Noninvasive Brain Stimulation to Enhance Cognitive Training in Older Adults

Study Overview
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Brief Summary
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This research study explores the feasibility of pairing computer-based cognitive training (CBCT) with transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, in order to enhance and preserve mental skills in older adults. The investigators aim to enhance participants ability to perform tasks of memory, attention, processing speed and other areas of cognition. Additionally, researchers are interested in the ability of the brain to adapt to change-neuroplasticity. Neuroplasticity is thought to impact how individuals respond to cognitive training and tDCS. In order to look at individual differences in neuroplasticity transcranial magnetic stimulation (TMS), a noninvasive brain stimulation technique, will be used. Individual responses to TMS can be used as a marker of neuroplastic changes in brain function, in order to reveal the relationship between brain plasticity and tDCS-induced changes in cognitive ability.

Detailed Description
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Promising evidence suggests that cognitive training regimens may have some beneficial effects on cognition in older adults. However, the improvement from computer-based cognitive training (CBCT) diminish over time which highlights a fundamental challenge for CBCT interventions. Transcranial direct current stimulation (tDCS) can enhance certain cognitive skills, particularly when stimulation is combined with rehearsal of relevant behaviors. Importantly, these benefits have been shown to persist up to 2 months after the intervention. This study will lay the groundwork for larger scale studies that will combine CBCT with neuromodulation, potentially leading to the development of a persistent, transferrable, multimodal technique to preserve cognition in older adults. In this study, participants will be randomly assigned to receive either real or sham tDCS for 5 consecutive days in conjunction with CBCT. The participant's cognition will be assessed with a neuropsychological assessment at baseline, 1 week, 2 weeks, and 2 months in order to determine any changes. Additionally, transcranial magnetic stimulation (TMS) will be used to characterize the relationship between baseline differences in brain plasticity and cognitive changes induced by tDCS+CBCT. The effects of TMS on cortical activity have been shown to depend on a variety of neuroplasticity-related mechanisms. In this study, changes in motor physiology (called motor evoked potentials (MEPs)) induced by TMS will be used. Stimulation of the motor cortex with TMS induces robust, transient, and readily quantifiable changes in motor excitability, which are sensitive to changes in the mechanisms of neuroplasticity. Investigators hypothesize that individual variability in brain plasticity, measured by changes in MEP response to TMS, will predict the degree of cognitive benefit afforded by tDCS+CBCT. Study Visits: ---------------- Visit 1 - Consent and Screening (2 hours) Review enrollment documents and conduct baseline neuropsychological assessment ---------------- Visit 2 - Visit 5 - tDCS + CBCT (30 minutes) Subjects will receive either real or sham stimulation along with cognitive training --------------- Visit 6 - tDCS + CBCT & Follow-up (3 hours) Subjects will receive either real or sham stimulation along with cognitive training & follow-up neurospychological assessment --------------- Visit 7 - TMS (3 hours) Subjects will receive TMS in order to induce MEPs ------------ Visit 8 - 2 week follow-up (1 .5 hours) Follow-up neuropsychological assessment ----------- Visit 9 - 2 month follow-up (1.5 hours) Follow-up neuropsycological assessment

Official Title
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Noninvasive Brain Stimulation to Enhance Cognitive Training and Assess Neuroplasticity in Older Adults

Conditions
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Normal Aging

Intervention / Treatment
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* Device: Transcranial Direct Current Stimulation
* Behavioral: Computer-based cognitive therapy (CBCT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Normal cognition English as their native language Exclusion Criteria: . History of neurological disorders . History of head injury with unconsciousness lasting more than 5 minutes . History of psychiatric disorders . Currently abusing alcohol or drugs (prescription or otherwise) . History of epilepsy or seizures within the past 6 months . Previous brain surgery . Pacemaker

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants are assigned to either receive real or sham tDCS without the option of crossover.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Real tDCS + CBCT<br>20 minutes of 2.0mA of tDCS for 5 consecutive days | Device: Transcranial Direct Current Stimulation<br>* tDCS is a neuromodulatory technique that delivers a small electric current (about the equivalent of a 9V battery) to the head. A fixed current between 1 and 2 mA is typically applied. tDCS works by applying a positive (anodal) or negative (cathodal) current via electrodes to an area, facilitating the depolarization or hyperpolarization of neurons, respectively.<br>Behavioral: Computer-based cognitive therapy (CBCT)<br>* Repetitive, drill-like training usually presented in the form of a game that targets a specific cognitive construct.<br>|
| Sham Comparator: Sham + CBCT<br>Sham stimulation closely imitates reals tDCS 30 second ramp-up / ramp-down | Device: Transcranial Direct Current Stimulation<br>* tDCS is a neuromodulatory technique that delivers a small electric current (about the equivalent of a 9V battery) to the head. A fixed current between 1 and 2 mA is typically applied. tDCS works by applying a positive (anodal) or negative (cathodal) current via electrodes to an area, facilitating the depolarization or hyperpolarization of neurons, respectively.<br>Behavioral: Computer-based cognitive therapy (CBCT)<br>* Repetitive, drill-like training usually presented in the form of a game that targets a specific cognitive construct.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Executive Function | Change in tDCS induced executive function as measured by the Delis-Kaplan Executive Function Systems (DKEFS) test. DKEFS utilizes a scaled score which ranges from 1-20 with scores between 8-12 considered average. | baseline, day 5, 2 week, 2 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| TMS brain activation | Change in average amplitude of MEPs as a response to TMS. We expect to see an initial reduction (or inhibition) in average amplitude of the MEP response to TMS, followed by a return to baseline amplitude. | 2 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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non-invasive brain stimulation, cognition, transcranial direct current stimulation (tDCS)