Acute improvement in the attention network with repetitive transcranial magnetic stimulation in Parkinson’s disease

Abstract

Purpose

To investigate the effect of two weeks of repetitive transcranial magnetic stimulation (rTMS) on the attention network in Parkinson’s disease (PD) patients.

Materials and methods

Sixty PD patients were randomly divided into equal-sized active- and sham-rTMS groups. Executive function was assessed by neuropsychological tests including the Trail-Making Test (TMT), word fluency test, digit span, Wisconsin Card Sorting Test (WCST) and Stroop test. The attention network was evaluated by the attention network test (ANT). rTMS (5 Hz) was applied over the left dorsolateral prefrontal cortex (DLPFC) in the active-rTMS group, and the sham-rTMS group underwent sham stimulation, both for two weeks. All tests were performed before and after rTMS.

Results

After active rTMS, nonparametric analysis revealed significant improvements in categories completed (CC) (p < 0.001) in the WCST and reaction times (RTs) in part 3 (p = 0.002) and the Stroop interference effect (SIE) (p < 0.001) in the Stroop test. Regarding the ANT, the RTs of the executive control network were significantly reduced (p < 0.001). There was no significant change after sham rTMS.

Conclusions

In the short term, in PD patients, rTMS improved the executive control network involved in resolving conflicting information. However, it showed milder effects on neuropsychological test outcomes assessing executive function, which may involve different neuromechanisms.

Implications for rehabilitation

• Cognitive impairment is common in patients with Parkinson’s disease (PD), and it is related to functional disability and reduced quality of life.

• Attention is a main component of the cognitive system, and attention deficits are responsible for disability.

• This study demonstrates that rTMS is beneficial for cognitive rehabilitation in PD, as patients showed improved performance on the attention network test and neuropsychological tests.

Keywords:

• Parkinson’s disease
• rTMS
• attention network test
• executive control
• executive functions

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We are grateful to Ms. Rong Zhang for her expert advice regarding the statistical analysis.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

The data collected in this study are available from the corresponding authors upon request.

Additional information

Funding

This work was supported by a research foundation grant from the Health and Family Planning Commission of Sichuan Province (Grant No. 17PJ085) and a research foundation grant from Southwest Medical University (Grant No. 2018-ZRQN-015).