Objective: Using intermittent “theta burst” transcranial magnetic stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC) to assess the potential of long-term improvements in cognitive performance.

Background: Up to 40% of Parkinson’s disease (PD) patients have mild cognitive impairment early in the disease and up to 80% of PD patients will develop dementia over a period of 8 years. It has been reported that cognitive deficits in PD patients were associated with functional alterations in the DLPFC and caudate nucleus. Previous studies showed short-term improvement in cognitive performance after stimulating the DLPFC.

Methods: 28 patients with idiopathic PD and mild cognitive impairment received iTBS (real, N=14; or sham, N=14) over the left DLPFC, twice a day for three days with 1-2 days in between. Detailed neuropsychological assessment of five cognitive domains (Attention, Executive function, Language, Memory, Visuospatial) was performed before iTBS and on days 1, 10, and 30 after the last iTBS session. Composite Z-scores were calculated for each domain and for the overall cognition.

Results: The mixed-design repeated measures ANCOVA of average Z-scores between assessments showed a main effect of Time in Overall Cognition (F3,75=4.30, p=.007, ηp2=.147), Attention (F2.83,70.9=3.71, p=.017, ηp2=.129), Executive Function (F3,75=3.65, p = .016, ηp2 = .128) and Visuospatial domain (F3,75=4.29, p=.008, ηp2=.146), but not in Language (F3,75=0.55, p=.651) or Memory (F3,75=0.639, p=.592). The Attention domain showed a significant Time x Group interaction (F2.83,70.9=3.91, p=.014, ηp2 =.135) with a significant simple effect of Time in the active iTBS group (F3,36=5.29, p=.004, ηp2 =.306). Pairwise comparisons showed significant improvement in global cognition for up to one month following active iTBS, but not sham. Significant effects were depicted in Attention, Executive Function and Visuospatial domains for the active iTBS group. Executive Function revealed a significantly enhanced performance after active iTBS at 1 and 30 days after the protocol, while the sham group had a significant enhancement at one month.

Conclusions: Our findings suggest that active iTBS can modulate overall cognitive performance in patients with PD who have mild cognitive deficits and improvements in cognitive performance can last up to one month. Our results support the possibility of using iTBS to slow down cognitive decline in patients with Parkinson’s disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transcranial-magnetic-stimulation-increases-cognition-globally-and-longitudinally-in-parkinsons-disease/