Dementia

Dementia, also known as Alzheimer’s Disease, is the most common type of cognitive disorder and degenerative brain disease in the elderly. However, Dementia is by no means a normal aging phenomenon. It is rather a chronic neurodegenerative disease such that the brain cells of patients are significantly reduced and gradually dysfuntionized.

 

Despite medical advancement, the cause of dementia remains unclear. As of 2012, 10% of the elderly aged 65 or above in Hong Kong suffer from dementia, with more than 18,000 new cases each year.

The study estimates that by 2036, there will be up to 280,000 patients with brain degeneration, accounting for about 4% of the population of Hong Kong. The study also pointed out that women have a higher incidence than men. Among the 65-year-old elders, 1 out of every 5 women is likely to have dementia, as opposed to the ratio of 1:10 in men.

 

Mild patients:

• Memory loss – often forgetting and losing personal items (such as keys)
• Loss of the sense of time and direction – for example, forgetting address
• Decreased judgment  – for example, unable to distinguish day and night, forget how to wear clothes according to seasons
• Difficulty in language expression – the meaning cannot be clearly expressed
• Sudden Change in Personality – for example, patients become emotionally indifferent, suspicious, confused, etc.

 

Moderate patients:

In addition to the above symptoms, patients with moderate dementia may also have neurological symptoms:

• Hallucinations & delusions etc. – accusing others of stealing patients’ items ; delusions of betrayal by spouses are more common in male patients
• Emotional and behavioral fluctuation
• Loss of motivation
• Difficulties in daily activities and personal hygiene

Severe patients:

• Complete loss of memory
• Aphasia, loss of recognition, etc.
• Incontinence problems

At present, the treatment of dementia is mainly divided into two types: drug and non-drug treatment.

Side Effects of Drugs:

• Nausea, stomach upset and diarrhea.
• Seizure
• Slow heartbeat
• Reduced appetite
• Weight loss

In conjunction to the above drugs, doctors usually prescribe other psychiatric drugs to eliminate other accompanying symptoms, such as: early psychosis, depression, anxiety and so on.

 

In addition to eliminating symptoms through medical treatment, it is necessary to integrate with other treatments to improve the cognitive ability and mood of the patients, so that their quality of life can still be protected under the influence of the disease. Common treatments include:

• Cognitive therapy – reality orientation, memory training, etc.
• Behavioral therapy – Focusing on improving patients’ behaviors
• Reminiscence therapy – assisting patients in recalling past events to stimulate cognitive function

Since most people with dementia are elderly, the side effects of drugs are more detrimental to them. Therefore, patients can choose a non-invasive, safe and effective TMS therapy to treat their dementia.

TMS has been certified by the European Union for the treatment of mild to moderate Alzheimer’s disease. In the United States, a number of large-scale clinical trials are undergoing in universities. The relevant technology has been applied to the US Food and Drug Administration (FDA) and is awaiting approval.

It is believed that TMS will become increasingly popular, bringing new hope to patients with brain degenerative diseases and their families.

 

During treatment, a short electromagnetic pulse generated by a magnetic field can directly pass through the scalp and stimulate the cerebral cortex.

As a result, it increases the excitability and plasticity of the brain cells, improving the brain activity and signals in a desirable way. A full treatment of TMS is able to create long-lasting enhancements in brain cell connection.

Patients’ emotions and cognitive ability such as memory, attention and execution skills are therefore improved.

 

According to the results of the latest research, the patient with dementia indicated structural neuroanatomical differences than the normal, for example, dysfunctional connectivity, low neuroplasticity, and decreased cortical excitability. However, but the medical treatment available today is ineffective in treating the above-mentioned problems.

TMS is playing an important role in increasing the connectivity of brain neurons. Studies have shown that:

• Continuous and appropriate TMS therapy is more effective than medication
• TMS can improve spatial memory deficit, cognitive ability, daily activities and decision-making ability
• TMS can enhance the patient’s associative memory by increasing the functional connectivity of the cerebral cortex and hippocampus
• After completing the course of treatment, the effect of TMS lasts
• TMS  has significant effects on the treatment of mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease

Reference：

Cirillo, J. & Perez, M.A. (2015). Subcortical contribution to late TMS-induced I-waves in intact humans, Front Integr Nuerosci, 9, 38.

de Haan, W., van Straaten, E., Gouw, A., & Stam, C. (2017). Altering neuronal excitability to preserve network connectivity in a computational model of Alzheimer’s disease. PLoS Comput Biol, 13(9).

Freitas, C., Mondragon-Llorca, H. Pascual-Leone, A.(2011). Noninvasive brain stimulation in Alzheimer’s disease: systematic review and perspective for the future. Exp Gerontol, 46(8), 611-27.

Lage, C., Wiles, K., Shergill, S.S., Tracy, D.K. (2016). A systematic review of the effects of low-frequency repetitive transcranial magnetic stimulation on cognition. J Neural Transm (Vienna), 123(12), 1479-1490.

Perry, E.K., Gibson, P.H., Blessed, G., Peery, R.H. & Tomlinson, B.E. (1977). Neurotransmitter enzyme abnormalities in senile dementia. Choline acetyltransferase and glutamic acid decarboxylase activities in necropsy brain tissue. J Neurol Sci, 34(2), 247-65.

Lisanby, S., Luber, B., Perera, T., & Sackeim, H.A. (2000). Transcranial magnetic stimulation: applications in basic neuroscience and neuropsychopharmacology. Int J Neuropsychopharmacology, 3(3), 259-273.

Wang, J.X., Rogers, L.M., Gross, E.Z., Ryals, A.J. Dokucu, M.E., Brandstatt, K.L., Hermiller, M.S., & Voss, J.L. (2014). Targeted enhancement of cortical-hippocampal brain networks and associative memory. Science, 345(6200), 1054-7.

臺灣失智症協會. Retrieved from http://www.tada2002.org.tw/tada_know_02.html

 

*Declaration: The application of TMS to Dementia is still experimental. Although some clinical studies have achieved positive results, this clinical application has not yet obtained FDA approval and CE mark.