Repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer's disease

Objective. - To assess the efficacy of a combination of cognitive training (COG) and repetitive transcranial magnetic stimulation (rTMS), on cognitive performance, locomotor activity, apathy, caregiver burden and dependence of patients with Alzheimer's disease (AD). Methods. - A combination of COG and rTMS was performed in 10 patients with AD (NeuroAD procedure) for a period of 5 weeks (one session per day, 5 days a week), without maintenance sessions. Patients were evaluated at the end of the treatment (D45) and 6 months later (M6) by the Mini Mental State Examination (MMSE), the Alzheimer disease assessment scale - cognitive subscale (ADAS-Cog), various neuropsychological tests and clinical scores specific for locomotor activity, apathy, caregiver burden, and dependence, recorded before the study (baseline). Results. - The primary endpoint was the improvement of the ADAS-Cog score at D45, which was reached. Six months after the end of the treatment, the ADAS-Cog score returned to baseline value, except for the best responders who remained significantly improved. The other main result was the improvement of apathy and dependence scores at both D45 and M6 for the entire series of patients. No serious adverse events occurred and all patients completed the study. Conclusions. - The results of this open-label study confirm the feasibility of the rTMS-COG procedure in AD patients, and suggest that these patients can benefit from the procedure, in terms of cognitive performances, apathy and dependence, even in the long term. These promising results remain to be confirmed in controlled studies based on a larger population size, which could also help identify the prognostic factors associated with good outcome, in order to optimize patient selection. (C) 2017 Elsevier Masson SAS. All rights reserved.