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Column: CNV-X Capstone Project — the effects of Alzheimer’s and how TMS can help

I recently attended a neuroscience summer camp called CNV-X (clinical Neuroscience Virtual Experience), which was taught by Stanford professors who are incredibly learned in the subject. During this experience, I was given the opportunity to work with five other members to create a capstone project. As the neurotechnology team, we decided to set up a clinical trial using TMS (Transcranial Magnetic Stimulation), a new treatment for diseases that affects the brain. Our target population were the elderly most affected by Alzheimer’s.

About 5.8 million Americans are devastated by Alzheimers each year. It is also the fifth leading cause of death for those aged 65 and older, and the #1 leading cause for disability and poor health. Alzheimer’s causes severe memory loss, slurred speech, wandering, change in personality, and difficulty completing daily tasks. 

Alzheimer’s is a neurodegenerative disease that leads to the decline of behavioral and cognitive thinking skills. The disease begins in the temporal lobe, located at the center of the brain, and then slowly expands to other parts. It first arises from amyloid and tau tangles (protein malfunctions) that are often caused by high blood pressure. The clumps bind to the receptors of the neuron and change the structure of the synapse, thus disrupting neurological communication. The clump deposits outside the neuron creating dense plaques. Eventually, this will cause tangles in the actual nerve cell, destroying the structure of the cytoskeleton, and collapsing the neuron’s transport system.

There are a few common stimulants of Alzheimer’s, first being hereditary. If someone had a first degree relative, say a parent or sibling, they are two to three times more likely to get the disease. Moreover, if you previously had a moderate concussion than you are two to three times as susceptible. Finally, if you ever had a severe concussion, then you are three times more prone to get Alzheimer’s when you are an elder. 

My group decided to look into how TMS can become a common treatment for people affected by Alzheimer’s. TMS (Transcranial Magnetic stimulation) is a frequent and non intrusive treatment for brain diseases.

During Alzheimer’s, neurons slowly deteriorate and die, which will break the connections that are vital for a human to function properly. To solve that issue, TMS uses a short, electromagnetic coil to send a powerful outburst to help stimulate neurons in your brain. The stimulation helps the neurons continue to communicate smoothly. One session of TMS is a daily process lasting up to 60 minutes for four to six weeks. TMS is at a rather nascent stage, but is proven to be relatively successful. TMS is also cheaper in comparison to other treatments, especially compared to DBS(deep brain stimulations). Many insurance companies such as Aetna and Cigna are slowly working to absorb most of the cost. The side effects are also minute, there may be a small headache but that quickly dissipates. In contrast, deep brain stimulation is very invasive and going through surgery can produce many complications, of which the elderly are particularly vulnerable.

TMS commonly used for patients with PTSD, OCD, and depression. There are many existing studies to test the effects of TMS on Alzheimer’s disease. However, there are many shortcomings in those trials. For instance, they had a small sample size (<15). Also, they did not take into account that Alzheimer’s and depression overlap up to 50% of the time, therefore it is difficult to discern if it affected Alzheimer’s or other diseases. Finally, the unit of measurement was usually a test, nevertheless most patients would improve after the procedure because they practiced, not purely because of TMS. 

My neurotechnology group sought to improve upon these studies and produce a more accurate clinical trial. We will first implement a larger sample size so we can control for confounding variables and also extend the duration to flesh out more data. We will create multiple cognitive tests with family member’s faces and also examine their ability to perform daily tasks (brushing teeth, combing hair, simple conversations etc.). Lastly, a questionnaire will be given a few weeks after the session to see their overall discomfort and emotional state. In the future, we hope to test for concomitant medication that will positively impact the patient and may decrease the length of each session. 

If successful, TMS will be a key way to alleviate the torment of Alzheimer’s disease in an elderly person. Not only will it help the patient strive to become more self-reliant, but also give the community more contributing members. The positive impacts of TMS are endless. 

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