Dementia

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transkranielle Magnetstimulation

Dementia (lat. dementia „without spirit“) is a deficit of cognitive, emotional and social abilities which leeds to an impairment of social and professional functions and often are accompanied by verified respectively diagnosed brain-related problems. Especially the short-term memory, further on the ability to think, the language and the motor function - in some types also the personality structure – are affected. The loss of already acquired skills and capabilities is decisive in contrast to inherent reduced efficiency. Today several causes of dementia are cleared, some types can be treated to a certain extend. This means that the symptoms can be retarded in the early stages of a dementia. The most of all occurring type of dementia is the Alzheimer’s disease.

Our observations of more than 200 patients suffering of Alzheimer and frontotemporal dementia as well as vascular dementia showed very positive effects. The rTMS particularly had a favourable influence on the faculty of speech, on thinking abilities, concentration, attention and the general well being. Partly a significantly increased social interest combined with an improved capability of establishing contacts were stated. The success rate in this case is over 80%. Regarding mild cognitive impairment rTMS can avoid or at least retard the transition into a demental stage.

Based on PET examinations significant changes of the cerebral metabolism could be proven after only one rTMS-session:
 

Before
Before
After
After

Patient reports for dementia care:

1. Care of a patient with severe Alzheimer’s dementia:

The 63 year old patient is in the final stage of Alzheimer’s dementia. On November 3, 2001 after increasing obfuscation she fell into a coma with gasping of breath and bradycardia (Glasgow-coma-scale score: 03). After emergency medical intravenous Ringer solution care with Atropin, Akrinor as well as Xylocain, the patient awoke from the coma, remained however without any type of verbal reaction. Thereafter no medication was administered except for 1000ml Ringer solution. Since the summer of 2001, the patient proved to be therapeutically refractory with regards to the medication with Donepecil and Memantine.

After four weeks without any verbal reaction but with ever increasing psychomotilic agitation the patient in December received several treatments with rTMS.

As a result after three stimulations a reduction in the psychomotilic agitation could be observed. After another three stimulations the patient began to speak again. Although in the beginning there were predominant neologisms, confabulations, and semantic blunders, the patient was able to express after time even concrete wishes and perceptions such as:  “Please come,” and “That hurts.” The verbal competence remained at this level into February 2002.

Additionally, after years of inability, the patient was able to lift a glass to her lips and drink independently. The appetite normalized after the magnet stimulation.

 

2.  Care of a patient with cerebral-vascular dementia:

During care of an 85 year old patient with mid grade dementia with rTMS there was a great degree of improvement of the symptoms. The positive development was displayed in a renewed vitality as well as an increased interest in the surroundings and an increase in the ability to communicate.

Process:

The patient was initially in a rehab clinic, was however not able to be properly treated there due to refusal to eat. He also displayed emotional lability with lachrymose, a tendency to flee, homesickness, and aggressiveness towards strangers. The necessary measures of care could not be properly administered. After arriving at home the patient appeared emaciated and dehydrated, was relatively immobile, denied basic care, was extremely aggressive during assistance, was disoriented in time and displayed no interest in verbal communication. The patient was at home for a total of 3 weeks when the first treatment of rTMS began.

After the 3rd treatment there was still no considerable change. The relatives did however notice that the patient seemed more lucid and the eyes were clearer.

After the 4th treatment there was a definite increase in interest for the surroundings, for example in the media, current events, as well as the outside world, seasons, and weather.

After the 5th treatment the patient was mindful of his appearance, combed his hair, examined himself in the mirror, used after shave, cleaned spots from his clothes. The patient continued to read the paper daily and watch television.

After the 6th treatment the patient tried to employ remaining abilities such as the following activities around the house: put away dishes, open and close window shades. The patient felt the desire to leave the house and for example visit a Café, and this although he is disabled and it is difficult for him to walk.

The relatives noticed after the 7th treatment that the patient actively participated in family discussions and also discussed politics.  The newspaper continued to interest him and the local events. The relatives noticed a return of short term memory in as much as the patient was able to remember discussions and events of the previous two weeks, for example he inquired as to when the bath tub seat would arrive and knew that in the pre-Christmas period the Christkindl Market was approaching. However the orientation was still missing for the time of day and week.  All in all the patient felt more well adjusted and now took pleasure in life. He had discarded his indifference with relation to his surroundings and had become very communicative.

In December he had caught such a bad cold that the treatments needed to be interrupted. After about 6 weeks without therapy there was a degradation of the re-gained abilities that for example the forgetfulness returned as well as an increased withdrawal inward, increased limitation of mobility and activities.

 

Current rTMS studies concerning dementia: