Cognitive Remediation + tDCS for Mental Health Disorders in Seniors

(CREAtE Trial)

Overseen By Shima Ovaysikia, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Centre for Addiction and Mental Health

Disqualifiers: Active substance use, ECT, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 40

Duration: 8 weeks

18 Participants Needed

Trial Summary

What is the purpose of this trial?

Focusing on seniors with mental health conditions who are living in the community, this initiative proposes to assess the acute and long-term effects of an 8-week course of daily (5 days/week) cognitive remediation (CR) training among 270 participants living in five LOFT senior housing units. The acute course of CR will be followed by monthly one-week boosters until the end of this 5-year study, totaling approximately 24-60 months of follow-up. This trial will also be used as a platform to explore the ability to use transcranial direct current stimulation (tDCS) to optimize response to CR by participant randomization to active versus sham tDCS. Our ultimate goal is to improve the lives of seniors experiencing mental illness and shape a future where they can live independently.

Do I need to stop my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications. However, you must be clinically stable, which includes not having any changes in your psychotropic medication dosage within the 4 weeks before assessment.

What data supports the effectiveness of the treatment Cognitive Remediation and Transcranial Direct Current Stimulation for mental health disorders in seniors?

Research shows that transcranial direct current stimulation (tDCS) can improve cognitive functions like processing speed, working memory, and executive functions in people with mood and schizophrenia-spectrum disorders. It also suggests potential benefits for mental flexibility and inhibition in older adults with depression or anxiety. ^{1 2 3 4 5}

Is Cognitive Remediation + tDCS safe for seniors with mental health disorders?

Transcranial Direct Current Stimulation (tDCS) has been used safely in many human trials, including with seniors and those with mental health disorders, without serious side effects. Common mild side effects include skin redness, tingling, and itching, which are usually temporary and well-tolerated. ^{1 3 6 7 8}

How does the treatment Cognitive Remediation + tDCS for Mental Health Disorders in Seniors differ from other treatments?

This treatment is unique because it combines cognitive remediation (a therapy to improve thinking skills) with transcranial direct current stimulation (tDCS), a non-invasive method that uses a low electrical current to enhance brain function. Unlike traditional treatments, this approach specifically targets cognitive deficits in seniors with mental health disorders by potentially improving processing speed, working memory, and executive functions. ^{1 2 3 4 5}

Research Team

Angela Golas, MD

Principal Investigator

Centre for Addiction and Mental Health

Eligibility Criteria

This trial is for seniors aged 50+ with mental health conditions who are stable, haven't been hospitalized for psychiatric reasons in the last 3 months, and haven't changed their psychotropic meds in the last month. They must be able to see, hear well enough to participate, speak English, and give informed consent.

Inclusion Criteria

Corrected visual ability that enables reading of newspaper headlines and corrected hearing capacity that is adequate to respond to a raised conversational voice.

Willingness to provide informed consent or assent as applicable.

Clinically stable as operationalized by (1) having not been admitted to a psychiatric hospital within the 3 months prior to assessment, (2) having had no change in psychotropic medication dosage within the 4 weeks prior to assessment, and (3) ascertained to be clinically and medically stable by one the study psychiatrists.

Exclusion Criteria

Has significant cognitive impairment that, in the opinion of the PI, precludes benefit from CR and therefore study participation.

I don't have skin diseases, pacemakers, metal in my head, brain devices, or conditions like epilepsy.

I have not had electroconvulsive therapy in the last 6 months.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants undergo clinical, neuropsychological, and functional assessments before enrollment

1-2 weeks

Treatment

Participants receive Cognitive Remediation (CR) and tDCS for 8 weeks, 5 days per week

8 weeks

40 sessions (in-person)

Booster Sessions

Monthly booster sessions of CR and tDCS for 3-5 days each month

24-60 months

Follow-up

Participants are monitored for safety and effectiveness after treatment, with annual assessments

24-60 months

Treatment Details

Interventions

• Cognitive Remediation and Transcranial Direct Current Stimulation

Trial Overview The study tests an 8-week daily cognitive remediation (CR) training with monthly boosters over up to five years. It also examines if brain stimulation using tDCS can enhance CR's effectiveness. Participants will be randomly assigned to active or sham (fake) tDCS groups.

Participant Groups

Group I: Cognitive Remediation and Active Transcranial Direct Current Stimulation Active Control 1 Intervention

Cognitive Remediation (CR) is a form of group psychosocial intervention that uses a hybrid approach of restorative and strategy based methods to improve areas of cognition (ie. attention, memory, processing speed and learning) through the use of computerized exercises. Transcranial Direct Current Stimulation (tDCS): tDCS will be administered for 30 min/day, at the beginning of each group session. tDCS montage will be frontal with anode placed over Fz and the cathode over Iz. The direct current will be of 2 mA (current density = 0.57 A/m2). CR + tDCS is administered in groups consisting of 2-10 participants and one or two therapists. The groups meet 5 times per week for two hours per session over eight weeks, for a total of 40 sessions in induction phase. Afterwards 3 to 5 sessions per week on monthly boosters.

Group II: Cognitive Remediation and Sham Transcranial Direct Current Stimulation Placebo Group 1 Intervention

CR is identical to the one described under the Active Comparator Arm. However, sham tDCS will consist of active stimulation for only 1 min/day, at the beginning of each group session. tDCS montage and the frequency of the sessions and the boosters will be the same as for the Active Arm.

Who Is Running the Clinical Trial?

Centre for Addiction and Mental Health

Lead Sponsor

Trials

388

Recruited

84,200+

LOFT Community Services

Collaborator

LOFT Community Services

Collaborator

Trials

4

Recruited

490+

Findings from Research

Transcranial direct current stimulation (tDCS) has shown potential to improve cognitive functions such as processing speed, working memory, and executive functions in patients with mood disorders and schizophrenia, based on a systematic review of 41 studies.

The effects of tDCS on cognitive functioning and memory in Alzheimer's disease and mild cognitive impairment are less clear, with evidence being inconclusive or weak, highlighting the need for standardized protocols in future research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcranial Direct Current Stimulation and Cognition in Neuropsychiatric Disorders: Systematic Review of the Evidence and Future Directions. Ciullo, V., Spalletta, G., Caltagirone, C., et al.[2022]

Anodal transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex significantly improved cognitive tasks related to processing speed, selective attention, and planning in five older adults with mild cognitive impairment (MCI).

The study suggests that combining tDCS with cognitive stimulation programs may enhance cognitive performance in individuals with MCI, but further research is needed to explore long-term effects and practical applications in daily life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Transcranial Direct Current Stimulation on the Cognitive Functions in Older Adults with Mild Cognitive Impairment: A Pilot Study. Cruz Gonzalez, P., Fong, KNK., Brown, T.[2022]

Anodal transcranial direct current stimulation (tDCS) significantly improved cognitive performance in healthy elderly individuals by increasing neural activity, as evidenced by enhanced P200 and P300 amplitudes during a working memory task.

Cathodal tDCS also showed potential benefits for Alzheimer's disease patients, increasing P200 amplitude and frontal theta activity, suggesting that tDCS can modulate neural function differently based on the individual's cognitive state.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioural and electrophysiological modulations induced by transcranial direct current stimulation in healthy elderly and Alzheimer's disease patients: A pilot study. Cespón, J., Rodella, C., Miniussi, C., et al.[2020]

In a pilot study involving 30 older adults with depression and/or anxiety, transcranial direct current stimulation (tDCS) significantly improved executive functioning, particularly inhibitory processing and cognitive flexibility, as evidenced by better performance on the Stroop test and Trail Making Test-Part B.

The study suggests that tDCS may be a promising non-invasive treatment to enhance cognitive processing in geriatric patients, although it did not show significant effects on attention or working memory.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

tDCS over the left prefrontal Cortex improves mental flexibility and inhibition in geriatric inpatients with symptoms of depression or anxiety: A pilot randomized controlled trial. Figeys, M., Villarey, S., Leung, AWS., et al.[2022]

Transcranial Direct Current Stimulation (tDCS) has been shown to be safe, with no reports of Serious Adverse Effects or irreversible injuries across over 33,200 sessions involving more than 1,000 subjects, including vulnerable populations.

Safety assessments indicate that the current densities used in conventional tDCS (≤4 milliamperes) are significantly lower than those that could potentially cause brain injury, suggesting that tDCS protocols are well within safe limits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Bikson, M., Grossman, P., Thomas, C., et al.[2022]

Transcranial direct current stimulation (tDCS) is a non-invasive technique that can influence neuronal activity and induce lasting synaptic changes, making it a promising treatment for neuropsychiatric disorders, particularly unipolar depression.

tDCS is advantageous due to its minimal side effects and potential for portability, which could allow for home use and enhance patient care in the future.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Non-invasive cortical stimulation: Transcranial direct current stimulation (tDCS). Sudbrack-Oliveira, P., Razza, LB., Brunoni, AR.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Transcranial Direct Current Stimulation and Cognition in Neuropsychiatric Disorders: Systematic Review of the Evidence and Future Directions. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

The Effects of Transcranial Direct Current Stimulation on the Cognitive Functions in Older Adults with Mild Cognitive Impairment: A Pilot Study. [2022]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Behavioural and electrophysiological modulations induced by transcranial direct current stimulation in healthy elderly and Alzheimer's disease patients: A pilot study. [2020]

4. Switzerland pubmed.ncbi.nlm.nih.gov

tDCS over the left prefrontal Cortex improves mental flexibility and inhibition in geriatric inpatients with symptoms of depression or anxiety: A pilot randomized controlled trial. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Effects of bilateral transcranial direct current stimulation on working memory and global cognition in older patients with remitted major depression: A pilot randomized clinical trial. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Non-invasive cortical stimulation: Transcranial direct current stimulation (tDCS). [2022]

8. Ireland pubmed.ncbi.nlm.nih.gov

Tolerance of transcranial direct current stimulation in psychiatric disorders: An analysis of 2000+ sessions. [2020]