Someone in your family, perhaps your beloved mother, father, grandmother or aunt, may be suffering from Alzheimer's disease. Or perhaps you are interested in learning more about this disease. Alzheimer's is the most common form of dementia, a condition in which thinking skills such as memory, problem-solving skills, and language are gradually lost. This can make it difficult to carry out everyday tasks.
The biggest risk factor for Alzheimer's disease is aging. While current medications can control symptoms to some extent, they cannot completely stop the disease. That's why researchers are looking for new treatments that can slow the progression of the disease. Today, we'll talk about two of these treatments that stimulate the brain. Simply put, these treatments use electrical or magnetic waves to "turn on" or "off" the activity of certain parts of the brain.
What is rTMS (Repetitive Transcranial Magnetic Stimulation) therapy?
This is one of the new treatments being tested for Alzheimer's patients. It involves using an external magnet to activate a specific part of the brain, without surgery. It is called "repetitive" because the treatment is done five days a week, every day for four to six weeks.
Imagine you're sitting in a regular chair. A doctor places an electromagnetic coil over your head. When it's activated, it feels like a small tukanawak is hitting your forehead with a "click" "click" sound that lasts for a few seconds. It doesn't require anesthesia (numbing your head). Since it's not surgical, it can be done in a doctor's office or clinic.
It's not 100% clear how rTMS actually works in Alzheimer's patients. Researchers believe that stimulating the brain in this way can speed up or slow down brain activity related to memory and thinking.
How successful is this?
The success of rTMS treatment depends on several factors. For example, low-frequency stimulation has been shown to reduce brain activity, while high-frequency stimulation has been shown to increase it. Also, the area of the brain targeted by the treatment and any other medications the patient is taking can affect the results.
In general, high-frequency stimulation has been shown to be more effective in people with mild dementia than in those with more severe dementia. Sometimes, good results are seen immediately after treatment, but for some people, it may take up to 6 weeks to see results. These benefits may last for 3 months or longer.
Sometimes rTMS is combined with cognitive training , which involves various activities and exercises to improve brain function. Combining the two has been shown to produce better results, especially in patients with mild to moderate Alzheimer's disease.
Importantly, about half of Alzheimer's patients suffer from depression. rTMS is an FDA-approved treatment for depression. Therefore, it is difficult to distinguish whether the benefit of rTMS treatment for Alzheimer's patients is due to the actual disease or to the associated depression.
| Side effects and complications of rTMS treatment | Description |
|---|---|
| Common side effects | Discomfort at the site of the magnet, tingling in the jaw, skull, or face, headache, and dizziness may occur. |
| Serious but rare side effects | Seizures may occur rarely. Not much is known about the long-term side effects yet. |
| Problems with complications | According to some researchers, there is concern that high-frequency stimulation may actually worsen Alzheimer's disease. Further research is needed on this. |
What is Deep Brain Stimulation (DBS)?
Unlike rTMS, DBS is an invasive treatment that requires brain surgery. This is a big step forward. In this surgery, a pair of electrodes are implanted in your brain. Like a pacemaker, two small generators that control these electrodes are implanted under the skin of your chest.
Before the surgery, you will have an MRI scan of your head. You will be awake during the surgery. Don't worry, your head will be numbed (local anesthetic) so you won't feel any pain. Because the brain doesn't feel pain, the doctor can use the MRI images to place the electrodes in the exact right places. Then, you will be put under general anesthesia and the generator and wires that connect them to the electrodes in your brain will be implanted in your chest. After the surgery, this device will provide continuous stimulation to your brain.
DBS therapy was first used to treat symptoms of Parkinson's disease, such as tremors and rigidity. It was only after one patient who received DBS treatment for obesity showed improvement in memory that researchers began to investigate whether it could also be used for Alzheimer's disease.
How successful is this?
Early studies show that DBS is a promising treatment. However, its success depends on the stage of the disease and the treatment plan (the area of the brain targeted, the strength of the stimulation).
In general, DBS treatment is most effective when used in the early stages of the disease (early-stage Alzheimer's) . People diagnosed after age 65 (late-onset) may benefit, meaning the disease may slow down its progression. But surprisingly, people diagnosed before age 65 (early-onset) have not seen significant benefit from this treatment.
| Side effects and complications of DBS treatment | |
|---|---|
| Complications related to surgery | |
| Surgery can cause bleeding, infection, and malfunction of the hardware in the chest. | |
| Stimulation-related side effects | |
| |
| Other possible side effects | |
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Some side effects (headache, diarrhea, vomiting) will subside over time, but it's important to remember that DBS is a risky treatment.
Take-Home Message
- Alzheimer's is a progressive disease. Although current medications can control the symptoms, they cannot cure the disease.
- rTMS is a non-surgical, low-risk brain stimulation technique that may be of some benefit to people in the early stages of the disease, but it is still in the research phase.
- DBS is a serious, risky treatment that requires brain surgery. It may also be helpful for some people in the early stages of the disease, but it is not yet widely used.
- Both of these treatments are still experimental for Alzheimer's disease and are not commonly prescribed treatments.
- The most important thing is that if someone in your family has Alzheimer's disease, before deciding on any treatment, talk to your doctor carefully and understand what is best suited to the patient's condition.
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