Highlights
- •What is the Primary Question addressed by this study?
- •This study examines the feasibility and tolerability of an intermittent Theta Burst Stimulation (iTBS) paradigm in older adults with depression and co-ocurrring executive dysfunction.
- •What is the Main finding of this study?
- •Older adults undergoing iTBS over bilateral dorso-lateral-prefrontal cortex experienced improvements in both depression and executive function.
- •Older adults with depression undergoing iTBS experienced noticeable reduction in problematic dysexecutive behaviors.
- •What is the meaning of the finding?
- •Our findings inform on the feasibility of this paradigm and advance the field towards testing neuromodulation treatments that target brain-networks affected in late life depression.
ABSTRACT
Background
Executive Function Deficits (EFD) accompany depression and are associated with poor
outcomes in older adults. We examined whether Intermittent Theta Burst Stimulation
(iTBS) could improve depression with EFD.
Methods
Thirteen geriatric patients with depression and EFD were enrolled. Open label iTBS
was delivered bilaterally over the dorso-lateral-prefrontal-cortex for four weeks.
Results
Montgomery Asberg Depression Scale scores improved significantly from baseline to
treatment-end, mean change in score = 11.82 points, 95% CI = 8.3, 15.4. The Flanker
Inhibitory control and attention test showed significant improvement in executive
function from baseline to treatment-end, mean change in score = −7.73, 95% CI ( −13.54,
−1.92). Side effects included twitching in facial muscles (n = 11), headaches (n = 10)
and stimulation discomfort (n = 4).
Limitations
Small sample size and lack of a sham comparator.
Conclusion
iTBS improved depression with EFD in older adults. Side effects appeared higher than
in previous iTBS studies.
Key Words
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REFERENCES
- A meta-analysis of executive dysfunction and antidepressant treatment response in late-life depression.Am J Geriatr Psychiatry. 2016; 24: 31-41
- Role of executive dysfunction and dysexecutive behavior in late-life depression and disability.Am J Geriatr Psychiatry. 2015; 23: 1038-1045
- Mechanisms and treatment of late-life depression.Transl Psychiatry. 2019; 9: 188
- Depression in the elderly: brain correlates, neuropsychological findings, and role of vascular lesion load.Curr Opin Neurol. 2013; 26: 656-661
- Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial.Lancet. 2018; 391: 1683-1692
- The effects of theta burst stimulation (TBS) targeting the prefrontal cortex on executive functioning: a systematic review and meta-analysis.Neuropsychologia. 2018; 111: 344-359
- Meta-analytic evidence for a superordinate cognitive control network subserving diverse executive functions.Cogn Affect Behav Neurosci. 2012; 12: 241-268
- Distinct brain networks for adaptive and stable task control in humans.Proc Natl Acad Sci U S A. 2007; 104: 11073-11078
- Potentiation of gamma oscillatory activity through repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex.Neuropsychopharmacology. 2009; 34: 2359-2367
- Can repetitive magnetic stimulation improve cognition in schizophrenia? Pilot data from a randomized controlled trial.Biol Psychiatry. 2013; 73: 510-517
- User's Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders SCID-I: Clinician Version.American Psychiatric Pub, 1997
- A new depression scale designed to be sensitive to change.Br J Psychiatry. 1979; 134: 382-389
- The cognition battery of the NIH toolbox for assessment of neurological and behavioral function: validation in an adult sample.J Int Neuropsychol Soc. 2014; 20: 567-578
- Frontal Systems Behavior Scale (FrSBe): Professional Manual.Psychological Assessment Resources, Lutz: Fl, 2001
- The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53: 695-699
- An efficient and accurate new method for locating the F3 position for prefrontal TMS applications.Brain Stimul. 2009; 2: 50-54
- Safety and benefits of distance-adjusted prefrontal transcranial magnetic stimulation in depressed patients 55-75 years of age: a pilot study.Depress Anxiety. 2004; 19: 249-256
- An update on repetitive transcranial magnetic stimulation for the treatment of major depressive disorder.Clin Pharmacol Ther. 2019; 106: 747-762
- Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial.Neuropsychopharmacology. 2018; 43: 2231-2238
- Depression and rumination: relation to components of inhibition.Cogn Emot. 2012; 26: 758-767
Article info
Publication history
Published online: March 07, 2020
Accepted:
March 2,
2020
Received in revised form:
February 28,
2020
Received:
December 10,
2019
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry.
