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Various studies report discordant results regarding the efficacy, parameters, and underlying mechanisms of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training (CT) on Alzheimer’s disease (AD). The objective of the study was to assess the effect of rTMS-CT on cognition, the activities of daily life, neuropsychiatric behavioral symptoms, and metabolite levels beneath the stimulated areas of the brain in patients with AD and to investigate the correlation of metabolic changes (measured with proton magnetic resonance spectroscopy [ 1 H-MRS]) with clinical outcomes after treatment. Thirty consecutive patients with mild or moderate AD were enrolled and randomly divided into one of the two intervention groups: (1) real rTMS with CT (i.e., real group) and (2) sham rTMS with CT (i.e., sham group). 10 Hz rTMS was used to stimulate the left dorsolateral prefrontal cortex (DLPFC) and then to stimulate the left lateral temporal lobe (LTL) for 20 min each day for 4 weeks. Each patient underwent neuropsychological assessment at baseline (T0), immediately after treatment (T1), and 4 weeks after treatment (T2). The ratios of N -acetylaspartate/creatine (NAA/Cr), myoinositol/creatine (mI/Cr), and choline/creatine (Cho/Cr) in the stimulated cortex were measured using 1 H-MRS at T0 and T1. Twenty-eight patients were treated with rTMS-CT for 4 weeks. Two patients in the sham group withdrew after being treated several times. Compared with the sham group, the cognitive function and behavior in the real rTMS group improved significantly at T1 and T2. In the real group, compared with the sham group, the NAA/Cr ratio in the left DLPFC was significantly elevated ( p  = 0.045); however, in the left LTL, it only showed a tendency toward increase ( p  = 0.162). The change in the NAA/Cr ratio in the left DLPFC was negatively correlated with the change in the cognitive scales of the Alzheimer’s Disease Assessment Scale (ADAS-cog). This study indicated a possible modest effect of rTMS-CT on preventing clinical and neuronal functional deterioration in the left DLPFC of patients with AD. The left DLPFC is a better candidate area than the left LTL.

背景：日間照顧中心工作人員提供長者許多活動，但缺乏一個能符合台灣民情文化且有系統的課程，來提升長者認知功能及自我照顧能力，並改善憂鬱心情。目的：發展一系列音樂律動結合本土化認知刺激訓練課程，並檢測其對於日間照顧中心長者的認知功能及自我照顧能力的提升，以及改善憂鬱情緒之成效。方法：本研究採群體隨機對照實驗研究設計，用隨機方式將5家日間照顧中心分為實驗組、對照組和控制組。實驗組的長者接受由中心的直接照顧者提供音樂律動及結合腦力活化的本土化結構性認知刺激訓練。之後檢測不同組別參與者的認知功能、自我照顧能力，以及憂鬱情緒狀態。結果：研究結果發現實驗組研究參與者在注意力、進食、及憂鬱情緒出現顯著性改變外；在控制活動參與次數及參與度後，對照組的長者在第三次認知功能得分較第二次認知功能得分呈現顯著性的降低。結論／實務應用：研究證實該介入措施可運用於日間照顧中心長者預防自我照顧能力的衰退，同時也可預防長者認知功能衰退或憂鬱的情緒發生；未來需擴大收案樣本，以提高介入措施的成效之驗證。

Background: Staff caregivers of day care centers provide many activities for older people. However, there is a lack of a systematic curriculum based on Taiwanese culture to improve cognitive function, self-care ability, and depressive mood status in these individuals. Purpose: This study was designed to test the effectiveness of a series of localized cognitive stimulation training courses implemented by direct caregivers and aimed at improving cognitive function, self-care ability, and depressive mood in older people at day care centers. Methods: This cluster-randomized controlled trial research was conducted over a four-month period. The participants were randomly assigned to the experimental, comparison, or control groups based on their day care center affiliation. The experimental group received a series of localized cognitive stimulation training sessions with musical rhythm courses from day care center direct caregivers. The cognitive function, self-care ability, and depression mood state of the three gr

The promise of transcranial direct-current stimulation (tDCS) as a modulator of cognition has appealed to researchers, media, and the general public. Researchers have suggested that tDCS may increase effects of cognitive training. In this study of 123 older adults, we examined the interactive effects of 20 sessions of anodal tDCS over the left prefrontal cortex (vs. sham tDCS) and simultaneous working memory training (vs. control training) on change in cognitive abilities. Stimulation did not modulate gains from pre-to posttest on latent factors of either trained or untrained tasks in a statistically significant manner. A supporting meta-analysis (n = 266), including younger as well as older individuals, showed that, when combined with training, tDCS was not much more effective than sham tDCS at changing working memory performance (g = 0.07, 95% confidence interval, or CI = [-0.21, 0.34]) and global cognition performance (g = -0.01, 95% CI = [-0.29, 0.26]) assessed in the absence of stimulation. These results question the general usefulness of current tDCS protocols for enhancing the effects of cognitive training on cognitive ability.

Background Non-invasive brain stimulation (NIBS) combined with cognitive training (CT) may have shown some prospects on improving cognitive function in patients with Alzheimer’s disease (AD) and mild cognitive impairment (MCI). However, data from clinical trials or meta-analysis involving NIBS combined with CT have shown controversial results. The aim of this systematic review and meta-analysis was to evaluate short-term and long-term effects of NIBS combined with CT on improving global cognition and other specific cognitive domains in patients with AD and MCI. Methods This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases including PubMed, Web of Science, EBSCO, Cochrane Library and Embase were searched up from inception to 20 November 2023. The PEDro scale and the Cochrane’s risk of bias assessment were used to evaluate risk of bias and methodological quality of included studies. All statistical analyses were conducted with Review Manager 5.3. Results We included 15 studies with 685 patients. The PEDro scale was used to assess methodological quality with a mean score of 7.9. The results of meta-analysis showed that NIBS combined with CT was effective on improving global cognition in AD and MCI (SMD = 0.52, 95% CI (0.18, 0.87), p  = 0.003), especially for patients accepting repetitive transcranial magnetic stimulation (rTMS) combined with CT (SMD = 0.46, 95% CI (0.14, 0.78), p  = 0.005). AD could achieve global cognition improvement from NIBS combined with CT group (SMD = 0.77, 95% CI (0.19, 1.35), p  = 0.01). Transcranial direct current stimulation (tDCS) combined with CT could improve language function in AD and MCI (SMD = 0.29, 95% CI (0.03, 0.55), p  = 0.03). At evaluation follow-up, rTMS combined with CT exhibited larger therapeutic responses to AD and MCI in global cognition (SMD = 0.55, 95% CI (0.09, 1.02), p  = 0.02). AD could achieve global cognition (SMD = 0.40, 95% CI (0.03, 0.77), p  = 0.03) and attention/working memory (SMD = 0.72, 95% CI (0.23, 1.20), p  = 0.004) improvement after evaluation follow-up from NIBS combined with CT group. Conclusions Overall, NIBS combined with CT, particularly rTMS combined with CT, has both short-term and follow-up effects on improving global cognition, mainly in patients with AD. tDCS combined with CT has advantages on improving language function in AD and MCI. Future more studies need evaluate cognitive effects of NIBS combined with CT on other specific cognitive domain in patients with cognitive deterioration.

Cognitive training is an effective tool to improve a variety of cognitive functions, and a small number of studies have now shown that brain stimulation accompanying these training protocols can enhance their effects. In the domain of behavioral inhibition, little is known about how training can affect this skill. As for transcranial direct current stimulation (tDCS), it was previously found that stimulation over the right inferior frontal gyrus (rIFG) facilitates behavioral inhibition performance and modulates its electrophysiological correlates. This study aimed to investigate this behavioral facilitation in the context of a learning paradigm by giving tDCS over rIFG repetitively over four consecutive days of training on a behavioral inhibition task (stop signal task (SST)). Twenty-two participants took part; ten participants were assigned to receive anodal tDCS (1.5 mA, 15 min), 12 were assigned to receive training but not active stimulation. There was a significant effect of training on learning and performance in the SST, and the integration of the training and rIFG–tDCS produced a more linear learning slope. Better performance was also found in the active stimulation group. Our findings show that tDCS-combined cognitive training is an effective tool for improving the ability to inhibit responses. The current study could constitute a step toward the use of tDCS and cognitive training as a therapeutic tool for cognitive control impairments in conditions such as attention-deficit hyperactivity disorder (ADHD) or schizophrenia.

Cognitive decline in older adults has significant implications for autonomy and quality of life. This study evaluated the combined effects of cognitive training (CT) and transcranial direct current stimulation (tDCS) on cognitive performance in older adults. Two CT approaches—core training and strategy training—were paired with either active or sham anodal tDCS over the left DLPFC. Eighty-five participants were assigned to three groups: (1) CT with active tDCS, (2) CT with sham tDCS, and (3) a control group attending memory-related lectures. Participants underwent 16 intervention sessions and completed cognitive assessments at three points: pre-intervention, immediately after, and three months post-intervention. Results showed that the active tDCS group experienced immediate and sustained improvements across all cognitive tests, while the sham tDCS group showed gains only in specific memory tasks. The control group showed no significant changes. These findings suggest that combining CT with active tDCS is more effective in enhancing and sustaining cognitive performance in older adults compared to CT alone. The study highlights the importance of further research to explore the mechanisms underlying the effectiveness of combined CT and tDCS interventions and their potential in mitigating age-related cognitive decline. Trial registration : NCT04997226. 09/08/2021.

Background Post-stroke cognitive impairment (PSCI) is the focus and difficulty of poststroke rehabilitation intervention with an incidence of up to 61%, which may be related to the deterioration of cerebrovascular function. Computer-aided cognitive training (CACT) can improve cognitive function through scientific training targeting activated brain regions, becoming a popular training method in recent years. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, can regulate the cerebral vascular nerve function, and has an effect on the rehabilitation of cognitive dysfunction after stroke. This study examined the effectiveness of both CACT and tDCS on cognitive and cerebrovascular function after stroke, and explored whether CACT combined with tDCS was more effective. Methods A total of 72 patients with PSCI were randomly divided into the conventional cognitive training (CCT) group ( n  = 18), tDCS group ( n  = 18), CACT group ( n  = 18), and CACT combined with tDCS group ( n  = 18). Patients in each group received corresponding 20-minute treatment 15 times a week for 3 consecutive weeks. Montreal Cognitive Assessment (MoCA) and the Instrumental Activities of Daily Living Scale (IADL) were used to assess patients’ cognitive function and the activities of daily living ability. Transcranial Doppler ultrasound (TCD) was used to assess cerebrovascular function, including cerebral blood flow velocity (CBFV), pulse index (PI), and breath holding index (BHI). These outcome measures were measured before and after treatment. Results Compared with those at baseline, both the MoCA and IADL scores significantly increased after treatment ( P  < 0.01) in each group. There was no significantly difference in efficacy among CCT, CACT and tDCS groups. The CACT combined with tDCS group showed greater improvement in MoCA scores compared with the other three groups ( P  < 0.05), especially in the terms of visuospatial and executive. BHI significantly improved only in CACT combined with tDCS group after treatment ( p  ≤ 0.05) but not in the other groups. Besides, no significant difference in CBFV or PI was found before and after the treatments in all groups. Conclusion Both CACT and tDCS could be used as an alternative to CCT therapy to improve cognitive function and activities of daily living ability after stroke. CACT combined with tDCS may be more effective improving cognitive function and activities of daily living ability in PSCI patients, especially visuospatial and executive abilities, which may be related to improved cerebral vasomotor function reflected by the BHI. Trial registration number The study was registered in the Chinese Registry of Clinical Trials (ChiCTR2100054063). Registration date: 12/08/2021.

The capacity for transcranial direct current stimulation (tDCS) to increase learning and cognition shows promise for the development of enhanced therapeutic interventions. One potential application is the combination of tDCS with cognitive training (CT), a psychological intervention which aims to improve targeted cognitive abilities. We have previously shown that tDCS enhanced performance accuracy, but not skill acquisition, on a dual n -back working memory (WM) CT task over repeated sessions. In the current study, we investigated the optimal timing for combining tDCS with the same CT task to enhance within and between session performance outcomes across two daily CT sessions. Twenty healthy participants received in a randomised order 30 min of anodal tDCS to the left dorsolateral prefrontal cortex immediately before (‘offline’ tDCS) and during performance (‘online’ tDCS) on a dual n -back WM CT task, in an intra-individual crossover design. Analyses examined within and between session consolidation effects of tDCS on CT performance outcomes. Results showed that ‘online’ tDCS was associated with better within session skill acquisition on the CT task, with a significant difference found between conditions the following day. These results suggest that ‘online’ tDCS is superior to ‘offline’ tDCS for enhancing skill acquisition when combining anodal tDCS with CT. This finding may assist with the development of enhanced protocols involving the combination of tDCS with CT and other rehabilitation protocols.

Introduction: Non-pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues to produce mixed results.Methods: In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System.Results: Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols.Discussion: We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area.