This from October 2016 means your doctor is likely incomptent since then for not having this set up as a protocol. Why hasn't your doctor set up a protocol? Ask her/him.
Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job? The board of directors didn't tell them that totally solving stroke was their job, not just lazily relying on the status quo?
Magnetic Stimulation Helpful in Stroke Rehab October 2016
The writeup looked like this in Medpage Today:
High-frequency transcranial magnetic stimulation (TMS) temporarily increased activity in the hippocampal-cortical network and improved memory in cognitively normal older adults, a small pilot study showed.
Non-invasive brain stimulation increased fMRI recollection signals throughout the hippocampal-cortical network and led to a 31% jump in ability to recall new memories 24 hours later, reported Joel Voss, PhD, of Northwestern University in Chicago, and colleagues in Neurology.
"As we age, we are less able to form new memories of life events due to declining function of the hippocampal brain network," Voss told MedPage Today. "We demonstrate for the first time that it is possible to improve the function of this network in older adults using noninvasive brain stimulation, which rescued event memory to young-adult levels in our small feasibility experiment."
High-frequency TMS that targeted the hippocampal-cortical network has been shown to improve recollection and alter network function in young adults, but whether this would be the same for older adults, who have structural and functional brain changes with age, was not known.
To test this, Voss and colleagues designed a single-blind, sham-controlled experiment. They studied 15 cognitively normal adults, ages 64 to 80 (mean age 72), 11 of whom were women, and applied TMS to specific lateral parietal locations based on each person's fMRI connectivity with the hippocampus. Participants completed fMRI memory assessments before and approximately 24 hours after five consecutive daily sessions of full-intensity TMS or sham stimulation.
Relative to a sample of younger adults (mean age 26) who performed the same task, older adults showed impairments in recollection, but not recognition, at baseline.
At 24 hours, stimulation improved recollection by 31.1% on average, compared with a non-significant change of -3.1% for sham. Improvements were highly consistent across the treatment group and their recollection no longer differed significantly from that of younger adults. Stimulation effects on recollection fMRI signals were coherent throughout the hippocampal-cortical network and occurred at the targeted location of the hippocampus.
While recollection remained elevated, it was not significantly different from sham 1 week later, indicating the gains seen at 24 hours did not persist.
The findings demonstrate a causal link between recollection and the hippocampal-cortical network in older adults and support the hypothesis that dysfunction of this network with age may lead to memory impairment, Voss noted.
"Disruption and abnormal functioning of the hippocampal-cortical network, the region of the brain involved in memory formation, has been linked to age-related memory decline, so it's exciting to see that by targeting this region, magnetic stimulation may help improve memory in older adults," he said. "These results may help us better understand how this network supports memory."
The study was designed to test neural and behavioral target engagement, not evaluate clinical efficacy, Voss added. The sample of this pilot study was small and all testing was performed at the same site. Future work is needed to investigate whether TMS shows similar results in larger groups of people and whether memory gains can be retained over longer periods of time.
The study was supported by the National Institute on Aging and the Northwestern University Cognitive Neurology and Alzheimer's Disease Center.
Voss and co-authors disclosed no relevant relationships with industry.
The research it is based upon:
Network-targeted stimulation engages neurobehavioral hallmarks of age-related memory decline
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Abstract
Objective
To test whether targeting hippocampal-cortical brain networks with
high-frequency transcranial magnetic stimulation in older adults
influences behavioral and neural measures characteristic of age-related
memory impairment.
Methods
Fifteen adults aged 64 to 80 years (mean = 72 years) completed a
single-blind, sham-controlled experiment. Stimulation targets in
parietal cortex were determined based on fMRI connectivity with the
hippocampus. Recollection and recognition memory were assessed after 5
consecutive daily sessions of full-intensity stimulation vs
low-intensity sham stimulation using a within-subjects crossover design.
Neural correlates of recollection and recognition memory formation were
obtained via fMRI, measured within the targeted hippocampal-cortical
network vs a control frontal-parietal network. These outcomes were
measured approximately 24 hours after the final stimulation session.
Results
Recollection was specifically impaired in older adults compared to a
young-adult control sample at baseline. Relative to sham, stimulation
improved recollection to a greater extent than recognition. Stimulation
increased recollection fMRI signals throughout the hippocampal-cortical
network, including at the targeted location of the hippocampus. Effects
of stimulation on fMRI recollection signals were greater than those for
recognition and were greater in the targeted network compared to the
control network.
Conclusions
Age-related recollection impairments were causally related to
hippocampal-cortical network function in older adults. Stimulation
selectively modified neural and behavioral hallmarks of age-related
memory impairment, indicating effective engagement of memory
intervention targets in older adults.
- Received September 12, 2018.
- Accepted in final form January 17, 2019.
- © 2019 American Academy of Neurology
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