Newly published study from Germany on TPS

Newly published study from Germany on TPS

Several studies by a research team at the Medical University of Vienna, Department of Neurology, have already shown that patients with symptoms of Alzheimer’s dementia report an increase in cognitive abilities (measured by CERAD test) after TPS and also report a significant improvement in depressive symptoms (using Beck’s Depression Inventory; BDI).1,2

In a new study, Cont et al. analyse initial TPS results from a centre in Germany.3 The authors provide a retrospective pilot study of the feasibility, safety, and short-term effect of TPS on cognitive and emotional function in Alzheimer’s patients. To gain further insight into TPS in patients with symptoms of Alzheimer’s disease at different stages, patients with symptoms of mild, moderate, and severe Alzheimer’s dementia were included in the study.

Eleven patients with Alzheimer’s disease were assessed for their cognitive and emotional functions in the Department of Neurology and Neurorehabilitation at Hospital zum Heiligen Geist in Kempen, Germany, before and after the first TPS stimulation series (nine men, two women, ages 59–77 years, average = 69.8 years). The following treatment protocol was used:

  • Energy: 0.20 mJ/mm2
  • Frequency: 4 Hz
  • Treatment areas: bilateral frontal cortex, bilateral lateral parietal cortex, and extended precuneus cortex. Compared to previous studies, the bilateral temporal cortex was included in the TPS treatment for the first time.
  • Treatment sessions: either six sessions of 6,000 pulses over 2 weeks with a ≥ 48 h break between sessions or 12 sessions of 3,000 pulses each day.

Four patients had »mild«, five had »moderate«, and two had »severe« cognitive symptoms. The following outcomes were collected before and after the TPS stimulation series: Alzheimer’s Disease Assessment Scale (ADAS), consisting of a cognitive subscale (ADAS-Cog) and a subscale assessing behavioural and psychological symptoms (ADAS-Non-Cog), Mini-Mental Status Examination (MMSE), and Montreal Cognitive Assessment (MoCA). In addition, subjective changes in symptom severity, effects on depressive symptoms, and side effects were assessed using numerical rating scales (NRS). Changes from pre- to post-measurement and associations between these changes and initial disease severity were statistically analysed. Changes within groups of different symptom severity (mild, moderate, and severe according to MSSE) were descriptively presented.

Results and conclusions
Adverse events (pain in the jaw, nausea, drowsiness) occurred rarely (in 4% of sessions), and none lasted longer than one day. Significant improvements were seen in ADAS and ADAS-Cog. Some patients showed only modest improvements, with others showing significant improvements. The largest increase in one patient was 40%. No significant change was observed in the MMSE and the MoCA. The patients’ self-reported symptom severity improved significantly. Depressive symptoms measured in an ADAS subscale also improved significantly. Statistical data analysis revealed no significant correlation between clinical improvement and baseline symptom severity. These non-significant results may be explained by the small number of cases and the associated power; however, a descriptive analysis of the data showed greater improvement in severely and moderately affected patients compared with mildly affected patients in most tests.

According to the authors, these results suggest that severely and moderately affected patients also benefit from TPS in the same way as mildly affected patients.

Click here to read the full study

1. Beisteiner R, Matt E, Fan C, et al. Transcranial pulse stimulation with ultrasound in Alzheimer’s disease—a new navigated focal brain therapy. Adv Sci. 2019;7:1902583.
2. Matt E, Dörl G, Beisteiner R. Transcranial pulse stimulation (TPS) improves depression in AD patients on state-of-the-art treatment. Alzheimer’s Dement. 2022;8:e12245.
3. Cont C, Stute N, Galli A, Schulte C, Logmin K, Trenado C and Wojtecki L. Retrospective real-world pilot data on transcranial pulse stimulation in mild to severe Alzheimer's patients. Front Neurol. 2022 Sept 14;13:948204. doi: 10.3389/fneur.2022.948204