TOPLINE:
Compared with sham treatment, personalised repetitive transcranial magnetic stimulation (rTMS) of the precuneus over 52 weeks led to a reduction in cognitive decline by 52% and functional decline by 96% in patients with mild to moderate Alzheimer's disease, a trial showed.
METHODOLOGY:
- This monocentric, sham-controlled, randomised, double-blind pilot trial conducted in Italy included 48 patients (mean age, 72.8 years; 56% women) with mild to moderate Alzheimer's disease, of whom 27 received personalised precuneus rTMS and 21 received sham treatment.
- Participants underwent a 52-week treatment protocol consisting of a 2-week intensive course, followed by weekly maintenance sessions.
- The primary outcome was the change in the Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) score from baseline to week 52.
- Secondary outcomes were score changes from baseline to week 52 in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Mini-Mental State Examination, Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale, Frontal Assessment Battery, and Neuropsychiatric Inventory (NPI) test.
TAKEAWAY:
- Compared with sham treatment, precuneus rTMS led to a significant reduction in cognitive decline at week 52 (CDR-SB score mean difference, 2.45 vs 1.36; P = .007).
- Moreover, compared with the sham group, the rTMS group showed a significant improvement in ADCS-ADL (P < .001) and ADAS-Cog (P = .007) scores, indicating a reduction in cognitive and functional decline.
- NPI scores were higher in the rTMS group than in the sham group at week 36 (P = .014).
- Individuals with stronger default mode network connectivity at baseline had a favourable response to rTMS treatment, suggesting its potential as a biomarker for patient selection.
IN PRACTICE:
"PC-rTMS [precuneus rTMS] may reduce the progression of cognitive decline and delay the impairment of autonomies of daily living and behavioural disturbances," the authors wrote.
SOURCE:
This study was led by Giacomo Koch, Santa Lucia Foundation IRCCS, Rome, Italy. It was published online on April 02 in Alzheimer's Research & Therapy.
LIMITATIONS:
More than half of the participants were enrolled from a previous 24-week trial extension, potentially introducing selection bias. The single-site nature and modest sample size limited the generalisability of the findings. Moreover, the COVID-19 pandemic led to patient dropouts. Additionally, this study did not monitor cerebrospinal fluid or blood-based biomarkers providing evidence for biological effects of rTMS.
DISCLOSURES:
This trial was supported by grants from the Italian Ministry of Health, BrightFocus Foundation, and Italian Ministry of University and Research. Several authors reported having ties with various sources. Details are provided in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
