rTMS may have potential to improve memory function in veterans with cognitive impairment

Current treatments for Alzheimer’s disease are of limited effectiveness and do not halt disease progression and associated cognitive decline. A recent study, published in the Alzheimer’s Disease Journal, showed that a new treatment, repetitive transcranial magnetic stimulation (rTMS), may have the potential to improve memory function in veterans with cognitive impairment due to Alzheimer’s disease.

rTMS has already been approved by the FDA for the treatment of patients with treatment-resistant depression. Recent studies have also shown that rTMS can improve cognition. Under the direction of the Director and Co-Director of the Mental Illness Research Teaching and Clinical Center (MIRECC), Drs. Jerome Yesavage and J. Kaci Fairchild, a team of researchers from VA Palo Alto, conducted a pilot study to investigate the effect of rTMS on cognitive impairment in veterans with multiple medical comorbidities. Study participants completed 20 rTMS treatment sessions over a period of approximately 4 weeks.

The study protocol is similar to that used for the treatment of depression. Measures of these veterans’ cognitive function (including memory, language, fluency, and executive function) were acquired at baseline, at the end of treatment, and 4 months after the last rTMS session. The research team found that the study protocol was well tolerated. Thirty-two veterans with cognitive impairment likely due to early Alzheimer’s disease were enrolled, 29 completed the treatment phase of the study, and 26 (13 in the active rTMS group, 13 in the sham rTMS group) have completed all phases of the study and have been assessed.

Analysis of the study results suggested that the patients in the sham group showed an expected slight decline in memory tests during the study, while the active treatment group showed a slight improvement at 4 months of post-treatment follow-up. However, the active rTMS group also demonstrated a trend of decreased fluency at the end of treatment and at 4-month follow-up.

Conclusion: Pilot results show that rTMS is generally safe in this population of older veterans with cognitive impairment and multiple comorbidities, and that there was a suggestion of cognitive benefit for veterans receiving active treatment. Given the small sample size, these effects need to be confirmed by larger studies.

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