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Effects of intermittent theta burst stimulation on cognitive and swallowing function in patients with MCI and
Jie Wang1,2, Mengqing Zhang3, Xiaomei Wei2
1Department of Rehabilitation Medicine (Rehabilitation Center), Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan , Shandong, 250012, China.
Background:
Mild cognitive impairment (MCI) is a high-risk factor for dementia and dysphagia; therefore, early intervention is vital. The effectiveness of intermittent theta burst stimulation (iTBS) targeting the right dorsal lateral prefrontal cortex (rDLPFC) remains unclear.
Methods:
Thirty-six participants with MCI were randomly allocated to receive real (n = 18) or sham (n = 18) iTBS. Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and executive function was evaluated with the Trail Making Test (TMT), Digital span test (DST) and Stroop color word test (SCWT). Quantitative swallowing measurements were obtained using temporal and kinetic parameters based on the videofluoroscopic swallowing study (VFSS). Resting-state functional magnetic imaging (fMRI) was performed to observe brain plasticity, functional connectivity (FC) values were calculated. All assessments were completed at baseline and two weeks after treatment. Participants received 10 sessions of daily robotic navigated iTBS.
Results:
The MoCA score and the SCWT duration of the real group improved significantly compared with that of the sham group. Temporal parameters of VFSS included 5-ml oral transit time (OTT), 5-ml soft palate elevation time (SET) and 10-ml OTT showed a decreasing trend. However, there was significant improvement in 10-ml OTT when choosing patients with OTT exceeding 1000 ms. FC value between the left middle frontal gyrus and the rDLPFC increased significantly in real stimulation group (p < 0.05 with false discovery rate corrected). We found that baseline FC scores were negatively correlated with the SCWT task duration (r = -0.554, p = 0.017) and with the 10-ml OTT (rho = -0.442, p = 0.027) across all participants. Among those in the iTBS group with a pre-10-ml OTT greater than 1000 ms, we observed a positive correlation between changes in MoCA scores and changes in FC values (r = 0.789, p = 0.035). Furthermore, changes in MoCA scores were positively correlated with changes in 10-ml OTT (r = 0.648, p = 0.031), as determined by Pearson analysis.
Conclusions:
Navigated iTBS over the rDLPFC has the potential to improve global cognition, response inhibition ability, and certain aspects of swallowing function for patients with MCI at high risk for dysphagia. Changes in FC between right and left DLPFC may underlie the neural mechanisms responsible for the effectiveness of iTBS targeting the right DLPFC.
Insights
Intermittent theta burst stimulation (iTBS) targeting the right dorsal lateral prefrontal cortex (rDLPFC) improved cognition and swallowing in mild cognitive impairment (MCI) patients. Changes in functional connectivity (FC) between brain regions may explain iTBS effectiveness.
Area of Science:
- Neuroscience
- Neuromodulation
- Cognitive Neurology
Background:
- Mild cognitive impairment (MCI) is a significant risk factor for dementia and dysphagia, necessitating early interventions.
- The efficacy of intermittent theta burst stimulation (iTBS) applied to the right dorsal lateral prefrontal cortex (rDLPFC) for MCI is not well-established.
Purpose of the Study:
- To investigate the effects of navigated iTBS on cognitive function and swallowing in individuals with MCI.
- To explore the neural mechanisms, specifically functional connectivity (FC) changes, underlying the therapeutic effects of rDLPFC iTBS.
Main Methods:
- Thirty-six participants with MCI were randomized to receive real or sham iTBS over the rDLPFC.
- Cognitive assessments included MoCA, TMT, DST, and SCWT. Swallowing function was evaluated using videofluoroscopic swallowing study (VFSS) parameters.
- Resting-state fMRI was used to measure functional connectivity (FC) before and after 10 sessions of daily iTBS.
Main Results:
- The real iTBS group showed significant improvements in Montreal Cognitive Assessment (MoCA) scores and Stroop Color Word Test (SCWT) duration compared to the sham group.
- Swallowing function, particularly 10-ml oral transit time (OTT), improved significantly in a subgroup of patients with baseline OTT exceeding 1000 ms.
- Real iTBS increased FC between the left middle frontal gyrus and rDLPFC. Baseline FC correlated negatively with SCWT duration and 10-ml OTT.
Conclusions:
- Navigated iTBS over the rDLPFC shows potential for improving global cognition, response inhibition, and specific swallowing parameters in MCI patients at risk for dysphagia.
- Increased FC between the right and left DLPFC regions appears to be a key neural mechanism mediating the benefits of rDLPFC iTBS.
