Precuneus rTMS: A Novel Therapy for Mild AD Patients
Alzheimer's disease is a global health challenge. Our efforts will aim at developing an effective treatment able to meet the needs of patients and their families. Thus, the primary aim of this project is to investigate the efficacy of a non-invasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), on memory skills in patients with mild Alzheimer's disease. rTMS is considered a safe, well tolerated and relatively cheap treatment. The appealing idea of our intervention is to improve memory by directly modulating the activity of precuneus, key area linked to memory impairment. Patients will be treated with rTMS in two phases: an intensive phase and a maintenance phase for a total of six months. This project will provide a valid treatment to slow the worsening of symptoms and improve quality of life for those with Alzheimer's and their caregivers.
The goal of this project is to provide a first robust clinical evidence that transcranial magnetic stimulation can be effective in slowing down cognitive and functional decline in patients suffering from Alzheimer's disease for a long term period of one year. The innovation of the project resides in the use of repetitive transcranial magnetic stimulation (rTMS) as a novel strategy to modulate the neural activity of the precuneus, a key node of the default mode network (DMN). We expect that DMN rTMS will increase the neural activity of the stimulated areas and of the interconnected nodes inducing relevant clinical effects in terms of cognitive functions and autonomies of daily living. We aim to use multimodal neurophysiological tools, such as transcranial magnetic stimulation combined with electroencephalography (TMS/EEG), to measure changes in cortical activity and connectivity/plasticity of the parieto-frontal network. Our research, if successful, will transfer the well know potential of non-invasive brain stimulation methods from an experimental setting towards a real-life clinical setting. We expect that our proposed rTMS therapy will be well tolerated and available for most of the patients, given the well-established safety profile. Hence the current proposal aims to deliver an alternative therapeutic tool, to be eventually combined with other treatments based on new compounds or drugs that hopefully will reach soon the market. Indeed, our proposal might have a relevant impact in terms of promoting a new therapeutic approach which is relatively cheap and easily accessible for AD patients. Since the cost for a repetitive TMS machine is less than 50.000 USD we believe that our approach could be easily replicated across several dementia centers all over the world.
About the Researcher
Giacomo Koch is a neurologist and neuroscientist leading the non-invasive brain stimulation lab at the Santa Lucia Foundation in Rome. The main goals of his research are to understand the mechanisms underlying cortical plasticity and cortical connectivity in the healthy human brain, in order to develop novel therapeutic approaches to promote recovery of neurological functions trough methods of non-invasive brain stimulation. Dr. Koch has a long-lasting experience in the field of clinical neurophysiology of cognitive functions. His main expertise is in the application of non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), mainly used in combination with structural and functional magnetic resonance imaging (MRI) and with electroencephalography (EEG). In the last years his research has been oriented to clarifying the mechanisms of cortical plasticity in patients with Alzheimer’s Disease (AD) and in testing new therapeutic approaches in people with dementia in phase II/III clinical trials.
I became fascinated with the complexity of the brain and the beauty of neuroscience during my internship in neurophysiology, while I was studying to become a medical doctor. Since the early phases of my career I combined clinical and research activity, being especially fascinated by the possibility to study in vivo the changes in brain physiology occurring during neurodegenerative conditions such as Alzheimer’s disease. This research put the basis to search for new therapeutic approaches using non-invasive brain stimulation methods. This need to find a cure was the consequence of watching a loved one struggle with cognitive decline in dementia, as had happened to my grandfather. Now that I am focusing part of my research program on non-invasive brain stimulation in patients suffering from dementia, I am realizing how important is to give a hope for the patients and their family. I am constantly inspired by their courage and hope, and this provides great incentive to push our work forward in the hopes that we will contribute to the development of novel treatments for Alzheimer's disease. I would like to express my deep gratitude and appreciation to BrighFocus donors for their support of this project.
First published on: June 18, 2019
Last modified on: July 1, 2019