For people living with Alzheimer’s disease, TMS offers new hope.
More than five million Americans live with Alzheimer’s disease, a neurodegenerative disorder that causes loss of memory function. Alzheimer’s typically affects people 60 years and older, and risk substantially increases with age.1 Early symptoms usually involve mild memory loss, which progresses over time to severe functional impairment that can prevent a person from thinking, speaking, and remembering clearly. A person with advanced Alzheimer’s disease may be unable to safely live unassisted; for instance, they may become lost in a familiar place or forget that they left the stove on. As a result, the disease tends to place immense emotional and financial burdens both on the sufferer, who is often cognizant of and distressed by their illness, and their loved ones, who may become personally responsible for full-time care or must pay for long-term residential treatment.
As the elderly population in the United States continues to grow rapidly, researchers believe that the number of people living with Alzheimer’s disease will triple by the year 2060.1 These alarming estimates have prompted a surge of research to determine the underlying causes of Alzheimer’s and promising treatment options that may slow or reverse the progressive functional decline caused by the disease. Neuroimaging studies reveal that the brains of people who suffer from Alzheimer’s are characterized by two unique formations: amyloid-beta (Aβ) plaques (abnormal clumps of protein that disrupt cell function) and neurofibrillary tangles (twisted threads of accumulated proteins that impair brain cells’ ability to communicate with each other).2 Although the exact mechanisms by which these brain structures cause disease remain unclear, neuroscientists believe that preventing or mitigating the accumulation of these hallmark structures in the brain may reduce symptoms associated with Alzheimer’s disease.
Treatment for Alzheimer’s disease has posed an immense scientific challenge. The FDA has not approved a new drug treatment for the disease since 2003, and more than 200 research studies to develop new drugs have failed in the last decade.3 Fortunately, in recent years researchers have expanded beyond traditional drug therapies to explore the potential of a cutting-edge technology known as transcranial magnetic stimulation (TMS) to treat Alzheimer’s disease. TMS has already received FDA approval for major depressive disorder (in 2008),4 obsessive-compulsive disorder (in 2018),5 and smoking cessation (in 2020)6 and is under investigation for a broad array of conditions including autism spectrum disorder, anorexia nervosa, anxiety, and post-traumatic stress disorder (PTSD). Recent evidence suggests that the therapy is also effective for reducing the symptoms of Alzheimer’s disease.
TMS works by stimulating electrical activity in the brain that can permanently modify malfunctioning patterns of neuronal communication, reducing the symptoms associated with neurocognitive disease. To do so, a small wire coil positioned above the patient’s head generates a magnetic field that produces electrical activity in the brain. Neuroscientists have found that TMS, when applied at certain frequencies, can induce a brain state that mimics long-term potentiation, a strengthening of neuronal communication pathways that facilitates learning and memory.7 Given that Alzheimer’s fundamentally is a disease of impaired learning and memory processes, TMS is a highly promising treatment for this neurodegenerative disorder. Some researchers have also suggested that TMS may slow the brain’s production of Aβ plaques and neurofibrillary tangles, further improving outcomes in patients with Alzheimer’s disease.8
Research studies have determined that TMS can improve multiple outcomes in Alzheimer’s patients at all stages of disease.9 Because TMS for Alzheimer’s has not yet been standardized by the FDA, each researcher and clinic uses a unique protocol to achieve results. In one study, 54 patients with Alzheimer’s disease received either low-frequency TMS or a placebo treatment five days a week for four weeks. At the end of study, participants who had received real TMS showed significantly greater improvement than the placebo group as measured by BEHAVE-AD and ADAS-Cog, two well-validated measures of cognitive performance in Alzheimer’s.10 Another study of older adults with Alzheimer’s disease found that just 13 TMS sessions over 4 weeks caused significant improvement in both general cognitive function and memory capacity, which were maintained at one month post-treatment.11 Other studies of more specific outcomes have found that TMS can also improve object naming, word association, language abilities, and recognition memory in patients with Alzheimer’s disease.9
Importantly, one research study found that TMS also improves outcomes in older adults who are at high risk for Alzheimer’s but have not yet developed the disease. Mild cognitive impairment (MCI) is a condition that often precedes Alzheimer’s disease and other forms of dementia, but currently there are no drug treatments or interventions specific to this condition. When 17 people with MCI underwent just 10 sessions of TMS over two weeks, they showed significant improvements in memory abilities as measured by the Rivermead Behavioral Memory Test compared to a group who received a placebo treatment, and these improvements were maintained at one-month follow-up. These findings indicate that TMS may work as an early intervention to mitigate cognitive decline prior to Alzheimer’s disease onset.12
Although there is no known cure for Alzheimer’s disease, cutting-edge therapies like TMS may be able to slow disease progression and reduce functional impairments that interfere with a person’s ability to engage in everyday life. For a person living with Alzheimer’s, improved cognitive function and memory capacity may afford them the chance to live independently, spend more lucid time with loved ones, and lead a fulfilling life. While TMS for Alzheimer’s awaits FDA approval, Depression Doctors proudly offers this therapy—and the potential for a fuller, more independent quality of life—for our patients living with the disease.
1 Matthews KA, Xu W, Gaglioti AH, et al. (2018). Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged≥ 65 years. Alzheimer’s & Dementia.
2 Bloom GS. (2014). Amyloid-β and tau: The trigger and bullet in Alzheimer disease pathogenesis. JAMA Neurology, 71(4):505-508.
3 Yiannopoulou KG & Papageorgiou SG. (2020). Current and future updates in Alzheimer disease: An update. Journal of Central Nervous System Disorders, 12.
4 Horvath JC, Mathews J, Demitrack MA, & Pascual-Leone A. (2010). The NeuroStar TMS Device: Conducting the FDA-approved protocol for treatment of depression. Journal of Visualized Experiments, 45.
5 Food and Drug Administration. (2018). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder
6 BrainsWay. Mental health conditions is deep TMS cleared to treat? (2020). Retrieved from: https://www.brainsway.com/professionals-faqs/what-mental-health-conditions-is-deep-tms-fda-cleared-to-treat
7 Weiler M, Stieger KC, Long JM, & Rapp PR. (2020). Transcranial magnetic stimulation in Alzheimer’s disease: Are we ready?. eNeurology, 7(1).
8 Huang Z, Tan T, Du Y, et al. (2017). Low-frequency repetitive transcranial magnetic stimulation ameliorates cognitive function and synaptic plasticity in APP23/PS45 mouse model of Alzheimer’s disease. Frontiers in Aging Neuroscience, 9:292.
9 Chou Y, That VT, & Sundman M. (2019). A systematic review and meta-analysis of rTMS effects on cognitive enhancement in mild cognitiveiImpairment and Alzheimer’s disease. Neurobiology of Aging.
10 Wu Y, Xu W, Liu X, et al. (2015). Adjunctive treatment with high frequency repetitive transcranial magnetic stimulation for the behavioral and psychological symptoms of patients with Alzheimer’s disease: A randomized, double-blind, sham-controlled study. Shanghai Archives of Psychiatry, 27(5):280-288.
11 Rutherford G, Lithgow B, & Moussavi Z. (2015). Short and long-term effects of rTMS treatment on Alzheimer’s disease at different stages: A pilot study. Journal of Experimental Neuroscience, 9:43-51.
12 Drumond Marra HL, Myczkowski ML, Maia Memória C, et al. (2015). Transcranial magnetic stimulation to address mild cognitive impairment in the elderly: A randomized controlled study. Behavioral Neurology.
Original Article was published at our sister site TMSProgram.com.