Functional MRI-guided repetitive transcranial magnetic stimulation in cognitive impairment in cerebral small vessel disease

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Abstract

Introduction. Cerebral small vessel disease (CSVD) is one of the leading causes of vascular and mixed cognitive impairment (CI). Treatment options for CSVD-associated CI are limited. Repetitive transcranial magnetic stimulation (rTMS) is a promising non-drug treatment option.

The aim of the study was to evaluate the effects of 10 rTMS sessions of the left dorsolateral prefrontal cortex (DLPFC) on cognitive functions in CSVD patients.

Materials and methods. The study included 30 patients with CSVD and moderate CI randomized to the active (DLPFC stimulation; n = 20) and control (vertex stimulation; n = 10) groups. Both groups received 10 sessions of high-frequency rTMS. The DLPFC target was selected based on the individual paradigm fMRI data with a focus on executive functions. Cognitive function was assessed using the Montreal Cognitive Assessment Scale (MoCA), the Trail Making Test (TMT), the Tower of London Test, and the Rey–Osterrieth Complex Figure Test before, immediately after, and 3 months after the stimulation. Adverse events were assessed using standardized questionnaires.

Results. The active group showed a significantly better effect compared to the control group according to MoCA, TMT A and B, The Tower of London Test, delayed recall on the Rey–Osterrieth Complex Figure Test immediately after the stimulation and MoCA, TMT A and B and The Tower of London 3 months after the stimulation. Adverse events in the study were mild and did not affect treatment adherence.

Conclusion. rTMS is a promising, safe, and well-tolerated treatment option for mild cognitive impairment in CSVD. However, additional research is needed to make recommendations for its clinical use.

About the authors

Dmitry Yu. Lagoda

Research Center of Neurology

Author for correspondence.
Email: lagoda.d@neurology.ru
ORCID iD: 0000-0002-9267-8315

Cand. Sci. (Med.), researcher, Noninvasive neuromo- dulation group, Institute of Neurorehabilitation and Rehabilitation Medicine, Research Center of Neurology

Russian Federation, Moscow

Ilya S. Bakulin

Research Center of Neurology

Email: bakulinilya@gmail.com
ORCID iD: 0000-0003-0716-3737

Cand. Sci. (Med.), senior researcher, Head, Noninvasive neuromodulation group, Institute of Neurorehabilitation and Rehabilitation Medicine, Research Center of Neurology

Russian Federation, Moscow

Alexandra G. Poydasheva

Research Center of Neurology

Email: alexandra.poydasheva@gmail.com
ORCID iD: 0000-0003-1841-1177

Cand. Sci. (Med.), researcher, Noninvasive neuromodulation group, Institute of Neurorehabilitation and Rehabilitation Medicine, Research Center of Neurology

Russian Federation, Moscow

Dmitry O. Sinitsyn

Research Center of Neurology

Email: d_sinitsyn@mail.ru
ORCID iD: 0000-0001-9951-9803

Cand. Sci. (Physics and Math.), researcher, Institute of neurorehabilitation and rehabilitation medicine, Research Center of Neurology

Russian Federation, Moscow

Alfiia K. Zabirova

Research Center of Neurology

Email: alfijasabirowa@gmail.com
ORCID iD: 0000-0001-8544-3107

postgraduate student, neurologist, Research Center of Neurology

Russian Federation, Moscow

Zukhra S. Gadzhieva

Research Center of Neurology

Email: zuhradoc@mail.ru
ORCID iD: 0000-0001-7498-4063

Cand. Sci. (Med.), neurologist, 3rd Neurological department, Institute of Clinical and Preventive Neurology, Research Center of Neurology

Russian Federation, Moscow

Maryam R. Zabitova

Research Center of Neurology

Email: gadjieva@neurology.ru
ORCID iD: 0000-0003-2523-333X

Cand. Sci. (Med.), researcher, 3rd Neurological department, Institute of Clinical and Preventive Neurology, Research Center of Neurology

Russian Federation, Moscow

Kamila V. Shamtieva

Research Center of Neurology

Email: kamila.shamt@gmail.com
ORCID iD: 0000-0002-6995-1352

Cand. Sci. (Med.), researcher, 3rd Neurological department, Institute of Clinical and Preventive Neurology, Research Center of Neurology

Russian Federation, Moscow

Larisa A. Dobrynina

Research Center of Neurology

Email: dobrla@mail.ru
ORCID iD: 0000-0001-9929-2725

D. Sci. (Med.), chief researcher, Head, 3rd Neurological department, Institute of Clinical and Preventive Neurology, Research Center of Neurology

Russian Federation, Moscow

Natalia A. Suponeva

Research Center of Neurology

Email: nasu2709@mail.ru
ORCID iD: 0000-0003-3956-6362

D. Sci. (Med.), Corresponding Member of the Russian Academy of Sciences, Director, Institute of Neurorehabilitation and Resto- rative Technologies, Research Center of Neurology

Russian Federation, Moscow

Michael A. Piradov

Research Center of Neurology

Email: mpi711@gmail.com
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med.), Academician of the Russian Academy of Sciences, Director, Research Center of Neurology

Russian Federation, Moscow

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3. Fig. 2. Localization of stimulation target within the left DLPFC in the active group.

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Copyright (c) 2024 Lagoda D.Y., Bakulin I.S., Poydasheva A.G., Sinitsyn D.O., Zabirova A.K., Gadzhieva Z.S., Zabitova M.R., Shamtieva K.V., Dobrynina L.A., Suponeva N.A., Piradov M.A.

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