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postgraduate thesis: Efficacy of transcranial pulse stimulation in treating mild neurocognitive disorders
Title | Efficacy of transcranial pulse stimulation in treating mild neurocognitive disorders |
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Authors | |
Advisors | |
Issue Date | 2024 |
Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
Citation | Fong, T. K. H. [方君憲]. (2024). Efficacy of transcranial pulse stimulation in treating mild neurocognitive disorders. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. |
Abstract | Background: The current drug treatments for mild neurocognitive disorder (NCD) have limited success and can cause potential side effects. Transcranial Pulse Stimulation (TPS), a method that utilizes repeated, high-pressure, shortened shockwave pulses to stimulate brain areas, has demonstrated its effectiveness in significantly improving cognitive function in old-age adults with Alzheimer’s Disease. However, it is still unclear whether TPS can be equally effective in patients with mild NCD.
Objective/Hypothesis: The objective of this study was to assess the efficacy and acceptability of TPS using a global brain stimulation method in elderly individuals with mild NCD. This evaluation was conducted through clinical assessments, biochemical tests, and neuroimaging analysis.
Methods: In this open-label study, old-aged adults with mild NCD were enrolled to undergo a neuro-navigated TPS intervention for over two weeks, with three sessions each week. The primary cognitive outcome was evaluated using the Hong Kong version of the Montreal Cognitive Assessment (HK-MoCA) total scores, which were measured at baseline, after 12-week treatment-as-usual period, immediately after TPS intervention, and at 3-month follow-up. Magnetic Resonance Imaging (MRI) scans were conducted before and after the TPS
interventions to analyze changes in functional connectivity and cortical thickness among the participants. Blood samples were collected to assess the APOE genotype, C-Reactive Protein (CRP), and Brain-derived neurotrophic factor (BDNF).
Results: 19 participants (7 males and 12 females) completed all TPS sessions with without any adverse side effects. Repeated measures ANOVAs showed significant improvements over time in several cognitive tests (all p < 0.05), including the HK-MoCA, 30-second interval of Verbal Fluency Test, Stroop interference, and the Chinese Instrumental Activities of Daily Living score after TPS intervention. Notably, the improvement on HK-MoCA remained significant in 3-month follow-up after Bonferroni correction. However, there were no significant changes in the levels of BDNF and CRP serum. Functional MRI analysis revealed significant changes in functional connectivity (FC) in the left hippocampus and posterior right parahippocampus after TPS intervention. A decrease in FC in the posterior left parahippocampus was significantly associated with higher global cognition (HK-MoCA) scores, B = 0.087 (CI, 0.007-0.167; p = 0.038). There was no significant difference in the average cortical thickness of brain regions before and after TPS. Interestingly, an inverse correlation was found between the HK-MoCA scores and the cortical thickness of right precuneus (r = -0.764, p = 0.019).
Conclusion: TPS has shown considerable success in enhancing cognitive function in older adults with mild NCD. It holds substantial promise as an adjunct treatment option that could potentially slow down cognitive decline in the elderly. The long-term impact of TPS on cognitive functioning could be further elucidated through additional large-scale, randomized, sham-controlled trials. |
Degree | Master of Philosophy |
Subject | Nervous system - Diseases - Treatment Brain stimulation |
Dept/Program | Psychiatry |
Persistent Identifier | http://hdl.handle.net/10722/350301 |
DC Field | Value | Language |
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dc.contributor.advisor | Cheng, PWC | - |
dc.contributor.advisor | Chan, WC | - |
dc.contributor.author | Fong, Tommy Kwan Hin | - |
dc.contributor.author | 方君憲 | - |
dc.date.accessioned | 2024-10-23T09:46:01Z | - |
dc.date.available | 2024-10-23T09:46:01Z | - |
dc.date.issued | 2024 | - |
dc.identifier.citation | Fong, T. K. H. [方君憲]. (2024). Efficacy of transcranial pulse stimulation in treating mild neurocognitive disorders. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. | - |
dc.identifier.uri | http://hdl.handle.net/10722/350301 | - |
dc.description.abstract | Background: The current drug treatments for mild neurocognitive disorder (NCD) have limited success and can cause potential side effects. Transcranial Pulse Stimulation (TPS), a method that utilizes repeated, high-pressure, shortened shockwave pulses to stimulate brain areas, has demonstrated its effectiveness in significantly improving cognitive function in old-age adults with Alzheimer’s Disease. However, it is still unclear whether TPS can be equally effective in patients with mild NCD. Objective/Hypothesis: The objective of this study was to assess the efficacy and acceptability of TPS using a global brain stimulation method in elderly individuals with mild NCD. This evaluation was conducted through clinical assessments, biochemical tests, and neuroimaging analysis. Methods: In this open-label study, old-aged adults with mild NCD were enrolled to undergo a neuro-navigated TPS intervention for over two weeks, with three sessions each week. The primary cognitive outcome was evaluated using the Hong Kong version of the Montreal Cognitive Assessment (HK-MoCA) total scores, which were measured at baseline, after 12-week treatment-as-usual period, immediately after TPS intervention, and at 3-month follow-up. Magnetic Resonance Imaging (MRI) scans were conducted before and after the TPS interventions to analyze changes in functional connectivity and cortical thickness among the participants. Blood samples were collected to assess the APOE genotype, C-Reactive Protein (CRP), and Brain-derived neurotrophic factor (BDNF). Results: 19 participants (7 males and 12 females) completed all TPS sessions with without any adverse side effects. Repeated measures ANOVAs showed significant improvements over time in several cognitive tests (all p < 0.05), including the HK-MoCA, 30-second interval of Verbal Fluency Test, Stroop interference, and the Chinese Instrumental Activities of Daily Living score after TPS intervention. Notably, the improvement on HK-MoCA remained significant in 3-month follow-up after Bonferroni correction. However, there were no significant changes in the levels of BDNF and CRP serum. Functional MRI analysis revealed significant changes in functional connectivity (FC) in the left hippocampus and posterior right parahippocampus after TPS intervention. A decrease in FC in the posterior left parahippocampus was significantly associated with higher global cognition (HK-MoCA) scores, B = 0.087 (CI, 0.007-0.167; p = 0.038). There was no significant difference in the average cortical thickness of brain regions before and after TPS. Interestingly, an inverse correlation was found between the HK-MoCA scores and the cortical thickness of right precuneus (r = -0.764, p = 0.019). Conclusion: TPS has shown considerable success in enhancing cognitive function in older adults with mild NCD. It holds substantial promise as an adjunct treatment option that could potentially slow down cognitive decline in the elderly. The long-term impact of TPS on cognitive functioning could be further elucidated through additional large-scale, randomized, sham-controlled trials. | - |
dc.language | eng | - |
dc.publisher | The University of Hong Kong (Pokfulam, Hong Kong) | - |
dc.relation.ispartof | HKU Theses Online (HKUTO) | - |
dc.rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject.lcsh | Nervous system - Diseases - Treatment | - |
dc.subject.lcsh | Brain stimulation | - |
dc.title | Efficacy of transcranial pulse stimulation in treating mild neurocognitive disorders | - |
dc.type | PG_Thesis | - |
dc.description.thesisname | Master of Philosophy | - |
dc.description.thesislevel | Master | - |
dc.description.thesisdiscipline | Psychiatry | - |
dc.description.nature | published_or_final_version | - |
dc.date.hkucongregation | 2024 | - |
dc.identifier.mmsid | 991044860749403414 | - |