45 Depression in the elderly Major depression is a common neurops

45 Depression in the elderly Major depression is a common neuropsychiatric disease that afflicts elderly adults.46 For adults, research has found TMS to be efficacious in reducing depressive symptoms and was approved by the US FDA in 2008 for the treatment of MDD.The approved treatment consists of 6 weeks of 10 Hz rTMS sessions applied to the left dorsolateral prefrontal cortex. Since MDD is a prevalent condition among the elderly and its treatment within Inhibitors,research,lifescience,medical this population can be challenging due to medication complications (eg, drug-drug interaction, medication sensitivity), TMS is being explored as an antidepressant strategy. However, a number

of studies have not found TMS to have similar beneficial effects in elderly patients as has been reported in younger adult populations. For instance, one open-label study Inhibitors,research,lifescience,medical reported that 56% of young depressed patients responded to rTMS of the left prefrontal cortex, whereas only 23%

of elderly patients responded with the same treatment.47 Also, three randomized controlled clinical trials found no antidepressant benefit from rTMS in elderly patients,48-50 and a metanalysis of five clinical TMS trials (four randomized, double-blind, one open-label) found age to be a negative predictor of therapeutic benefit.51 These Inhibitors,research,lifescience,medical findings have led some to conclude that rTMS was ineffective for the treatment of depression in the elderly.52 A more recent study also reported only modest antidepressant effects for rTMS in an elderly cohort.53 The null finding of rTMS in treating MDD in elderly Volasertib manufacturer adults may be related to the increased scalp-to-cortex distance in that population.47 This was Inhibitors,research,lifescience,medical suggested because motor and prefrontal cortex atrophy occurs in elderly subjects.54 Atrophy inevitably increases scalp to cortical distance, likely resulting in the need Inhibitors,research,lifescience,medical for a stronger stimulus intensity, since magnetic field strength than decreases exponentially as distance increases. Two subsequent studies that used structure MRI methods

found relationships between Batimastat the antidepressant effect of TMS and scalp-to-cortex distance.55,56 Nahas et al54 tested these ideas by adjusting the TMS dosage by the distance to prefrontal cortex in a group of older adults, which resulted in a higher rate of responders than in earlier studies. One way to compensate for the scalp-to-cortex distance to improve antidepressant benefit would be to use a more powerful stimulus, such as used in magnetic seizure therapy (see below). TMS and plasticity with aging As the depression research suggests, changes with aging may mediate the association between TMS stimulation and cortical activity, as cortical atrophy with aging can reduce the delivered dosage of magnetic stimulation.

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