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Targeting Brain Physiology to Treat Neuropsychiatric Symptoms of Dementia Using TMS-EEG and tDCS

Alzheimer Disease | Dementia | Behavior Problem | Dementia, Alzheimer Type | Dementia, Mixed

Agitation and aggression impose a tremendous burden on the individuals living with dementia, their families, caregivers, and healthcare systems. Neuropsychiatric symptoms of dementia (NPS) affect up to 80% of patients with Alzheimer's dementia (AD). The mechanisms of agitation in AD are poorly understood and the current interventions are only modestly effective while having serious adverse effects. In this study, the investigators propose to assess the mechanisms and treatment of neuropsychiatric symptoms in AD with the use of non-invasive, brain stimulation approaches. By applying magnetic stimulation to the surface of the head (transcranial magnetic stimulation - TMS) combined with electroencephalography (EEG), the investigators will be able to study the mechanisms of agitation and advance our understanding of AD. Further, the investigators will evaluate if transcranial direct current stimulation (tDCS) is effective to treat agitation dementia.

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Participation Requirements

  • Sex:

    ALL

  • Eligible Ages:

    50 and up

Participation Criteria

Participants with AD+Agitation

Inclusion:

1. Age 50 years or older.
2. Participant or substitute decision maker able and willing to provide informed consent.
3. Dementia due to probable or possible AD as defined by NIA-AA criteria.
4. Presence of mild to moderate agitation and/or aggression as defined by: Agitation in cognitive disorders. International Psychogeriatric Association Provisional Consensus Clinical and Research Definition.
5. Availability of a support person to accompany the participant to study appointments and provide collateral information as needed.
6. If taking medication for neuropsychiatric symptoms, the dose should be stable for at least 1 week.

Exclusion:

1. Psychiatric diagnosis other than dementia significantly impacting the presentation.
2. Presence of delirium or other acute medical condition significantly contributing to agitation/aggression or making the study participation unsafe for a participant.
3. Any contraindication to TMS or tDCS.
4. Any other condition that in the opinion of principal investigator will make the study participation unsafe or non-feasible for the participant.
5. Currently taking anticonvulsants or benzodiazepines at a dose sufficient to cause interference with TMS-EEG.

Participants with AD without aggression

All the above inclusion/exclusion criteria except meeting the inclusion criterion 4 pertaining to agitation/aggression. Participants with significant agitation/aggression will be excluded from this group.

Healthy comparator participants

Inclusion:

1. Age 50 years or older.
2. Able and willing to provide informed consent.
3. Free from any significant neurological disorder.

Exclusion:

1. Lifetime DSM-5 diagnosis other than simple phobias or adjustment disorder.
2. Any Contraindication to TMS.
3. Currently taking anticonvulsants or benzodiazepines at a dose sufficient to cause interference with TMS-EEG.

Study Location

Centre for Addiction and Mental Health
Centre for Addiction and Mental Health
Toronto, Ontario
Canada

Contact Study Team

Primary Contact

Sanjeev Kumar, MD, FRCPC

[email protected]
416-535-8501
Study Sponsored By
Centre for Addiction and Mental Health
Participants Required
More Information
Study ID: NCT03846492