Theta-burst Stimulation for Cognitive Enhancement in Parkinson's Disease With Mild Cognitive Impairment: A Randomized, Double-Blind, Sham-Controlled Trial. (16th November 2020)

• Record Type: Journal Article
• Authors: Lang, Stefan T; Gan, Liu S; Yoon, Eunjin; Hanganu, Alexandru; Kibreab, Mekale; Cheetham, Jenelle; Hammer, Tracy; Kathol, Iris; Sarna, Justyna; Martino, Davide; Monchi, Oury
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_625
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Mild cognitive impairment is a common non-motor symptom of Parkinson's disease (PD-MCI) and has minimal treatment options. METHODS: This was a randomized, double-blind, sham-controlled trial conducted in accordance with CONSORT guidelines. 212 subjects with PD were assessed for eligibility, and 41 subjects with PD-MCI (21 real, 20 sham) were enrolled. Subjects underwent neuropsychological assessments before, one day, and one month after stimulation. Stimulation was targeted using individualized neuronavigation. Subjects recieved 6 stimulation sessions over the course of 1 week. Resting-state fMRI was performed before and 48 hours after stimulation. The primary outcome was the change in cognitive domain z-scores across time. Secondary outcomes included changes in functional connectivity and changes in motor or neuropsychiatric symptom scores. An exploratory analysis assessed for relationships between demographic and imaging features with the response to stimulation. RESULTS: There was no difference between groups in baseline demographic variables. However, the sham group had lower baseline visuospatial abilities. The real stimulation group demonstrated improved executive functioning (b = 0.281, 95% CI = 0.010-0.552, t(117) = 2.05, P = .042) at the one month follow-up compared to sham. There was no difference between groups in other cognitive domains or in motor or neuropsychiatric symptom scores. Following real stimulation, the DLPFC showed decreased connectivity to the left caudate head (t(35) = −2.43, P = .0205). There was no change in connectivity within or between the stimulation network (a network of cortical regions connected to the stimulation site) and the striatal network. However, higher baseline connectivity between the stimulation network and the striatal network was related with improved executive function scores at one month (F(2, 18) = 7.55, P = .0132). CONCLUSION: These results suggest that iTBS over the DLPFC in subjects with PD-MCI may improve executive function, while decreasing the connectivity of the stimulation site with the ipsilateral caudate head. This intervention may be more effective in subjects with higher baseline connectivity between the stimulation network and the striatal network. Further trials should be performed to confirm these results.