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71 Treatment with TMS Improves Aspects of Attention in Depression: A Pilot Study

Published online by Cambridge University Press:  21 December 2023

Nicole C Walker ,
Nathan Ramirez ,
Laurie Chin ,
Sonia S Rehman ,
Stephanie C Gee ,
Kathleen Hodges ,
Leanne M Williams ,
Robert Hickson ,
L. Chauncey Green  and
Talaya Patton
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Nicole C Walker*
Affiliation:
Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA. Stanford University School of Medicine, Palo Alto, CA, USA.
Nathan Ramirez
Affiliation:
Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA. California School of Professional Psychology, Fresno, CA, USA.
Laurie Chin
Affiliation:
Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA. University of Indianapolis, Graduate Department of Clinical Psychology, Indianapolis, IN, USA.
Sonia S Rehman
Affiliation:
Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA. Fielding Graduate University, Santa Barbara, CA, USA.
Stephanie C Gee
Affiliation:
Stanford University School of Medicine, Palo Alto, CA, USA. Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
Kathleen Hodges
Affiliation:
Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
Leanne M Williams
Affiliation:
Stanford University School of Medicine, Palo Alto, CA, USA. Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
Robert Hickson
Affiliation:
Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA. Palo Alto University, Palo Alto, CA, USA.
L. Chauncey Green
Affiliation:
Stanford University School of Medicine, Palo Alto, CA, USA. Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
Talaya Patton
Affiliation:
Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
Hanaa Aldasouqi
Affiliation:
Stanford University School of Medicine, Palo Alto, CA, USA. Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
Noah S Philip
Affiliation:
Providence VA Healthcare System, Providence, RI, USA. Warren Alpert Medical School of Brown University, Providence, RI, USA.
F. Andrew Kozel
Affiliation:
Department of Behavioral Sciences and Social Medicine Florida State University, Tallahassee, FL, USA
Jerome A Yesavage
Affiliation:
Stanford University School of Medicine, Palo Alto, CA, USA. Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
Michelle R Madore
Affiliation:
Stanford University School of Medicine, Palo Alto, CA, USA. Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Palo Alto, CA, USA.
*
Correspondence: Nicole C. Walker, Mental Illness Research, Education, and Clinical Center VA Palo Alto Health Care System, Stanford University School of Medicine, Nicole.walker1@va.gov
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Abstract

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Objective:

Repetitive transcranial magnetic stimulation (TMS) is an evidenced based treatment for adults with treatment resistant depression (TRD). The standard clinical protocol for TMS is to stimulate the left dorsolateral prefrontal cortex (DLPFC). Although the DLPFC is a defining region in the cognitive control network of the brain and implicated in executive functions such as attention and working memory, we lack knowledge about whether TMS improves cognitive function independent of depression symptoms. This exploratory analysis sought to address this gap in knowledge by assessing changes in attention before and after completion of a standard treatment with TMS in Veterans with TRD.

Participants and Methods:

Participants consisted of 7 Veterans (14.3% female; age M = 46.14, SD = 7.15; years education M = 16.86, SD = 3.02) who completed a full 30-session course of TMS treatment and had significant depressive symptoms at baseline (Patient Health Questionnaire-9; PHQ-9 score >5). Participants were given neurocognitive assessments measuring aspects of attention [Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV) subtests: Digits Forward, Digits Backward, and Number Sequencing) at baseline and again after completion of TMS treatment. The relationship between pre and post scores were examined using paired-samples t-test for continuous variables and a linear regression to covary for depression and posttraumatic stress disorder (PTSD), which is often comorbid with depression in Veteran populations.

Results:

There was a significant improvement in Digit Span Forward (p=.01, d=-.53), but not Digit Span Backward (p=.06) and Number Sequencing (p=.54) post-TMS treatment. Depression severity was not a significant predictor of performance on Digit Span Forward (f(1,5)=.29, p=.61) after TMS treatment. PTSD severity was also not a significant predictor of performance on Digit Span Forward (f(1,5)=1.31, p=.32).

Conclusions:

Findings suggested that a standard course of TMS improves less demanding measures of working memory after a full course of TMS, but possibly not the more demanding aspects of working memory. This improvement in cognitive function was independent of improvements in depression and PTSD symptoms. Further investigation in a larger sample and with direct neuroimaging measures of cognitive function is warranted.

Keywords

attentiondepressionneurostimulation
Type
Poster Session 05: Neuroimaging | Neurophysiology | Neurostimulation | Technology | Cross Cultural | Multiculturalism | Career Development
Information
Journal of the International Neuropsychological Society , Volume 29 , Supplement s1: Final Program Fifty First Annual Meeting International Neuropsychological Society February 1–4, 2023 San Diego, CA, USA , November 2023 , pp. 476 - 477
Copyright
Copyright © INS. Published by Cambridge University Press, 2023