rTMS to Improve Cognition in Parkinson's (TMSCogReP)

VA Office of Research and Development

Status and phase: Enrolling; Phase 2; Phase 1

Conditions: Mild Cognitive Impairment; Parkinson's Disease

Treatments: Device: MagVenture MagProX100 stimulator (MagVenture, Falun, Denmark)

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT03836950

IK2RX002938 (U.S. NIH Grant/Contract)

N2938-W

2023CWR-NDS-831171250 (Other Grant/Funding Number)

Details and patient eligibility

About

The purpose of this study is to examine safety, feasibility, and the behavioral and brain effects of a non-invasive treatment, repetitive transcranial magnetic stimulation (rTMS), for Veterans with Parkinson's disease or atypical parkinsonism and mild impairments in their thinking. The hypothesis is that rTMS can improve thinking for people with Parkinson's disease or atypical parkinsonism who are experiencing mild problems with their thinking ability.

Full description

Repetitive transcranial magnetic stimulation (rTMS) shows promise as an effective cognitive neurorehabilitation treatment. To date, no rTMS studies have assessed the effect of rTMS on cognitive function in PD-MCI. Nor has there been PD neurophysiological studies using rTMS to examine neural plasticity in cognitive neural networks. This study seeks to fill this gap by conducting a small scaled pilot randomized controlled trial (RCT) designed to assess the safety and therapeutic effects of rTMS on cognitive outcomes as well as on brain connectivity in Veterans with PD-MCI. PD-MCI participants will be randomized to either active rTMS or sham rTMS. Participants will complete a standardized neurocognitive battery assessment at baseline, endpoint and at a one month follow-up. The primary outcome is change in executive function. Secondary outcomes include performance on other cognitive domain tasks and a proximal measure of real-life function that captures relevant functional changes related to cognitive impairment in PD. Multi-modal neuroimaging, in a subsample of participants, will be used to study neural connectivity changes induced by rTMS. Changes in resting state functional connectivity, grey matter volume via voxel-based morphometry and white matter integrity via diffusion tensor imaging will be assessed at baseline and endpoint. To inform how to optimize rTMS treatment in PD-MCI, these changes will be correlated with changes in cognitive performance.

Enrollment: 56 estimated patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Veterans who seek services at Hines VA Hospital or Jesse Brown VA Medical Center
• Diagnosis of PD or atypical parkinsonism as determined by a neurologist
• Meet criteria for having mild cognitive impairment
• Receiving stable (i.e., no changes in medication and medication dose) medication and who are expected to remain on stable medication for the duration of the RCT
• Speak and read English
• 50 years or older

Exclusion criteria

• Dementia

• Failure to demonstrate decision making capacity

• History of deep brain stimulation surgery

• Severe depression

• Resting head tremor

• Dyskinesia that will interfere with collecting imaging data

• Has congestive heart failure

• Implanted cardiac pacemaker or defibrillator

• Cochlear implant, nerve stimulator, or intracranial metal clips

• Implanted medical pump

• Increased intracranial pressure

• History of claustrophobia

• Metal in eyes/face, shrapnel/bullet remnants in brain

• Participants at potential increased risk of seizure including those who have the following:

  • history (or family history) of seizure or epilepsy

  • history of stroke, head injury, or unexplained seizures

  • presence of other neurological disease that may be associated with an altered seizure threshold

    • such as CVA, cerebral aneurysm, dementia, increased intracranial pressure

• Concurrent medication use such as tricyclic antidepressants, neuroleptic medications, any other drug known to lower seizure threshold

• Secondary conditions that may significantly alter electrolyte balance or lower seizure threshold

• No quantifiable motor threshold such that rTMS dosage cannot be accurately deter-mined

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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56 participants in 2 patient groups

active rTMS

Experimental group

Description:

For active rTMS, a butterfly coil and MagVenture MagProX100 stimulator (MagVenture, Falun, Denmark) will be used. One rTMS session will consist of 40 trains of 5sec each at 110% of resting motor threshold and 15Hz will be provided at the left DLPFC.

Treatment:

Device: MagVenture MagProX100 stimulator (MagVenture, Falun, Denmark)

Device: MagVenture MagProX100 stimulator (MagVenture, Falun, Denmark)

sham rTMS

Sham Comparator group

Description:

For sham rTMS, the procedure will be carried out at the left DLPFC but a sham coil will be used. The MagVenture coil has an active side and a placebo side allowing a double-blind study to be conducted. The sham system looks, sounds and feels like active rTMS.

Treatment:

Device: MagVenture MagProX100 stimulator (MagVenture, Falun, Denmark)

Device: MagVenture MagProX100 stimulator (MagVenture, Falun, Denmark)