Rosa Manenti

Transcranial magnetic stimulation improves naming in Alzheimer disease patients at different stages of cognitive decline

Objective:  Word‐finding difficulty (anomia) is commonly observed in Alzheimer’s dementia (AD). The aim of this study was to assess the effect of repetitive transcranial magnetic stimulation (rTMS) applied to the dorso‐lateral prefrontal cortex (dlPFC) on picture naming in 24 probable AD patients with different degrees of cognitive decline.

Improved language performance in Alzheimer disease following brain stimulation

Objectives Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a possible treatment for the cognitive deficits associated with Alzheimer disease (AD). The aim of this study was to assess the long-term effects, on cognitive performance, of rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) in AD patients. Methods Ten AD patients were randomly assigned to one of two study groups. Multiple-baseline design was used.The first group underwent a 4-week real rTMS stimulation protocol, while the second underwent a 2-week placebo treatment, followed by 2 weeks of real rTMS stimulation. Each session consisted of the application of rhythmic high-frequency rTMS over the DLPFC for 25 min. Sessions occurred once daily, 5 days/week. The main analysed outcome was the change in cognitive test performance at 2 and 4 weeks after rTMS treatment initiation, with a follow-up performed 8 weeks after the end of rTMS, in comparison with baseline performance. Results A significant difference was found between groups over sessions in terms of the percentage of correct responses of auditory sentence comprehension. Only real treatment induced an improvement in performance with respect to baseline or placebo. Moreover, both groups showed a lasting effect on the improved performance 8 weeks after the end of treatment. Conclusion The findings provide initial evidence for the persistent beneficial effects of rTMS on sentence comprehension in AD patients. Rhythmic rTMS, in conjunction with other therapeutic interventions, may represent a novel approach to the treatment of language dysfunction in AD patients.

Negation in the brain: Modulating action representations

Sentential negation is a universal syntactic feature of human languages that reverses the truth value expressed by a sentence. An intriguing question concerns what brain mechanisms underlie our ability to represent and understand the meaning of negative sentences. We approach this issue by investigating action-related language processing and the associated neural representations. Using functional magnetic resonance imaging we measured brain activity in 18 healthy subjects during passive listening of sentences characterized by a factorial combination of polarity (affirmative vs. negative) and concreteness (action-related vs. abstract). Negation deactivated cortical areas and the left pallidum. Compared to abstract sentences, action-related sentences activated the left-hemispheric action-representation system. Crucially, the polarity by concreteness interactions showed that the activity within the action-representation system was specifically reduced for negative action-related vs. affirmative action-related sentences (compared to abstract sentences). Accordingly, functional integration within this system as measured by Dynamic Causal Modeling was specifically weaker for negative action-related than for affirmative action-related sentences. This modulation of action representations indicates that sentential negation transiently reduces the access to mental representations of the negated information.

Reminiscence therapy in dementia: A review

Dementia is a progressive disorder that impacts several cognitive functions. However, some aspects of cognitive function are preserved until late in the disease and can therefore be the targets of specific interventions. The rehabilitation of cognitive function disorders represents an expanding area of neurological rehabilitation, and it has recently attracted growing political, social and ethical attention. Here, we review the efficacy of reminiscence therapy to improve cognitive functions and/or mood. Available studies suggest that reminiscence therapy can improve mood and some cognitive abilities. Further studies, based on larger patient samples including placebo and control conditions, should be conducted to identify the optimal conditions for such treatment protocols.

Action and object naming in Parkinson's disease without dementia

The present study aimed to assess the ability in objects and actions naming in Parkinsons disease (PD) patients. Further, we wished to assess the effect of a particular conceptual dimension, i.e. manipulability, on the naming of object and actions. Patients were recruited from the Department of Neurology, University of Brescia. Thirty‐two were diagnosed as PD, according to published criteria, and 15 healthy volunteers matched in age and education to patients’ sample. All patients underwent a detailed clinical and neurological evaluation. The stimuli used in the action–object picture naming task were taken from the Center for Research in Language‐International Picture Naming Project corpus. To assess the effect of manipulability (or the involvement of fine hand movements) the noun–verb stimuli were re‐categorized into manipulable and non‐manipulable items (i.e. objects which can or cannot be manipulated and actions which do or do not involve fine hand movements). Patients showed a deficit both in action and object naming, compared with controls. In addition, patients with PD but not controls were significantly more impaired in action than in object naming. The current study supports the view that action naming is affected in patients with PD, possibly reflecting the presence of prefrontal dysfunction.

Enhancing verbal episodic memory in older and young subjects after non-invasive brain stimulation

Memory is the capacity to store, maintain, and retrieve events or information from the mind. Difficulties in verbal episodic memory commonly occur in healthy aging. In this paper, we assess the hypothesis that anodal transcranial direct current stimulation (tDCS) applied over the dorsolateral prefrontal cortex (DLPFC) or over the parietal cortex (PARC) could facilitate verbal episodic memory in a group of 32 healthy older adults and in a group of 32 young subjects relative to a sham stimulation using a single-blind randomized controlled design. Each participant underwent two sessions of anodal tDCS (left and right) and one session of sham stimulation. Overall, our results demonstrated that, in young and in older subjects, anodal tDCS applied during the retrieval phase facilitates verbal episodic memory. In particular, we found that tDCS applied over the left and right regions (DLPFC and PARC) induced better performance in young participants; only tDCS applied over the left regions (DLPFC and PARC) increased retrieval in older subjects. These results suggest that anodal tDCS can be a relevant tool to modulate the long-term episodic memory capacities of young and older subjects.

Anomia training and brain stimulation in chronic aphasia

Recent studies have reported enhanced performance on language tasks induced by non-invasive brain stimulation, i.e., repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS), in patients with aphasia due to stroke or Alzheimers disease (AD). The first part of this article reviews brain stimulation studies related to language recovery in aphasic patients. The second part reports results from a pilot study with three chronic stroke patients who had non-fluent aphasia, where real or placebo rTMS was immediately followed by 25 minutes of individualised speech therapy. Real rTMS consisted of high-frequency rTMS over the left dorsolateral prefrontal cortex (BA 8/9) for 25 minutes. Each patient underwent a total of four weeks of intervention. P1 underwent four weeks of real rTMS (5 days/week) where individualised speech therapy was provided for 25 minutes immediately following each rTMS session. P2 and P3 each underwent two weeks of placebo rTMS, followed immediately by individualised speech therapy; then two weeks of real rTMS, followed immediately by individualised speech therapy. Assessments took place at 2, 4, 12, 24 and 48 weeks post-entry/baseline testing. Relative to entry/baseline testing, a significant improvement in object naming was observed at all testing times, from two weeks post-intervention in real rTMS plus speech therapy, or placebo rTMS plus speech therapy. Our findings suggest beneficial effects of targeted behavioural training in combination with brain stimulation in chronic aphasic patients. However, further work is required in order to verify whether optimal combination parameters (rTMS alone or speech therapy alone) and length of rTMS treatment may be found.

Successful physiological aging and episodic memory: A brain stimulation study

Functional neuroimaging studies have shown that younger adults tend to asymmetrically recruit specific regions of an hemisphere in an episodic memory task (Hemispheric Encoding Retrieval Asymmetry-HERA model). In older adults, this hemispheric asymmetry is generally reduced as suggested by the Hemispheric Asymmetry Reduction for OLDer Adults-HAROLD-model. Recent works suggest that while low-performing older adults do not show this reduced asymmetry, high-performing older adults counteract age-related neural decline through a plastic reorganization of cerebral networks that results in reduced functional asymmetry. However, the issue of whether high- and low-performing older adults show different degrees of asymmetry and the relevance of this process for counteracting aging have not been clarified. We used transcranial magnetic stimulation (TMS) to transiently interfere with the function of the dorsolateral prefrontal cortex (DLPFC) during encoding or retrieval of associated and non-associated word pairs. A group of healthy older adults was studied during encoding and retrieval of word pairs. The subjects were divided in two subgroups according to their experimental performance (i.e., high- and low-performing). TMS effects on retrieval differed according to the subjects subgroup. In particular, the predominance of left vs. right DLPFC effects during encoding, predicted by the HERA model, was observed only in low-performing older adults, while the asymmetry reduction predicted by the HAROLD model was selectively shown for the high-performing group. The present data confirm that older adults with higher memory performance show less prefrontal asymmetry as an efficient strategy to counteract age-related memory decline.

Anodal tDCS during face-name associations memory training in Alzheimer's patients

Objective: Given the limited effectiveness of pharmacological treatments, non-pharmacological interventions to treat Alzheimers disease (AD) have gained attention in recent years. The aim of the present study is to investigate the effects of anodal tDCS (AtDCS) combined with memory training on face-name associations in an AD patient sample. Methods: Thirty six AD patients were randomly assigned to one of three study groups: Group 1, AtDCS plus individualized computerized memory training; Group 2, placebo tDCS plus individualized computerized memory training; Group 3, AtDCS plus motor training. Results: A general improvement in performance was observed after 2 weeks of memory training. Both the anodal tDCS plus individualized computerized memory training and the placebo tDCS plus individualized computerized memory training groups had significantly improved performances at 2 weeks compared with the AtDCS plus motor training group. Conclusion: Our findings suggest a beneficial effect of individualized memory rehabilitation in AD patients.

Transcranial brain stimulation studies of episodic memory in young adults, elderly adults and individuals with memory dysfunction: A review

Transcranial magnetic and electric stimulation studies examining episodic memory in young participants have established the role of the left prefrontal cortex during encoding and the right prefrontal cortex during episodic retrieval. Furthermore, these techniques have been used to verify the reduction in functional asymmetry in the prefrontal cortex that occurs with ageing, at least during encoding, suggesting the existence of compensatory adjustments for the structural and neurotransmitter loss that occurs with physiological ageing. Nevertheless, it has been shown that several factors can modulate performance based on the type of material or strategy used. It is important to note that although numerous studies have addressed the role of the prefrontal cortex in episodic memory, a number of studies have also demonstrated the involvement of a more distributed neural network sustaining this function involving the temporal lobes and parietal cortices. Finally, it is evident that the use of transcranial stimulation techniques might represent a powerful tool not only for investigating the involvement of cerebral areas in a specific cognitive task but also for designing interventional therapies for individuals with memory impairment.