Repetitive Transcranial Magnetic Stimulation (rTMS) of Dorsolateral Prefrontal Cortex May Influence Semantic Fluency and Functional Connectivity in Fronto-Parietal Network in Mild Cognitive Impairment (MCI)
Sabrina Esposito,
Francesca Trojsi,
Giovanni Cirillo,
Manuela de Stefano,
Federica Di Nardo,
Mattia Siciliano,
Giuseppina Caiazzo,
Domenico Ippolito,
Dario Ricciardi,
Daniela Buonanno,
Danilo Atripaldi,
Roberta Pepe,
Giulia D’Alvano,
Antonella Mangione,
Simona Bonavita,
Gabriella Santangelo,
Alessandro Iavarone,
Mario Cirillo,
Fabrizio Esposito,
Sandro Sorbi,
Gioacchino Tedeschi
Affiliations
Sabrina Esposito
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Francesca Trojsi
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Giovanni Cirillo
Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Manuela de Stefano
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Federica Di Nardo
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Mattia Siciliano
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Giuseppina Caiazzo
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Domenico Ippolito
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Dario Ricciardi
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Daniela Buonanno
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Danilo Atripaldi
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Roberta Pepe
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Giulia D’Alvano
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Antonella Mangione
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Simona Bonavita
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Gabriella Santangelo
Department of Psychology, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
Alessandro Iavarone
Neurological Unit, CTO Hospital, AORN Ospedali Dei Colli, 80131 Naples, Italy
Mario Cirillo
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Fabrizio Esposito
Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Sandro Sorbi
IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy
Gioacchino Tedeschi
First Division of Neurology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique that is increasingly used as a nonpharmacological intervention against cognitive impairment in Alzheimer’s disease (AD) and other dementias. Although rTMS has been shown to modify cognitive performances and brain functional connectivity (FC) in many neurological and psychiatric diseases, there is still no evidence about the possible relationship between executive performances and resting-state brain FC following rTMS in patients with mild cognitive impairment (MCI). In this preliminary study, we aimed to evaluate the possible effects of rTMS of the bilateral dorsolateral prefrontal cortex (DLPFC) in 27 MCI patients randomly assigned to two groups: one group received high-frequency (10 Hz) rTMS (HF-rTMS) for four weeks (n = 11), and the other received sham stimulation (n = 16). Cognitive and psycho-behavior scores, based on the Repeatable Battery for the Assessment of Neuropsychological Status, Beck Depression Inventory-II, Beck Anxiety Inventory, Apathy Evaluation Scale, and brain FC, evaluated by independent component analysis of resting state functional MRI (RS-fMRI) networks, together with the assessment of regional atrophy measures, evaluated by whole-brain voxel-based morphometry (VBM), were measured at baseline, after five weeks, and six months after rTMS stimulation. Our results showed significantly increased semantic fluency (p = 0.026) and visuo-spatial (p = 0.014) performances and increased FC within the salience network (p ≤ 0.05, cluster-level corrected) at the short-term timepoint, and increased FC within the left fronto-parietal network (p ≤ 0.05, cluster-level corrected) at the long-term timepoint, in the treated group but not in the sham group. Conversely, regional atrophy measures did not show significant longitudinal changes between the two groups across six months. Our preliminary findings suggest that targeting DLPFC by rTMS application may lead to a significant long-term increase in FC in MCI patients in a RS network associated with executive functions, and this process might counteract the progressive cortical dysfunction affecting this domain.
