The effect of repetitive transcranial magnetic stimulation on cognitive impairment in Parkinson's disease with dementia: Pilot study.
BACKGROUND
The exact mechanism of cognitive impairment in PD is not known. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a possible treatment for cognitive impairment and to treat the motor symptoms in Parkinson's disease (PD) where its effects seem additive to those of dopaminergic medications.


OBJECTIVE
In this pilot study we investigated whether repeated sessions of rTMS have an effect on measures of cognitive impairment in patients with PD dementia.


METHODS
33 patients with PD dementia were randomly assigned sham or real rTMS (2000 pulses; 20 Hz; 90% RMT; 10 trains of 10 s with 25 s between each train) over the hand area of each motor cortex (5 min between hemispheres) for 10 days (5 days/week) followed by 5 booster sessions every month for 3 months. Assessments included the Unified Parkinson's Disease Rating Scale part III (UPDRS), Montreal Cognitive Assessment (MoCA); Mini Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR); Memory and Executive Screening (MES) and Instrumental activity of Daily Living (IADL). Event related potentials (P300) and cortical excitability were measured before treatment and after the last session.


RESULTS
There were no significant differences in the effects of rTMS between groups. Although rTMS improved motor function in the active group it had only a minor effect on two of the dementia rating scores (the MMSE and MoCA) but not the others (CDR and MES). There was also a reduction in the latency of the P300 in the active group.


CONCLUSIONS
rTMS over M1 is useful for motor function and may have a small positive effect on cognition. However, better approaches for the latter are necessary, may be require multisite rTMS to target both motor and frontal cortical region.
['Khedr|Eman M|EM|', 'Mohamed|Khaled O|KO|', 'Ali|Anwar M|AM|', 'Hasan|Asmaa M|AM|']
D000368:Aged D003071:Cognition D060825:Cognitive Dysfunction D003704:Dementia D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009044:Motor Cortex D010300:Parkinson Disease D010865:Pilot Projects D050781:Transcranial Magnetic Stimulation
repetitive transcranial magnetic stimulations cognitive impairment dementia Montreal cognitive assessment Mini mental state examination Clinical Dementia Rating P300 Parkinson’s disease Unified Parkinson’s Disease Rating Scale part III cortical excitability parameters