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Fully updated for the second edition, this text remains a comprehensive and current treatment of the cognitive neuroscience of memory. Featuring a new chapter on group differences in long-term memory, areas covered also include cognitive neuroscience methods, human brain mechanisms underlying long-term memory success, long-term memory failure, implicit memory, working memory, memory and disease, memory in animals, and recent developments in the field. Both spatial and temporal aspects of brain processing during different types of memory are emphasized. Each chapter includes numerous pedagogical tools, including learning objectives, background information, further reading, review questions, and figures. Slotnick also explores current debates in the field and critiques of popular views, portraying the scientific process as a constantly changing, iterative, and collaborative endeavor.
This chapter describes the many methods of Cognitive Neuroscience that are revealing the neural processes underlying complex cognitive processes in the brain. The benefits and limitations of each method are discussed, highlighting how there is no single “best” method and how the choice of method in any experiment should be motivated by the hypothesis being evaluated. Neuropsychology provides novel insights into the neural bases of cognitive processes but is limited because it relies on naturally occurring lesions. Neuroimaging methods (fMRI, PET, fNIRS) provide excellent spatial resolution but cannot assess the temporal order of neural activity across regions. Electroencephalography (EEG) and magnetoencephalography (MEG) can track neural activity in real time, but their spatial precision is limited because they are recorded from outside the head. Neurostimulation methods (TMS, tDCS, tACS) can uniquely assess causality by testing if, and when, a brain area is necessary for a particular function. Methods using non-human animals (e.g., single-unit recordings) can provide the highest levels of spatial and temporal precision, but they are limited to mental processes that the non-human animals can be trained to do. This chapter ends with a comparison of methods that includes portability, spatial precision, and temporal resolution.
Attention is critical to our daily lives, from simple acts of reading or listening to a conversation to the more demanding situations of trying to concentrate in a noisy environment or driving on a busy roadway. This book offers a concise introduction to the science of attention, featuring real-world examples and fascinating studies of clinical disorders and brain injuries. It introduces cognitive neuroscience methods and covers the different types and core processes of attention. The links between attention, perception, and action are explained, along with exciting new insights into the brain mechanisms of attention revealed by cutting-edge research. Learning tools – including an extensive glossary, chapter reviews, and suggestions for further reading – highlight key points and provide a scaffolding for use in courses. This book is ideally suited for graduate or advanced undergraduate students as well as for anyone interested in the role attention plays in our lives.
Section 2.1 reviews the behavioral measures that allow for the interpretation of brain activation results. Section 2.2 discusses techniques with high spatial resolution, such as fMRI, which is the most popular method. Section 2.3 focuses on techniques with high temporal resolution, such as ERPs. ERPs measure voltages on the scalp that directly reflect the underlying brain activity. In Section 2.4, techniques with excellent spatial resolution and excellent temporal resolution are described, including combined fMRI and ERPs, as well as recording from patients with electrodes implanted in the brain for clinical reasons. Section 2.5 considers evidence from patients with brain lesions and cortical deactivation methods such as TMS. Both methods have limited spatial resolution and poor temporal resolution; however, they can assess whether a brain region is necessary for a given cognitive process. In Section 2.6, the spatial resolution and temporal resolution of the different techniques are compared.
Major depressive disorder is a serious and life-threatening condition not uncommon to older adults. Only 60-70% of patients respond to an adequate trial of two different antidepressants. Reasonable strategies to address treatment-resistant depression in older adults include adding an antidepressant in another class or adding one or more of many available augmentation agents. When patients have treatment-resistant depression a clinician may need to consider nonpharmacologic therapies for depression such as electroconvulsive therapy or transcranial magnetic stimulation.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Bipolar disorder is an affective disorder defined on the basis of the presence of periods of elevated mood. Patients often present with depression, and previous episodes of elevated mood may be missed if not specifically explored during assessment. Bipolar disorder may be difficult to differentiate from other conditions causing mood instability and impulsivity. It is important to identify comorbidities such as substance use, neurodiversity and physical illnesses. The first-line treatment for mania is antipsychotic medication. Antidepressants are reported to have little to no efficacy in treating bipolar depression on average. Lithium is not the only long-term prophylactic agent, but it remains the gold standard, with good evidence that it reduces mood episodes and adverse outcomes. Monitoring is required to ensure lithium level is optimised and potential side-effects minimised.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Classification of drug treatments for depression is described noting the ambiguities of current terminology and the move towards standardised nomenclature based on pharmacology and mode of action, such as that proposed by the Neuroscience-based Nomenclature group. Antidepressant drugs are described in terms of background, mechanism of action, pharmacokinetics, side effects, interactions, contraindications and toxicity in overdose. Groups include selective serotonin re-uptake inhibitors (SSRI), serotonin and noradrenaline re-uptake inhibitors (SNRI), tricyclics, noradrenergic and specific serotoninergic antidepressants (NaSSA), monoamine oxidase inhibitors (MAOI) and others such as buproprion, agomelatine, reboxetine, trazadone and vortioxetine. Augmentary medications are also described, including antipsychotics, antiepileptics and lithium. Developments with the use of ketamine and other compounds are discussed.
The classification of physical treatments for depression is into neuromodulatory (e.g. electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation and phototherapy) and neuroablative techniques (e.g. stereotactic psychosurgery).
We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer’s disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment.
Design:
Systematic review, Meta-Analysis
Setting:
We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023.
Participants and interventions:
RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included.
Measurement:
Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423).
Results:
The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer’s Disease Assessment Scale–Cognitive Subscale (SMD = −0.96 [−1.32, −0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity.
Conclusion:
The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.
Depressive symptoms in schizophrenia have a high prevalence – up to 20-60 %, at the different illness stages. Non-pharmacological treatment, namely rTMS, seems like a promising approach that lacks side-effects typical for antidepressants. RTMS is widely applied in the treatment of depression, however the studies within schizophrenia domain are still rather few
Objectives
The aim was to examine a potential of neurophysiological data for prediction of the effects of rTMS in the treatment of patients with schizophrenia with depressive symptoms
Methods
20 male patients with schizophrenia (F20.004, F20.014, F20.414, ICD–10) were examined at the stage of incomplete remission with predominance of prolonged (more than 6 months) treatment resistant depressive symptoms. An examination (clinical and neurophysiological (oddball ERP and EEG) fragments)) was repeated twice - before and after a course of 10 Hz rTMS (left DLPC, 2000 pulses per session, 15 sessions).
Results
Poor outcome was associated with initially higher coherence in alpha and lower - in beta1 EEG bands. The amplitudes of non-target N100 and mismatch negativity didn’t differ the groups of responders and nonresponders
Conclusions
The disturbances within brain networks of beta1 and alpha generators merit attention as potential neurophysiological markers with predictive value in rTMS treatment of patients with schizophrenia with depressive symptoms.
Trans-cranial magnetic stimulation (TMS) as a non-invasive method of altering brain activity (1) has widened the array of therapeutic options available for various psychiatric disorders.
Objectives
Trans-cranial Magnetic stimulation (TMS) as a non-invasive method of altering brain activity has widened the array of therapeutic options available for various psychiatric disorders. •A large number of studies have shown therapeutic benefits in a wide range of patient population with majority of studies in adults. •TMS is used increasingly for the treatment of child and adolescent depression. •Yet, the scarcity of studies and lack of published guidelines for this population is notable. •As TMS use is expanding in this population, an overview of the use of TMS in children and adolescents with depression may provide much needed and timely perspective on this neuropsychiatric intervention.
Methods
We searched all published studies using PubMed database, on TMS use in depressive disorders in children and adolescents. A total of 13 studies were found to have reported use of TMS in depression in children and adolescents.
Results
We found various case series, open label studies as well as sham controlled blind studies indicating that TMS has been effective in treating depression in children and adolescents. No significant side effects were found in our review.
Conclusions
Studies have shown that TMS is an effective treatment option for depressive disorders in children and adolescents. Initial studies look promising but implications in large pediatric population may be different and there is a need for more double blind, controlled trials with larger sample size.
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulatory treatment option, which is used in a variety of neurological and psychiatric diseases. It is approved for depression treatment and recommended in international guidelines. A significant reduction in treatment duration was achieved by using theta burst stimulation (TBS) protocols, which are practicable and non-inferior to conventional TMS.
Objectives
To analyse the efficacy and safety of intermittent theta burst stimulation (iTBS) of left DLPFC in inpatients with treatment-resistant depression.
Methods
We evaluated n=44 inpatients with treatment resistant major depressive disorder (n=37) and bipolar depression (n=7), who were treated with the 5 Hz intermittent TBS once daily for 3-6 weeks according to clinical decision. A total of 600 pulses and 200 bursts were applied in each treatment session. Clinical and response data were obtained by chart review.
Results
Mean age at time of first stimulation was 54 years. 61,3 % of patients were female. On average, the current episode started 21 months before the first stimulation. In total, 924 treatment sessions were performed. On average, patients received 21 sessions. The mean MADRS Score pre-treatment was 27.2. Post-treatment, there was a clear reduction in depression severity (MADRS 18.3). No severe adverse events and no seizures occurred in this clinical observational analysis.
Conclusions
Intermittent TBS is efficacious and safe in patients with chronic and refractory depression.
Depressive symptoms are common in individuals with tinnitus, however, the mechanisms of their interaction are not fully understood. There is neurobiological evidence that might help understanding the interplay between tinnitus and depression which, in turn, helps in making the right choice for treating both conditions.
Objectives
This case report describes a 70-year old female patient that presented with tinnitus and depressive symptoms lasting for the past 5 years.
Methods
The patient showed limited treatment results with different antidepressants. The otorhinolaryngologist ruled out any possible somatic causes of her tinnitus. Tinnitus was causing her sleep disturbances, which worsened her everyday functioning that was already quite poor even further.
Results
After being administered with 30 rounds of TMS, her symptoms either completely resolved or at least reached a level that was adequate for her to start functioning normally on a day-to-day basis.
Conclusions
TMS is a technique that provides non-invasive cortical stimulation, more specifically, when used for depression treatment it stimulates the left dorsolateral prefrontal cortex, a brain region synaptically connected to the limbic system involved in mood regulation that is proven to be hypoactive in depression. The limbic system is where tinnitus-related brain networks and regions involved in the pathophysiology of depression overlap. Further research is needed to deepen the understanding of this topic.
Insufficient efficacy of conventional treatment of auditory hallucinations (AH) in schizophrenia supports rising interest to brain stimulation techniques including transcranial magnetic stimulation (TMS). Left temporo-parietal cortex (TP3) is involved in emergence of AH, thus neuromodulation of this area might be reasonable.
Objectives
Comparison of efficacy and tolerability of 2 protocols of TMS (1 Hz and cTBS) over TP3 and sham-TMS for treatment resistant AH in schizophrenia.
Methods
76 schizophrenia (ICD-10 - F20) patients with prominent AH (PANSS P3 ≥ 4, AHRS ≥ 15), who had failed to respond to previous antipsychotic treatment, were randomized into 3 groups: 1) 1 Hz TMS (30 patients); 2) cTBS (25 patients); 3) Sham-TMS (21 patients). Sessions were performed 5 days a week for 3 weeks. Antipsychotic medication was continued throughout the study. Patients were assessed weekly with PANSS, AHRS, CDSS, CGI-S by blinded raters. The criterion of efficacy was 30% AHRS score reduction after 3 weeks of treatment.
Results
The number of responders were 13 (43,3%) in 1 Hz TMS group, 14 (56%) – in cTBS group, 4 (19,1%) in sham-TMS group. There was no statistically significant difference in efficacy between 1 Hz TMS and cTBS, but each of the active protocols was more effective than sham-TMS. Treatment was generally well tolerated in all groups, nobody was discontinued the study due to adverse events.
Conclusions
Both protocols of TMS (1 Hz and cTBS) over TP3 are safe and effective in the treatment of schizophrenic patients with pharmacotherapy resistant AH. Further studies are needed.
Post-traumatic stress disorder (PTSD) is a psychiatric disorder characterized by symptoms from four clusters after exposure to a traumatic event: re-experiencing symptoms including flashbacks and nightmares, hyperarousal, avoidance of internal and external stimuli related to trauma, and negative alterations in mood and cognition. As a noninvasive intervention that uses induction of electromagnetic fields to modulate cortical circuitry, TMS has a substantial body of literature demonstrating safety, tolerability, and efficacy in depression and potentially PTSD.
Objectives
Our aim is to perform a non-systematic review of the literature regarding TMS and PTSD
Methods
A semi-structured review was conducted on Pubmed concerning TMS and PTSD
Results
The majority of studies utilize repetitive TMS targeted to the right dorsolateral prefrontal cortex (DLPFC) at low frequency (1 Hz) or high frequency (10 or 20 Hz), however others have used alternative frequencies, targeted other regions, or trialed different stimulation protocols utilizing newer TMS modalities such as theta-burst TMS (TBS). It is encouraging that were positive outcomes have been shown, and often sustained for up to -3 months, nevertheless there is a paucity of long-term studies directly comparing available approaches.
Conclusions
TMS appears safe and effective for PTSD, although important steps are needed to operationalize optimal approaches for patients.
Recent studies suggest that online repetitive transcranial magnetic stimulation (rTMS) can induce local entrainment of ongoing endogenous oscillatory activity that impacts cognitive performance, and the effect may depend on the function of the oscillation. However, little is known about the effects of task-specific frequencies, especially when using an online rTMS paradigm. Our previous electroencephalogram (EEG) study showed that the frontal theta rhythm is associated with the cognitive giving-up processes during problem-solving tasks.
Objectives
In this study, we combined online rTMS and EEG to examine the frequency-dependent stimulation effects of rTMS on the performance of problem-solving tasks and ongoing oscillations. We hypothesized that rTMS at the theta frequency would induce ongoing theta activity and accelerate the giving-up behaviour.
Methods
rTMS was applied during problem-solving tasks with the following conditions: individual theta (4-6Hz)- and alpha (9-13Hz)-TMS, no-TMS, and sham-TMS; the order of conditions was counterbalanced across participants.
Results
Our results showed that theta-frequency rTMS application induced an increase in theta amplitudes and shortened the giving-up response, while a control alpha-frequency rTMS application induced an increase in alpha amplitudes, but did not change giving-up responses.
Conclusions
This study demonstrated the effectiveness of using specific task-relevant stimulation frequency and target location for the modulation of cognitive and behavioral performance. Furthermore, considering the close resemblance between giving-up behaviour and rumination in depression, neuromodulation of cognitive giving-up processes may lead to a new intervention to treat depression by rTMS.
Fifty years ago, the estimated prevalence of autism was 30-60 per 10,000; now, it has increased to 18.5 per 1,000. Autism disorders are 4.3 times as prevalent among boys as among girls.
Objectives
This systematic review provides an overview of the management of AD with Transcranial Magnetic Stimulation.
Methods
A systematic review was conducted using (“Autism spectrum disorder” AND “Repetitive Transcranial Magnetic stimulation” AND “RTMS” OR “Children and adolescent”) in PubMed, Embase, and PsycINFO, resulted in 453 hits and finally qualified 18 studies.
Results
We found 18 eligible studies, 8 randomize controlled clinical trials, 10 non-controlled clinical trials comparing TMS effects with waiting-list controls (n = 6), sham-treatment (n = 8) and no control group (n=4). There was a significant reduction of repetitive, stereotyped behaviors, irritability, social behavior, and executive function improvements with a medium-size effect. Eleven studies in this review had a moderate to high risk of bias due to small sample size, lack of blinding to treatment, and inadequate follow-up period. Four studies reported the stability of these gains in clinical outcomes for more than six months with no clarification after that.
Conclusions
The data encourages the potential safety and efficacy; it provides significant evidence to support TMS’s efficacy in symptom severity reductions and improved clinical outcomes in children with autism. Therefore, future large-scale randomized controlled trials are required to conclude intervention efficacy in a larger sample size further.
Eating Disorders (ED) tend to evolve chronically, with resistance to different therapeutic strategies. Chronicity is associated with high mortality rates, so it is necessary to study new therapeutic strategies. Transcranial Magnetic Stimulation (TMS) is a non-invasive, safe treatment method, whose application has been studied in several pathologies.
Objectives
Determine the therapeutic potential of Transcranial Magnetic Stimulation in the treatment of Eating Disorders.
Methods
Bibliographic review of the literature published in English in the last 10 years, in the databases Pubmed, PsycINFO and Cochrane. The keywords used were: TMS, Transcranial Magnetic Stimulation, Eating Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder. A review of the titles and abstracts of the resulting articles was made, and selected according to their relevance to the study.
Results
Eighteen articles related to the treatment of ED with TMS were selected, either as primary or secondary outcome, of which six were review articles, ten were randomized controlled trials (RCT), one article was an oral communication and another article was a case report. Three RCTs showed improvement in bulimia nervosa, specifically in symptoms of “food craving”. Four RCT and one case report showed improvement in the symptoms of anorexia nervosa, one RCT showed no improvement in anorexia nervosa.
Conclusions
TMS appears to have some therapeutic potential for the treatment of ED, particularly in reducing food craving, despite some contradictory results. This work reinforces the need for more robust studies to evaluate the effectiveness of TMS, preferably randomized, with a longer follow-up and a cost-benefit analysis.
Motor adaptation is a process by which the brain gradually reduces error induced by a predictable change in the environment, e.g., pointing while wearing prism glasses. It is thought to occur via largely implicit processes, though explicit strategies are also thought to contribute. Research suggests a role of the cerebellum in the implicit aspects of motor adaptation. Using non-invasive brain stimulation, we sought to investigate the involvement of the cerebellum in implicit motor adaptation in healthy participants. Inhibition of the cerebellum was attained through repetitive transcranial magnetic stimulation (rTMS), after which participants performed a visuomotor-rotation task while using an explicit strategy. Adaptation and aftereffects of the TMS group showed no difference in behaviour compared to a Sham stimulation group, therefore this study did not provide any further evidence of a specific role of the cerebellum in implicit motor adaptation. However, our behavioral findings replicate those in the seminal study by Mazzoni and Krakauer (2006).
La TMS est utilisée comme traitement des états dépressifs majeurs (EDM) depuis plusieurs années, le taux de répondeurs variant entre 20 et 60 %. Nous avons voulu confronter ces données avec des patients en conditions naturalistiques. L’objectif principal de ce travail est de déterminer le pourcentage de répondeurs à une première cure de TMS chez des patients présentant un épisode dépressif majeur (EDM). L’objectif secondaire est de déterminer le profil des patients répondeurs.
Méthode
Il s’agit d’une étude de cohorte rétrospective dont les critères d’inclusion sont : EDM isolé (MADRS > 20), ou intégré dans un trouble dépressif récurrent (TDR) ou bipolaire (TB), avec mauvaise réponse ou intolérance aux antidépresseurs. Les critères d’exclusion sont : cure de TMS antérieure, contre-indication. Le protocole de TMS était : 15 séances de stimulation sur le cortex dorso-latéral gauche, fréquence 10 Hz, dix trains de 40 chocs et durée inter-trains de 28 s. L’efficacité et la tolérance du traitement ont été évaluées par comparaison de la variation des scores des échelles MADRS, CGI, et MOCA à j1, puis à j31 après la cure. Une diminution de 25 % à 50 % du score MADRS est une réponse partielle, de 50 % minimum une réponse, un score MADRS inférieure à 10 est une rémission.
Résultats
De 2011 à 2013, 54 patients ont été inclus. L’analyse a porté sur 37 patients. La moyenne d’âge était de 57 ans et 60 % étaient des femmes. Vingt-sept pour cent sont en rémission, 16 % en réponse, 30 % en réponse partielle. Cinquante pour cent présentaient un TDR, 26 % un TB, et 14 % un 1er EDM. Le profil des répondeurs sera détaillé.
Conclusion
Les résultats sont conformes aux données de la littérature. De nouvelles études sont nécessaires pour mieux définir le profil de répondeurs.
In addition to suicide prediction, neuroscience can be expected to contribute in a unique and substantial way to the treatment of suicide risk. For psychotropic drugs such as lithium and clozapine a specific antisuicidal effect has been demonstrated, independent of effects on associated psychiatric disorders. The results from studies with ketamine are promising as they indicate a rapid and sustained relief of suicidal thoughts. Neurostimulation and neuromodulation provide new approaches to treatment, with a substantial impact on suicide risk. Novel pharmacological compounds targeting the vulnerability to suicidal behavior include drugs that affect the stress-response system and neuroprotective factors.