Abstract Details

Title Intermittent Theta Burst Transcranial Magnetic Stimulation Improves Language and Functional Connectivity in Primary Progressive Aphasia

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) S23 - Innovations in Dementia Treatment (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Background PPA refers to a clinical syndrome presenting with language impairment with relative preservation of other cognitive functions. Neuroimaging evidence suggests that the language network, anchored in left prefrontal and temporo-parietal cortices, is selectively affected in PPA. To date, no pharmacological or neuromodulation strategies can satisfactorily improve symptoms in PPA. Focal neuromodulation techniques, such as repetitive TMS (rTMS), can change resting-state functional connectivity in a network-specific manner. Thus, we investigated whether rTMS could selectively modulate functional connections within the degenerated language network in PPA.

Objective The goal of this study was to examine the effects of transcranial magnetic stimulation (TMS) on language and language network functional connectivity in a cohort of primary progressive aphasia (PPA) patients.

Design/Methods A double-blinded, sham controlled, cross-over design was used to administer intermittent theta burst stimulation (iTBS) for 10 days in a heterogeneous sample of PPA patients: 4 logopenic variant (lvPPA), 2 non-fluent variant (nfvPPA), 1 semantic variant (svPPA), and 3 with primary progressive apraxia of speech (PPAOS). We stimulated the left caudal middle frontal gyrus region most functionally correlated with the language network on an individual-subject basis. Standardized language assessments were administered at baseline, post-active TMS, and post-sham TMS. Resting-state fMRI data were analyzed to probe functional connectivity changes across sessions.

Results We found language test improvement following active TMS in areas of weakness for the respective patients: Naming performance in lvPPA; semantic performance in svPPA; and apraxia of speech severity in nfvPPA and PPAOS. Across all subtypes, increased functional connectivity was observed in the language and other networks subserving cognitive performance after active TMS.

Conclusions We demonstrate preliminary evidence that personalized functional-network guided iTBS can improve language impairments in a heterogeneous PPA cohort. Furthermore, improvements in language tests were accompanied by increases in functional network connectivity, pointing to a putative neural mechanism of TMS-induced benefits in PPA.

Authors/Disclosures
Thiago Paranhos, Sr., MD PRESENTER	Mr. Paranhos has nothing to disclose.
Anna Du	Miss Du has received personal compensation for serving as an employee of Wesleyan University.
Nneka Watson, MS, CCC-SLP	Ms. Watson has nothing to disclose.
Daisy Hochberg, MS	An immediate family member of Mrs. Hochberg has received research support from Department of Veterans Affairs. An immediate family member of Mrs. Hochberg has received intellectual property interests from a discovery or technology relating to health care.
Megan Quimby (Massachusetts General Hospital)	Ms. Quimby has nothing to disclose.
Neguine Rezaii, MD (Massachusetts General Hospital)	Dr. Rezaii has nothing to disclose.
Bonnie Wong, PhD	Dr. Wong has nothing to disclose.
Yuta Katsumi, PhD	The institution of Dr. Katsumi has received research support from the National Institute on Aging. The institution of Dr. Katsumi has received research support from the Alzheimer's Association.
Bradford Dickerson, MD, FAAN	Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acadia. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arkuda. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lantheus. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lilly. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novo Nordisk. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Dickerson has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arkuda. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acadia. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lilly. Dr. Dickerson has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Dickerson has received publishing royalties from a publication relating to health care. Dr. Dickerson has received publishing royalties from a publication relating to health care.
Mark C. Eldaief, MD (Massachusetts General Hospital)	No disclosure on file
Alexandra Touroutoglou, PhD	Dr. Touroutoglou has nothing to disclose.

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