Researchers from Brown and Rhode Island hospitals hope that transcranial magnetic stimulation will become the first successful treatment for frontotemporal dementia.
FTD is a neurodegenerative disease and is “the second most common cause of dementia in younger people — individuals under 65 — following Alzheimer’s,” said Brian Ott, a professor at the Warren Alpert Medical School and the director of Rhode Island Hospital’s Alzheimer’s Disease and Memory Disorders Center.
The study, led by Ott and Lindsay Oberman, director of the Neuroplasticity and Autism Spectrum Disorder Program at Bradley Hospital, aims to assess TMS’s efficacy as a treatment for FTD.
TMS uses an electromagnet device placed on the subject’s head to switch a magnetic field on and off very quickly, creating an electrical current in a localized region of the cerebral cortex of the brain. In cases where TMS improves cognitive function, the benefits are due to “an improvement in the connectivity between the region that they’re stimulating and a connected region,” Oberman said.
Though Alzheimer’s research has been the target of “huge investment,” FTD receives comparatively few research dollars, and there is no treatment for the disorder, Ott said.
Patients suffering from FTD, which has historically been confused with Alzheimer’s, can actually have their symptoms exacerbated by Alzheimer’s treatments. But brain imaging and neuropsychological tests can now distinguish between the diseases and allow researchers to develop treatments for FTD, Ott said.
In FTD, neurons die in the frontal and temporal lobes, and this degeneration leads to two main groups of disorders. “One is the behavioral variant that starts out with abnormalities of behavior,” Ott said. “And the other major group is people with progressive aphasia, where it starts out with progressive loss of language and speaking abilities.”
Oberman and Ott hope that with brief stimulations of the dorsolateral prefrontal cortex, they will see short-term benefits in patients suffering from both progressive aphasic and behavioral FTD because this area of the brain connects to neural networks involved in both subgroups of the disorder. “If we see that (improvement), then the next step would be to do a larger clinical trial, to see if we can lead to longer-term improvements,” Oberman said.
William Heindel, professor and chair of the cognitive, linguistic and psychological sciences department, and Elena Festa PhD’98, lecturer in CLPS, designed tests to assess the results of this stimulation. Progressive aphasia and behavioral FTD involve two different control paths in the brain, and “the two experimental tests are designed to assess the efficiency of these two different control processes using comparable tasks,” Heindel wrote in an email to The Herald.
The tests of progressive aphasiacs involve assessing the subject’s reaction times in identifying pictures of objects or of people performing actions. Tests of people with the behavioral variant involve showing the subject various “color words printed in a different colored ink — for example, the word ‘RED’ printed in green ink — for a brief period of time,” and asking them to either name the word or the color of the ink, Heindel wrote.
The study’s 12 subjects will undergo both types of tests after receiving real TMS treatment and a placebo. Improvements in their reaction times on these tests following the treatment will indicate that the treatment is successful.
The partnership among hospital researchers, Heindel and Festa, “really is an interdepartmental, cross-institutional collaboration, which is wonderful,” Ott said. This type of joint effort is “reasonably rare,” though “it’s something that Brown and the hospitals are really encouraging,” Oberman said.
“Collaborating with local hospitals is a critical feature” of Heindel’s research into neurodegenerative disorders, and he is “sure that these interactions will grow over time,” he wrote.
The researchers hope that after this study is completed in about six months, they will be able to move on to a larger treatment study. “I think the take-home message is that it has potential and promise for a group of patients where there’s not another good therapy,” Oberman said.