This scientific commentary refers to ‘Precuneus magnetic stimulation for Alzheimer’s disease: a randomized, sham-controlled trial’ by Koch et al. (https://doi.org/10.1093/brain/awac285).
Neurodegenerative dementia, in particular Alzheimer’s disease, is a global crisis with no existing cure. Technologies targeting neuroplasticity of the brain offer hope for slowing disease progression, avoiding further decline, and even reversing the decline that has occurred. Despite the scale of the efforts, the efficacy of most common medications for the treatment of dementia and Alzheimer’s disease (e.g. donepezil) is very low; donepezil shows some benefit for 20–60% of patients,1 but a substantial and marked benefit for only 2.3%.2 Moreover, a long-term study of donepezil showed no significant benefit compared to placebo for improving activities of daily living in patients with Alzheimer’s disease,3 and many patients discontinued it due to severe side effects.1,2
The use of non-pharmaceutical treatments to induce brain neuroplasticity is a relatively young and very fast-growing field, and is now being applied to dementia and its subtypes in research settings. Some 60 years ago, scientists thought neuroplasticity could occur only in infancy. However, neuroscience research in the latter half of the 20th century revealed that neurogenesis can occur even in old age. The brain is indeed plastic and can ‘rewire’ itself. These findings have paved the way for development and application of brain stimulation technologies that target neuroplasticity, such as repetitive transcranial magnetic stimulation (rTMS). A number of recent studies have suggested application of rTMS (though with somewhat different protocols) as a form of treatment to modulate cortical excitability for the treatment of Alzheimer’s disease with some encouraging outcomes4–6; it has also been used for the treatment of other neurological and mental disorders such as Parkinson’s disease, depression and schizophrenia, although it is approved clinically only for the treatment of major depression.
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