey R. Tyrka
- Mood Disorders Research ProgramButler Hospital Providence RI USA
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University Providence RI USA
| | - Daniel Z. Press
- Department of Neurology, Berenson‐Allen Center for Noninvasive Brain StimulationHarvard Medical School and Beth Israel Deaconess Medical Center Boston MA USA
| | - Linda L. Carpenter
- Mood Disorders Research ProgramButler Hospital Providence RI USA
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University Providence RI USA
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Abstract
Seizures occur at a higher frequency in people with Alzheimer's disease (AD) but overt, clinically obvious events are infrequent. Evidence from animal models and studies in mild cognitive impairment suggest that subclinical epileptic discharges may play a role in the clinical and pathophysiological manifestations of AD. In this feasibility study, the neurophysiological and cognitive effects of acute administration of levetiracetam (LEV) are measured in patients with mild AD to test whether it could have a therapeutic benefit. AD participants were administered low dose LEV (2.5 mg/kg), higher dose LEV (7.5 mg/kg), or placebo in a double-blind, within-subject repeated measures study with EEG recorded at rest before and after administration. After administration of higher dose of LEV, we found significant decreases in coherence in the delta band (1-3.99 Hz) and increases in the low beta (13-17.99 Hz) and the high beta band (24-29.99 Hz). Furthermore, we found trends toward increased power in the frontal and central regions in the high beta band (24-29.99 Hz). However, there were no significant changes in cognitive performance after this single dose administration. The pattern of decreased coherence in the lower frequency bands and increased coherence in the higher frequency bands suggests a beneficial effect of LEV for patients with AD. Larger longitudinal studies and studies with healthy age-matched controls are needed to determine whether this represents a relative normalization of EEG patterns, whether it is unique to AD as compared to normal aging, and whether longer term administration is associated with a beneficial clinical effect.
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Affiliation(s)
- Christian S Musaeus
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Danish Dementia Research Centre (DDRC), Rigshospitalet, University of Copenhagen, Denmark
| | - Mouhsin M Shafi
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, Brain Investigation and Neuromodulation Lab, (Si-BIN Lab), University of Siena, Italy
| | - Susan T Herman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Z Press
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Lonergan B, Nguyen E, Lembo C, Hinchman C, Morales OG, Press DZ, Pascual-Leone A, Stern AP. Patient- and Technician-Oriented Attitudes Toward Transcranial Magnetic Stimulation Devices. J Neuropsychiatry Clin Neurosci 2018; 30:242-245. [PMID: 29366375 PMCID: PMC6060026 DOI: 10.1176/appi.neuropsych.17070146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Four transcranial magnetic stimulation (TMS) devices are currently approved for use in treatment-resistant depression. The authors present the first data-driven study examining the patient- and technician-experience using three of these distinct devices. A retrospective survey design with both patient and technician arms was utilized. The study population included patients who received TMS for treatment-resistant depression at the Berenson Allen Center for Noninvasive Brain Stimulation for the first time between 2013 and 2016 and technicians who worked in the program from 2009 to 2017. Statistical analysis included t tests and analyses of variance to assess differences between and across the multiple groups, respectively. Patients treated with the NeuroStar device reported greater confidence that the treatment was being performed correctly compared with those treated with the Magstim device. Conversely, with regard to tolerability, patients treated with the Magstim device reported less pain in the last week and less pain on average compared with those treated with the NeuroStar device. On average, technicians reported feeling that both the Magstim and NeuroStar devices were significantly easier to use than the Brainsway Deep TMS H-Coil device. Additionally, they found the former two devices to be more reliable and better tolerated. Furthermore, the technicians reported greater confidence in the Magstim and NeuroStar devices compared with the Brainsway Deep TMS H-Coil device and indicated that they would be more likely to recommend the two former devices to other treatment centers.
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Affiliation(s)
- Brady Lonergan
- Department of Psychiatry, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215
| | - Eliza Nguyen
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215
| | - Cara Lembo
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215
| | - Carrie Hinchman
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215
| | | | - Daniel Z. Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215
| | - Adam P. Stern
- Department of Psychiatry, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215
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25
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Cavallari M, Dai W, Guttmann CRG, Meier DS, Ngo LH, Hshieh TT, Fong TG, Schmitt E, Press DZ, Travison TG, Marcantonio ER, Jones RN, Inouye SK, Alsop DC. Longitudinal diffusion changes following postoperative delirium in older people without dementia. Neurology 2017; 89:1020-1027. [PMID: 28779010 DOI: 10.1212/wnl.0000000000004329] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of postoperative delirium on longitudinal brain microstructural changes, as measured by diffusion tensor imaging. METHODS We studied a subset of the larger Successful Aging after Elective Surgery (SAGES) study cohort of older adults (≥70 years) without dementia undergoing elective surgery: 113 participants who had diffusion tensor imaging before and 1 year after surgery. Postoperative delirium severity and occurrence were assessed during the hospital stay using the Confusion Assessment Method and a validated chart review method. We investigated the association of delirium severity and occurrence with longitudinal diffusion changes across 1 year, adjusting for age, sex, vascular comorbidity, and baseline cognitive performance. We also assessed the association between changes in diffusion and cognitive performance across the 1-year follow-up period, adjusting for age, sex, education, and baseline cognitive performance. RESULTS Postoperative delirium occurred in 25 participants (22%). Delirium severity and occurrence were associated with longitudinal diffusion changes in the periventricular, frontal, and temporal white matter. Diffusion changes were also associated with changes in cognitive performance across 1 year, although the cognitive changes did not show significant association with delirium severity or occurrence. CONCLUSIONS Our study raises the possibility that delirium has an effect on the development of brain microstructural abnormalities, which may reflect brain changes underlying cognitive trajectories. Future studies are warranted to clarify whether delirium is the driving factor of the observed changes or rather a correlate of a vulnerable brain that is at high risk for neurodegenerative processes.
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Affiliation(s)
- Michele Cavallari
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Weiying Dai
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Charles R G Guttmann
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Dominik S Meier
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Long H Ngo
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Tammy T Hshieh
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Tamara G Fong
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Eva Schmitt
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Daniel Z Press
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Thomas G Travison
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Edward R Marcantonio
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Richard N Jones
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
| | - Sharon K Inouye
- From the Center for Neurological Imaging, Department of Radiology (M.C., C.R.G.G., D.S.M.), and Division of Aging (T.T.H.), Brigham and Women's Hospital, and Departments of Radiology (W.D., D.C.A.), Medicine (L.H.N., T.G.T., E.R.M., S.K.I.), and Neurology (T.G.F., D.Z.P.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Computer Science (W.D.), State University of New York at Binghamton; Aging Brain Center (T.T.H., T.G.F., E.S., T.G.T., S.K.I.), Institute for Aging Research, Hebrew SeniorLife, Boston, MA; and Departments of Psychiatry and Human Behavior and Neurology (R.N.J.), Brown University Warren Alpert Medical School, Providence, RI
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Hshieh TT, Dai W, Cavallari M, Guttmann CR, Meier DS, Schmitt EM, Dickerson BC, Press DZ, Marcantonio ER, Jones RN, Gou YR, Travison TG, Fong TG, Ngo L, Inouye SK, Alsop DC. Cerebral blood flow MRI in the nondemented elderly is not predictive of post-operative delirium but is correlated with cognitive performance. J Cereb Blood Flow Metab 2017; 37:1386-1397. [PMID: 27401806 PMCID: PMC5453459 DOI: 10.1177/0271678x16656014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Three-dimensional Arterial Spin Labeling (ASL) MRI was performed before surgery in a cohort of 146 prospectively enrolled subjects ≥ 70 years old scheduled to undergo elective surgery. We investigated the prospective association between ASL-derived measures of cerebral blood flow (CBF) before surgery with postoperative delirium incidence and severity using whole-brain and globally normalized voxel-wise analysis. We also investigated the cross-sectional association of CBF with patients' baseline performance on specific neuropsychological tests, and with a composite general cognitive performance measure (GCP). Out of 146 subjects, 32 (22%) developed delirium. We found no significant association between global and voxel-wise CBF with delirium incidence or severity. We found the most significant positive associations between CBF of the posterior cingulate and precuneus and the Hopkins Verbal Learning Test - Revised total score, Visual Search and Attention Test (VSAT) score and the GCP composite. VSAT score was also strongly associated with right parietal lobe CBF. ASL can be employed in a large, well-characterized older cohort to examine associations between CBF and age-related cognitive performance. Although ASL CBF measures in regions previously associated with preclinical Alzheimer's Disease were correlated with cognition, they were not found to be indicators of baseline pathology that may increase risk for delirium.
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Affiliation(s)
- Tammy T Hshieh
- 1 Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Weiying Dai
- 3 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,4 Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Michele Cavallari
- 5 Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles Rg Guttmann
- 5 Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dominik S Meier
- 5 Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eva M Schmitt
- 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Bradford C Dickerson
- 6 Martinos Center for Biomedical Imaging, Psychiatric Neuroimaging Division, Department of Psychiatry, and Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Daniel Z Press
- 7 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Edward R Marcantonio
- 8 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard N Jones
- 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,9 Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Yun Ray Gou
- 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Thomas G Travison
- 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,8 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tamara G Fong
- 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,7 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Long Ngo
- 8 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sharon K Inouye
- 2 Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,8 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David C Alsop
- 3 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Kelly MS, Olibeira-Maia AJ, BA MB, Stern AP, Press DZ, Pascual-Leone A, Boes AD. Initial Response to Transcranial Magnetic Stimulation Treatment for Depression Predicts Subsequent Response. J Neuropsychiatry Clin Neurosci 2017; 29:179-182. [PMID: 27899052 PMCID: PMC5592731 DOI: 10.1176/appi.neuropsych.16100181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study provides support for the hypothesis that treatment response to an initial course of repetitive transcranial magnetic stimulation (rTMS) for depression predicts the magnitude of response to a subsequent course of rTMS in the setting of symptom relapse.
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Affiliation(s)
- Michael S. Kelly
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston; University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, N.Y
| | - Albino J. Olibeira-Maia
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston; Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Margo Bernstein BA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston
| | - Adam P. Stern
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston; Department of Psychiatry at BIDMC
| | - Daniel Z. Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston
| | - Aaron D. Boes
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston; Noninvasive Brain Stimulation Clinical Program, Departments of Pediatrics and Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Caulfield KA, Bernstein MH, Stern AP, Pascual-Leone A, Press DZ, Fox MD. Antidepressant Effect of Low-Frequency Right-Sided rTMS in Two Patients with Left Frontal Stroke. Brain Stimul 2016; 10:150-151. [PMID: 28104083 DOI: 10.1016/j.brs.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 01/29/2023] Open
Affiliation(s)
- Kevin A Caulfield
- Brain Stimulation Laboratory, Medical University of South Carolina, Charleston, SC, USA; Berenson-Allen Center for Non-Invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Margo H Bernstein
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adam P Stern
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Z Press
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael D Fox
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Centre for Biomedical Imaging, Charlestown, MA, USA.
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Stern AP, Boes AD, Haller CS, Bloomingdale K, Pascual-Leone A, Press DZ. Psychiatrists' Attitudes Toward Transcranial Magnetic Stimulation. Biol Psychiatry 2016; 80:e55-6. [PMID: 26435222 PMCID: PMC6095700 DOI: 10.1016/j.biopsych.2015.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 07/23/2015] [Accepted: 07/23/2015] [Indexed: 11/26/2022]
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Caulfield KA, Tyler Ketchabaw W, Pascual-Leone A, Press DZ, Stern AP. Reductions in depression and anxiety measures are correlated in patients receiving transcranial magnetic stimulation. Brain Stimul 2016. [DOI: 10.1016/j.brs.2016.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Boes AD, Stern AP, Bernstein M, Hooker JE, Connor A, Press DZ, Pascual-Leone A. H-Coil Repetitive Transcranial Magnetic Stimulation Induced Seizure in an Adult with Major Depression: A Case Report. Brain Stimul 2016; 9:632-3. [PMID: 27160470 DOI: 10.1016/j.brs.2016.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/01/2016] [Accepted: 04/15/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- Aaron D Boes
- Berenson Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, 330 Longwood Avenue, Boston, MA 02115, USA.
| | - Adam P Stern
- Berenson Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, 330 Longwood Avenue, Boston, MA 02115, USA
| | - Margo Bernstein
- Berenson Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, 330 Longwood Avenue, Boston, MA 02115, USA
| | - Julia E Hooker
- Berenson Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, 330 Longwood Avenue, Boston, MA 02115, USA
| | - Ann Connor
- Berenson Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, 330 Longwood Avenue, Boston, MA 02115, USA
| | - Daniel Z Press
- Berenson Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, 330 Longwood Avenue, Boston, MA 02115, USA
| | - Alvaro Pascual-Leone
- Berenson Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, 330 Longwood Avenue, Boston, MA 02115, USA
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Cavallari M, Dai W, Guttmann CRG, Meier DS, Ngo LH, Hshieh TT, Callahan AE, Fong TG, Schmitt E, Dickerson BC, Press DZ, Marcantonio ER, Jones RN, Inouye SK, Alsop DC. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI. Brain 2016; 139:1282-94. [PMID: 26920674 DOI: 10.1093/brain/aww010] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/16/2015] [Indexed: 12/20/2022] Open
Abstract
Despite the significant impact of postoperative delirium on surgical outcomes and the long-term prognosis of older patients, its neural basis has not yet been clarified. In this study we investigated the impact of premorbid brain microstructural integrity, as measured by diffusion tensor imaging before surgery, on postoperative delirium incidence and severity, as well as the relationship among presurgical cognitive performance, diffusion tensor imaging abnormalities and postoperative delirium. Presurgical diffusion tensor imaging scans of 136 older (≥70 years), dementia-free subjects from the prospective Successful Aging after Elective Surgery study were analysed blind to the clinical data and delirium status. Primary outcomes were postoperative delirium incidence and severity during the hospital stay, as assessed by the Confusion Assessment Method. We measured cognition before surgery using general cognitive performance, a composite score based on a battery of neuropsychological tests. We investigated the association between presurgical diffusion tensor imaging parameters of brain microstructural integrity (i.e. fractional anisotropy, axial, mean and radial diffusivity) with postoperative delirium incidence and severity. Analyses were adjusted for the following potential confounders: age, gender, vascular comorbidity status, and general cognitive performance. Postoperative delirium occurred in 29 of 136 subjects (21%) during hospitalization. Presurgical diffusion tensor imaging abnormalities of the cerebellum, cingulum, corpus callosum, internal capsule, thalamus, basal forebrain, occipital, parietal and temporal lobes, including the hippocampus, were associated with delirium incidence and severity, after controlling for age, gender and vascular comorbidities. After further controlling for general cognitive performance, diffusion tensor imaging abnormalities of the cerebellum, hippocampus, thalamus and basal forebrain still remained associated with delirium incidence and severity. This study raises the intriguing possibility that structural dysconnectivity involving interhemispheric and fronto-thalamo-cerebellar networks, as well as microstructural changes of structures involved in limbic and memory functions predispose to delirium under the stress of surgery. While the diffusion tensor imaging abnormalities observed in the corpus callosum, cingulum, and temporal lobe likely constitute the neural substrate for the association between premorbid cognition, as measured by general cognitive performance, and postoperative delirium, the microstructural changes observed in the cerebellum, hippocampus, thalamus and basal forebrain seem to constitute a separate phenomenon that predisposes to postsurgical delirium independent of presurgical cognitive status.
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Affiliation(s)
- Michele Cavallari
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Weiying Dai
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dominik S Meier
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Tammy T Hshieh
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Amy E Callahan
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eva Schmitt
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Bradford C Dickerson
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, 149 13th St., Charlestown, MA, USA Psychiatric Neuroimaging Division, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 149 13th St., Charlestown, MA, USA Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 149 13th St., Charlestown, MA, USA
| | - Daniel Z Press
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Edward R Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Richard N Jones
- Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Sharon K Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Shafi MM, Liu A, Fox MD, Pascual-Leone A, Press DZ. Transcranial Magnetic Stimulation in the Treatment of Neurological Disease. Psychiatr Ann 2014. [DOI: 10.3928/00485713-20140609-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gray ZA, Greenberg SM, Press DZ. rTMS for treatment of depression in a patient with cerebral amyloid angiopathy: a case report on safety and efficacy. Brain Stimul 2014; 7:495-7. [PMID: 24674781 DOI: 10.1016/j.brs.2014.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/24/2014] [Indexed: 12/31/2022] Open
Affiliation(s)
- Zachary A Gray
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Stroke Research Centre, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Z Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Abstract
Transcranial magnetic stimulation (TMS) is a neurophysiologic technique to noninvasively induce a controlled current pulse in a prespecified cortical target. This can be used to transiently disrupt the function of the targeted cortical region and explore causal relations to behavior, assess cortical reactivity, and map out functionally relevant brain regions, for example during presurgical assessments. Particularly when applied repetitively, TMS can modify cortical excitability and the effects can propagate trans-synaptically to interconnected cortical, subcortical, and spinal cord regions. As such, TMS can be used to assess the functional integrity of neural circuits and to modulate brain activity with potential therapeutic intent.
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Affiliation(s)
- Mark C Eldaief
- Berenson-Allen Center for Noninvasive Brain Stimulation and the Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and the Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Daniel Z Press
- Berenson-Allen Center for Noninvasive Brain Stimulation and the Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and the Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and the Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and the Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Weuve J, Press DZ, Grodstein F, Wright RO, Hu H, Weisskopf MG. Cumulative exposure to lead and cognition in persons with Parkinson's disease. Mov Disord 2012; 28:176-82. [PMID: 23143985 DOI: 10.1002/mds.25247] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/17/2012] [Accepted: 09/20/2012] [Indexed: 11/06/2022] Open
Abstract
Dementia is an important consequence of Parkinson's disease (PD), with few known modifiable risk factors. Cumulative exposure to lead, at levels experienced in the community, may exacerbate PD-related neural dysfunction, resulting in impaired cognition. Among 101 persons with PD ("cases") and, separately, 50 persons without PD ("controls"), we evaluated cumulative lead exposure, gauged by tibia and patella bone lead concentrations, in relation to cognitive function, assessed using a telephone battery developed and validated in a separate sample of PD patients. We also assessed the interaction between lead and case-control status. After multivariable adjustment, higher tibia bone lead concentration among PD cases was associated with worse performance on all of the individual telephone tests. In particular, tibia lead levels corresponded to significantly worse performance on a telephone analog of the Mini-Mental State Examination and tests of working memory and attention. Moreover, higher tibia bone lead concentration was associated with significantly worse global composite score encompassing all the cognitive tests (P = 0.04). The magnitude of association per standard deviation increment in tibia bone lead level was equivalent to the difference in global scores among controls in our study, who were approximately 7 years apart in age. The tibia lead-cognition association was notably stronger within cases than within controls (P(difference) = 0.06). Patella bone lead concentration was not consistently associated with performance on the tests. These data provide evidence suggesting that cumulative exposure to lead may result in worsened cognition among persons with PD.
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Affiliation(s)
- Jennifer Weuve
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois 60612, USA.
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Fong TG, Inouye SK, Dai W, Press DZ, Alsop DC. Association cortex hypoperfusion in mild dementia with Lewy bodies: a potential indicator of cholinergic dysfunction? Brain Imaging Behav 2011; 5:25-35. [PMID: 20924800 DOI: 10.1007/s11682-010-9108-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dementia with Lewy bodies (DLB) is often associated with occipital hypometabolism or hypoperfusion, as well as deficits in cholinergic neurotransmission. In this study, 11 mild DLB, 16 mild AD and 16 age-matched controls underwent arterial spin-labeled perfusion MRI (ASL-pMRI) and neuropsychological testing. Patterns of cerebral blood flow (CBF) and cognitive performance were compared. In addition, combined ASL-pMRI and ChEI drug challenge (pharmacologic MRI) was tested as a probe of cholinergic function in 4 of the DLB participants. Frontal and parieto-occipital hypoperfusion was observed in both DLB and AD but was more pronounced in DLB. Following ChEI treatment, perfusion increased in temporal and parieto-occipital cortex, and cognitive performance improved on a verbal fluency task. If confirmed in a larger study, these results provide further evidence for brain cholinergic dysfunction in DLB pathophysiology, and use of pharmacologic MRI as an in vivo measure of cholinergic function.
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Affiliation(s)
- Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USA.
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Abstract
It is well known that certain cognitive abilities decline with age. The ability to form certain new declarative memories, particularly memories for facts and events, has been widely shown to decline with advancing age. In contrast, the effects of aging on the ability to form new procedural memories such as skills are less well known, though it appears that older adults are able to acquire some new procedural skills over practice. The current study examines the effects of normal aging on procedural memory more closely by comparing the effects of aging on the encoding or acquisition stage of procedural learning versus its effects on the consolidation, or between-session stage of procedural learning. Twelve older and 14 young participants completed a sequence-learning task (the Serial Reaction Time Task) over a practice session and at a re-test session 24 hours later. Older participants actually demonstrated more sequence skill during acquisition than the young. However, older participants failed to show skill improvement at re-test as the young participants did. Age thus appears to have a differential effect upon procedural learning stages such that older adults' skill acquisition remains relatively intact, in some cases even superior, compared to that of young adults, while their skill consolidation may be poorer than that of young adults. Although the effect of normal aging on procedural consolidation remains unclear, aging may actually enhance skill acquisition on some procedural tasks.
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Affiliation(s)
- Rachel M. Brown
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Edwin M. Robertson
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Daniel Z. Press
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
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Abstract
Many of the regions with the earliest atrophy in Alzheimer's Disease (AD) do not show prominent deficits on functional imaging studies of flow or metabolism. This paradox may provide unique insights into the pathophysiology of AD. We sought to examine the relationship between function and atrophy in AD using MRI blood flow and anatomic imaging. 22 subjects diagnosed with AD, mean Mini Mental State Exam (MMSE) score 22.2, and 16 healthy elderly controls were imaged with a volumetric arterial spin labeling blood flow MRI technique and an anatomical imaging method using the identical spatial resolution, image orientation, and spatial encoding strategy. Cerebral blood flow (CBF) and gray matter (GM) maps derived from the imaging were transformed to a standard anatomical space. GM and CBF maps were tested for significant differences between groups. Additionally, images were tested for regions with significant mismatch of the CBF and GM differences between groups. CBF was significantly lower in the bilateral precuneus, parietal association cortex and the left inferior temporal lobe but was non-significantly increased in the hippocampus and other medial temporal structures. After correction for GM loss, CBF was significantly elevated in the hippocampus and other medial temporal structures. The hippocampus and other regions affected early in AD are characterized by elevated atrophy-corrected perfusion per cm(3) of tissue. This suggests compensatory or pathological elevation of neural activity, inflammation, or elevated production of vasodilators.
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Affiliation(s)
- David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Fong TG, Press DZ, Alsop DC. P2‐222: Changes in cerebral blood flow measured by ASL‐perfusion MRI in diffuse Lewy body disease: Comparison to normal aging and Alzheimer's disease. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Demirtas-Tatlidede A, Mechanic-Hamilton D, Press DZ, Pearlman C, Stern WM, Thall M, Pascual-Leone A. An open-label, prospective study of repetitive transcranial magnetic stimulation (rTMS) in the long-term treatment of refractory depression: reproducibility and duration of the antidepressant effect in medication-free patients. J Clin Psychiatry 2008; 69:930-4. [PMID: 18505308 DOI: 10.4088/jcp.v69n0607] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Several studies have assessed the acute antidepressant effects of repetitive transcranial magnetic stimulation (rTMS), and many have revealed positive results. However, the impact of rTMS throughout the long course of major depressive disorder (MDD) and the efficacy of rTMS in the treatment of depressive relapses still remain to be elucidated. METHOD Sixteen medication-free patients with refractory MDD (diagnosed according to DSM-IV) who initially had clinically significant antidepressant responses to a 10-day course of 10-Hz rTMS were consecutively admitted to the protocol from 1997 to 2001 and were followed for 4 years. The cohort was studied during a total of 64 episodes of depressive relapse. Severity of depression was evaluated with the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI) prior to and after completion of each rTMS treatment course. Clinically significant response was defined as a reduction in HAM-D score of at least 50%. Safety was assessed by serial neurologic examinations and neuropsychological evaluations. RESULTS Approximately one half of the patients individually sustained a clinically significant response to the repeated courses of rTMS; the mean +/- SD decrease in HAM-D scores was 64.8% +/- 12.6% (p < .0001), and, in BDI scores, 60.4% +/- 20.6% (p < .0001). Despite the lack of adjuvant antidepressant medication, the mean interval between treatment courses was approximately 5 months, and the medication-free period ranged from 26 to 43 months. Transcranial magnetic stimulation was well tolerated, and evaluations regarding the safety of the repeated applications of rTMS revealed no findings of concern. CONCLUSIONS Repeated rTMS applications have demonstrated a reproducible antidepressant effect in patients with refractory depression who initially showed a clinically significant benefit. The duration of effect varied across patients, but benefits were sustained for a mean of nearly 5 months. Further studies with larger cohorts will be useful in determining the long-term effectiveness of rTMS maintenance therapy.
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Affiliation(s)
- Asli Demirtas-Tatlidede
- Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School, and the Department of Neurology, Behavioral Neurology Unit, Beth Israel Deaconess Medical Center, Boston, Mass 02215, USA
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Abstract
In the cerebellar type of multiple system atrophy (MSA-C), the burden of pathological changes involves the cerebellum and its associated brainstem structures in the basis pontis and the inferior olivary nucleus, and as a result, the clinical phenotype is dominated early on by the cerebellar dysfunction. We report our clinical and post mortem findings in a patient with MSA-C who exhibited pathological laughter in the absence of any congruent changes of mood. A review of the clinical notes of 27 other patients with MSA-C revealed a problem with pathological laughter, or crying, or both in 9 more patients. Our finding of about 36% occurrence suggests that the problem of dysregulation of emotional expression is more prevalent in MSA-C than the paucity of reports in the literature suggests. Our findings are consistent with the view that the cerebellum and its interconnected structures may be involved in the regulation of emotional expression.
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Affiliation(s)
- Josef Parvizi
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Stern WM, Tormos JM, Press DZ, Pearlman C, Pascual-Leone A. Antidepressant effects of high and low frequency repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex: a double-blind, randomized, placebo-controlled trial. J Neuropsychiatry Clin Neurosci 2007; 19:179-86. [PMID: 17431065 DOI: 10.1176/jnp.2007.19.2.179] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has antidepressant effects in patients with major depressive disorder. The mechanisms of action and optimal stimulation parameters remain unclear. To test the hypothesis that rTMS exerts antidepressant effects either by enhancing left dorsolateral prefrontal cortex (DLPFC) excitability or by decreasing right DLPFC excitability, the authors studied 45 patients with unipolar recurrent major depressive disorder in a double-blind, randomized, parallel group, sham-controlled trial. Patients were randomized to receive 1 Hz or 10 Hz rTMS to the left DLPFC, 1 Hz to the right DLPFC or sham TMS. Left 10 Hz and right 1 Hz rTMS showed similar significant antidepressant effects. Other parameters led to no significant antidepressant effects.
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Affiliation(s)
- William M Stern
- Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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Abstract
Humans adaptively control reaching movements to maintain good performance in the presence of novel forces acting on the arm. A recent study suggested that motor memories of different force conditions are not transformed from fragile to stable states, but rather are always vulnerable to interference from newly learned conditions (Caithness et al., 2004). This is contrary to the results of previous studies (Brashers-Krug et al., 1996; Shadmehr and Brashers-Krug, 1997), although all of these studies followed similar methods. Here, we show that a seemingly insignificant and inconsistently applied methodological detail may reconcile this discrepancy. Catch trials, in which the novel forces are removed, may be randomly interspersed among the more frequent force trials to assess how a subject is learning to predict the pattern of forces. In the absence of an interfering condition, subjects retained their learning until retest a day later regardless of whether they experienced catch trials. But in the presence of an interfering condition, only the subjects who had experienced forces intermittently retained their learning and thereby showed resistance to the interference. Thus, intermittent rather than constant practice conditions appear to be critical for dynamic motor memory stabilization.
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Affiliation(s)
- Simon A. Overduin
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Andrew G. Richardson
- Division of Health Sciences and Technology, Massachusetts Institute of Technology and Harvard Medical School, Cambridge, Massachusetts 02142, and
| | - Courtney E. Lane
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Emilio Bizzi
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Daniel Z. Press
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215
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Richardson AG, Overduin SA, Valero-Cabré A, Padoa-Schioppa C, Pascual-Leone A, Bizzi E, Press DZ. Disruption of primary motor cortex before learning impairs memory of movement dynamics. J Neurosci 2006; 26:12466-70. [PMID: 17135408 PMCID: PMC6674906 DOI: 10.1523/jneurosci.1139-06.2006] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although multiple lines of evidence implicate the primary motor cortex (M1) in motor learning, the precise role of M1 in the adaptation to novel movement dynamics and in the subsequent consolidation of a memory of those dynamics remains unclear. Here we used repetitive transcranial magnetic stimulation (rTMS) to dissociate the contribution of M1 to these distinct aspects of motor learning. Subjects performed reaching movements in velocity-dependent force fields over three epochs: a null-field baseline epoch, a clockwise-field learning epoch (15 min after the baseline epoch), and a clockwise-field retest epoch (24 h after the learning epoch). Half of the subjects received 15 min of 1 Hz rTMS to M1 between the baseline and learning epochs. Subjects given rTMS performed identically to control subjects during the learning epoch. However, control subjects performed with significantly less error than rTMS subjects in the retest epoch on the following day. These results suggest that M1 is not critical to the network supporting motor adaptation per se but that, within this network, M1 may be important for initiating the development of long-term motor memories.
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Affiliation(s)
- Andrew G. Richardson
- Division of Health Sciences and Technology, Massachusetts Institute of Technology and Harvard Medical School, Cambridge, Massachusetts 02142
| | - Simon A. Overduin
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Antoni Valero-Cabré
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts 02118
- Department of Neurology, Fondation Ophtalmologique Rothschild, 75019 Paris, France
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215
| | | | - Alvaro Pascual-Leone
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215
| | - Emilio Bizzi
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Daniel Z. Press
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215
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Zhao L, Taso M, Press DZ, Alsop DC. P4‐313: NON‐INVASIVE IMAGING OF CHOROID PLEXUS BLOOD FLOW AND ITS POTENTIAL RELATIONSHIP TO CSF GENERATION. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2018.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Li Zhao
- Beth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Children's National Medical CenterWashingtonDCUSA
| | - Manuel Taso
- Beth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Daniel Z. Press
- Beth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - David C. Alsop
- Beth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
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Abstract
We are all familiar with acquiring skills during practice, but skill can also continue to develop between practice sessions. These "off-line" improvements are frequently supported by sleep, but they can be time dependent when a skill is acquired unintentionally. The magnitude of these over-day and overnight improvements is similar, suggesting that a similar mechanism may support both types of off-line improvements. However, here we show that disruption of the primary motor cortex with repetitive transcranial magnetic stimulation blocks off-line improvements over the day but not overnight. This suggests that a memory may be rescued overnight and subsequently enhanced or that different aspects of a skill, with differential dependencies on the primary motor cortex, are enhanced over day and overnight. Off-line improvements of similar magnitude are not supported by similar mechanisms; instead, the mechanisms engaged may depend on brain state.
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Affiliation(s)
- Edwin M Robertson
- Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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