Top

Gepubliceerd in:

05-10-2021 | ORIGINAL PAPER

Enhancing Cognition in Older Persons with Depression or Anxiety with a Combination of Mindfulness-Based Stress Reduction (MBSR) and Transcranial Direct Current Stimulation (tDCS): Results of a Pilot Randomized Clinical Trial

Auteurs: Heather Brooks, Hanadi Ajam Oughli, Lojine Kamel, Subha Subramanian, Gwen Morgan, Daniel M. Blumberger, Jeanne Kloeckner, Sanjeev Kumar, Benoit H. Mulsant, Eric J. Lenze, Tarek K. Rajji

Gepubliceerd in: Mindfulness | Uitgave 12/2021

Abstract

Objectives

Individuals with subjective memory complaints and symptoms of depression and/or anxiety are at high risk for further cognitive decline, and possible progression to dementia. Low-burden interventions to help slow or prevent cognitive decline in this high-risk group are needed. The objective of this study is to assess the feasibility of combining Mindfulness-Based Stress Reduction (MBSR) with transcranial direct current stimulation (tDCS) to increase putative benefits of MBSR for cognitive function and everyday mindfulness in depressed or anxious older adults with subjective cognitive decline.

Methods

We conducted a two-site pilot double-blind randomized sham-controlled trial, combining active MBSR with either active or sham tDCS. The intervention included weekly in-class group sessions at the local university hospital and daily at-home practice. Anodal tDCS was applied for 30 min during MBSR meditative practice, both in-class and at-home.

Results

Twenty-six individuals with subjective cognitive complaints and symptoms of depression and/or anxiety were randomized to active (n = 12) or sham tDCS (n = 14). The combination of MBSR and tDCS was safe and well tolerated, though at-home adherence and in-class attendance were variable. While they were not statistically significant, the largest effect sizes for active vs. sham tDCS were for everyday mindfulness (d = 0.6) and social functioning (d = 0.9) (F_(1,21) = 3.68, p = 0.07 and F_(1,21) = 3.9, p = 0.06, respectively).

Conclusions

Our findings suggest that it is feasible and safe to combine tDCS with MBSR in older depressed and anxious adults, including during remote, at-home use. Furthermore, tDCS may enhance MBSR via transferring its meditative learning and practice into increases in everyday mindfulness. Future studies need to improve adherence to MBSR with tDCS.

Trial Registration

ClinicalTrials.gov (NCT03653351 and NCT03680664).

vorige artikel Testing Mindfulness-Based Relapse Prevention with Medications for Opioid Use Disorder Among Adults in Outpatient Therapy: a Quasi-experimental Study

volgende artikel The Mediating Role of Dispositional Mindfulness in the Associations Between Intimate Violence, Self-esteem, and Distress Among Adolescents

Alleen toegankelijk voor geautoriseerde gebruikers

Antonenko, D., Hayek, D., Netzband, J., Grittner, U., & Floel, A. (2019). tDCS-induced episodic memory enhancement and its association with functional network coupling in older adults. Scientific Reports, 9(1), 2273. https://doi.org/10.1038/s41598-019-38630-7CrossRefPubMedPubMedCentral

Badran, B. W., Austelle, C. W., Smith, N. R., Glusman, C. E., Froeliger, B., Garland, E. L., Borckardt, J. J., George, M. S., & Short, B. (2017). A double-blind study exploring the use of transcranial direct current stimulation (tDCS) to potentially enhance mindfulness meditation (E-Meditation). Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 10(1), 152–154.

Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125.

Bhang, I., Mogle, J., Hill, N., Whitaker, E. B., & Bhargava, S. (2020). Examining the temporal associations between self-reported memory problems and depressive symptoms in older adults. Aging & Mental Health, 24(11), 1864–1871.

Bierman, E., Comijs, H., Jonker, C., & Beekman, A. (2005). Effects of anxiety versus depression on cognition in later life. The American Journal of Geriatric Psychiatry, 13(8), 686–693.PubMed

Carlson, L. E., & Brown, K. W. (2005). Validation of the Mindful Attention Awareness Scale in a cancer population. Journal of Psychosomatic Research, 58(1), 29–33.PubMed

Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., & Choi, S. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63(11), 1179–1194.PubMedPubMedCentral

Chambers, R., Lo, B. C. Y., & Allen, N. B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Therapy and Research, 32(3), 303–322.

de Vibe, M., Bjørndal, A., Fattah, S., Dyrdal, G. M., Halland, E., & Tanner-Smith, E. E. (2017). Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: A systematic review and meta-analysis. Campbell Systematic Reviews, 13(1), 1–264.

Deyo, M., Wilson, K. A., Ong, J., & Koopman, C. (2009). Mindfulness and rumination: Does mindfulness training lead to reductions in the ruminative thinking associated with depression? Explore, 5(5), 265–271.PubMed

Dinn, W., Göral, F., Adigüzel, S., Karamürsel, S., Fregni, F., & Aycicegi-Dinn, A. (2017). Effectiveness of tDCS blinding protocol in a sham-controlled study. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 10(2), 401.

Dobkin, P. L., Hickman, S., & Monshat, K. (2014). Holding the heart of mindfulness-based stress reduction: Balancing fidelity and imagination when adapting MBSR. Mindfulness, 5(6), 710–718.

Donovan, N. J., Wu, Q., Rentz, D. M., Sperling, R. A., Marshall, G. A., & Glymour, M. M. (2017). Loneliness, depression and cognitive function in older US adults. International Journal of Geriatric Psychiatry, 32(5), 564–573.PubMed

Faucher, J., Koszycki, D., Bradwejn, J., Merali, Z., & Bielajew, C. (2016). Effects of CBT versus MBSR treatment on social stress reactions in social anxiety disorder. Mindfulness, 7(2), 514–526.

Feldman, G., Hayes, A., Kumar, S., Kamholz, B., Greeson, J., & Laurenceau, J. (2005). Assessing mindfulness in the context of emotion regulation: The Revised Cognitive and Affective Mindfulness Scale (CAMS-R). In 39th Annual Convention of the Association for behavioral and cognitive therapies, Washington, DC.

Fertonani, A., Brambilla, M., Cotelli, M., & Miniussi, C. (2014). The timing of cognitive plasticity in physiological aging: A tDCS study of naming. Frontiers in Aging Neuroscience, 6, 131.PubMedPubMedCentral

Furukawa, T. A., Takeuchi, H., Hiroe, T., Mashiko, H., Kamei, K., Kitamura, T., & Takahashi, K. (2001). Symptomatic recovery and social functioning in major depression. Acta Psychiatrica Scandinavica, 103(4), 257–261.PubMed

Gallegos, A. M., Hoerger, M., Talbot, N. L., Moynihan, J. A., & Duberstein, P. R. (2013). Emotional benefits of mindfulness-based stress reduction in older adults: The moderating roles of age and depressive symptom severity. Aging & Mental Health, 17(7), 823–829.

Gandiga, P. C., Hummel, F. C., & Cohen, L. G. (2006). Transcranial DC stimulation (tDCS): A tool for double-blind sham-controlled clinical studies in brain stimulation. Clinical Neurophysiology, 117(4), 845–850.PubMed

Gough, N., Brkan, L., Subramaniam, P., Chiuccariello, L., De Petrillo, A., Mulsant, B. H., Bowie, C. R., & Rajji, T. K. (2020). Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review. PLoS ONE, 15(2), e0223029.PubMedPubMedCentral

Haddad, R., Lenze, E. J., Nicol, G., Miller, J. P., Yingling, M., & Wetherell, J. L. (2020). Does patient expectancy account for the cognitive and clinical benefits of mindfulness training in older adults? International Journal of Geriatric Psychiatry, 35(6), 626–632.PubMed

Hahn, E. A., DeVellis, R. F., Bode, R. K., Garcia, S. F., Castel, L. D., Eisen, S. V., Bosworth, H. B., Heinemann, A. W., Rothrock, N., & Cella, D. (2010). Measuring social health in the patient-reported outcomes measurement information system (PROMIS): Item bank development and testing. Quality of Life Research, 19(7), 1035–1044.PubMedPubMedCentral

Hanley, C. J., Alderman, S. L., & Clemence, E. (2020). Optimising cognitive enhancement: Systematic assessment of the effects of tdcs duration in older adults. Brain Sciences, 10(5), 304.PubMedCentral

Irving, J. A., Dobkin, P. L., & Park, J. (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary Therapies in Clinical Practice, 15(2), 61–66.PubMed

Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11–21.PubMed

Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective, & Behavioral Neuroscience, 7(2), 109–119.

Johnson, L. A., Mauer, C., Jahn, D., Song, M., Wyshywaniuk, L., Hall, J. R., Balldin, V. H., & O’Bryant, S. E. (2013). Cognitive differences among depressed and non-depressed MCI participants: A project FRONTIER study. International Journal of Geriatric Psychiatry, 28(4), 377–382.PubMed

Johnson, L. A., Sohrabi, H. R., Hall, J. R., Kevin, T., Edwards, M., O’Bryant, S. E., & Martins, R. N. (2015). A depressive endophenotype of poorer cognition among cognitively healthy community-dwelling adults: Results from the Western Australia memory study. International Journal of Geriatric Psychiatry, 30(8), 881–886.PubMed

Jones, K. T., Stephens, J. A., Alam, M., Bikson, M., & Berryhill, M. E. (2015). Longitudinal neurostimulation in older adults improves working memory. PLoS ONE, 10(4), e0121904.PubMedPubMedCentral

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. Delta.

Kasschau, M., Reisner, J., Sherman, K., Bikson, M., Datta, A., & Charvet, L. E. (2016). Transcranial direct current stimulation is feasible for remotely supervised home delivery in multiple sclerosis. Neuromodulation: Technology at the Neural Interface, 19(8), 824–831.

Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R., & Schimmel, H. (1983). Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. The American Journal of Psychiatry, 140(6), 734–739.PubMed

Lavretsky, H., Laird, K. T., Krause-Sorio, B., Heimberg, B. F., Yeargin, J., Grzenda, A., Wu, P., Thana-Udom, K., Ercoli, L. M., & Siddarth, P. (2020). A randomized double-blind placebo-controlled trial of combined escitalopram and memantine for older adults with major depression and subjective memory complaints. The American Journal of Geriatric Psychiatry, 28(2), 178–190.PubMed

Lenze, E. J., Hickman, S., Hershey, T., Wendleton, L., Ly, K., Dixon, D., Doré, P., & Wetherell, J. L. (2014). Mindfulness-based stress reduction for older adults with worry symptoms and co-occurring cognitive dysfunction. International Journal of Geriatric Psychiatry, 29(10), 991–1000.PubMedPubMedCentral

Lenze, E. J., Stevens, A., Waring, J. D., Pham, V. T., Haddad, R., Shimony, J., Miller, J. P., & Bowie, C. R. (2020). Augmenting computerized cognitive training with vortioxetine for age-related cognitive decline: A randomized controlled trial. American Journal of Psychiatry, 177(6), 548–555.

Lenze, E. J., Voineskos, A. N., Butters, M. A., & Karp, J. F. (2018). Stopping cognitive decline in patients with late-life depression: A new front in the fight against dementia. The American Journal of Geriatric Psychiatry, 26(8), 828–834.PubMedPubMedCentral

Lin, C.-H., Yen, Y.-C., Chen, M.-C., & Chen, C.-C. (2013). Relief of depression and pain improves daily functioning and quality of life in patients with major depressive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 47, 93–98.PubMed

Martens, G., Lejeune, N., O’Brien, A. T., Fregni, F., Martial, C., Wannez, S., Laureys, S., & Thibaut, A. (2018). Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state. Brain Stimulation, 11(5), 982–990.PubMed

Matousek, R., & Dobkin, P. L. (2010). Weathering storms: A cohort study of how participation in a mindfulness-based stress reduction program benefits women after breast cancer treatment. Current Oncology, 17(4), 62–70.PubMedPubMedCentral

Meinzer, M., Lindenberg, R., Antonenko, D., Flaisch, T., & Flöel, A. (2013). Anodal transcranial direct current stimulation temporarily reverses age-associated cognitive decline and functional brain activity changes. Journal of Neuroscience, 33(30), 12470–12478.PubMed

Meinzer, M., Lindenberg, R., Phan, M. T., Ulm, L., Volk, C., & Flöel, A. (2015). Transcranial direct current stimulation in mild cognitive impairment: Behavioral effects and neural mechanisms. Alzheimer’s & Dementia, 11(9), 1032–1040.

Mitchell, A., Beaumont, H., Ferguson, D., Yadegarfar, M., & Stubbs, B. (2014). Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: A meta-analysis. Acta Psychiatrica Scandinavica, 130(6), 439–451.PubMed

Montejo, P., Montenegro, M., Fernández, M. A., & Maestu, F. (2011). Subjective memory complaints in the elderly: Prevalence and influence of temporal orientation, depression and quality of life in a population-based study in the city of Madrid. Aging & Mental Health, 15(1), 85–96.

Moynihan, J. A., Chapman, B. P., Klorman, R., Krasner, M. S., Duberstein, P. R., Brown, K. W., & Talbot, N. L. (2013). Mindfulness-based stress reduction for older adults: Effects on executive function, frontal alpha asymmetry and immune function. Neuropsychobiology, 68(1), 34–43.PubMed

Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699.PubMed

Nicol, G. E., Piccirillo, J. F., Mulsant, B. H., & Lenze, E. J. (2020). Action at a distance: Geriatric research during a pandemic. Journal of the American Geriatrics Society, 68(5), 922–925.PubMed

Nitsche, M. A., & Paulus, W. (2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of Physiology, 527(3), 633–639.PubMedPubMedCentral

Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D., & Group, P. C. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283.PubMedPubMedCentral

Rajji, T. K., Bowie, C. R., Herrmann, N., Pollock, B. G., Bikson, M., Blumberger, D. M., Butters, M. A., Daskalakis, Z. J., Fischer, C. E., & Flint, A. J. (2020). Design and rationale of the PACt-MD randomized clinical trial: Prevention of Alzheimer’s dementia with cognitive remediation plus transcranial direct current stimulation in mild cognitive impairment and depression. Journal of Alzheimer’s Disease, 76(2), 733–751.PubMed

Renner, F., Cuijpers, P., & Huibers, M. (2014). The effect of psychotherapy for depression on improvements in social functioning: A meta-analysis. Psychological Medicine, 44(14), 2913–2926.PubMed

Reynolds, C. F., Butters, M. A., Lopez, O., Pollock, B. G., Dew, M. A., Mulsant, B. H., Lenze, E. J., Holm, M., Rogers, J. C., & Mazumdar, S. (2011). Maintenance treatment of depression in old age: A randomized, double-blind, placebo-controlled evaluation of the efficacy and safety of donepezil combined with antidepressant pharmacotherapy. Archives of General Psychiatry, 68(1), 51–60.PubMedPubMedCentral

Riggs, A., Patel, V., Paneri, B., Portenoy, R. K., Bikson, M., & Knotkova, H. (2018). At-home transcranial direct current stimulation (tDCS) with telehealth support for symptom control in chronically-ill patients with multiple symptoms. Frontiers in Behavioral Neuroscience, 12, 93.PubMedPubMedCentral

Roehr, S., Luck, T., Pabst, A., Bickel, H., König, H.-H., Lühmann, D., Fuchs, A., Wolfsgruber, S., Wiese, B., & Weyerer, S. (2017). Subjective cognitive decline is longitudinally associated with lower health-related quality of life. International Psychogeriatrics, 29(12), 1939–1950.PubMed

Ruf, S. P., Fallgatter, A. J., & Plewnia, C. (2017). Augmentation of working memory training by transcranial direct current stimulation (tDCS). Scientific Reports, 7(1), 1–11.

Sellaro, R., Nitsche, M. A., & Colzato, L. S. (2016). The stimulated social brain: Effects of transcranial direct current stimulation on social cognition. Annals of the New York Academy of Sciences, 1369(1), 218–239.PubMed

Seo, E. H., Kim, H., Choi, K. Y., Lee, K. H., & Choo, I. H. (2017). Association of subjective memory complaint and depressive symptoms with objective cognitive functions in prodromal Alzheimer’s disease including pre-mild cognitive impairment. Journal of Affective Disorders, 217, 24–28.PubMed

Shalev, D., Docherty, M., Spaeth-Rublee, B., Khauli, N., Cheung, S., Levenson, J., & Pincus, H. A. (2020). Bridging the behavioral health gap in serious illness care: Challenges and strategies for workforce development. The American Journal of Geriatric Psychiatry, 28(4), 448–462.PubMed

Shapiro, S. L., Oman, D., Thoresen, C. E., Plante, T. G., & Flinders, T. (2008). Cultivating mindfulness: Effects on well-being. Journal of Clinical Psychology, 64(7), 840–862.PubMed

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(20), 22–33.

Slavin, M. J., Brodaty, H., Kochan, N. A., Crawford, J. D., Trollor, J. N., Draper, B., & Sachdev, P. S. (2010). Prevalence and predictors of “subjective cognitive complaints” in the Sydney Memory and Ageing Study. The American Journal of Geriatric Psychiatry, 18(8), 701–710.PubMed

SPSS, I. (2018). IBM statistical package for social services (Version 25). IBM.

Stahl, B., Meleo-Meyer, F., & Koerbel, L. (2014). A mindfulness-based stress reduction workbook for anxiety. New Harbinger Publications.

Teo, F., Hoy, K. E., Daskalakis, Z. J., & Fitzgerald, P. B. (2011). Investigating the role of current strength in tDCS modulation of working memory performance in healthy controls. Frontiers in Psychiatry, 2, 45.PubMedPubMedCentral

Valiengo, L. C. L., Goerigk, S., Gordon, P. C., Padberg, F., Serpa, M. H., Koebe, S., Dos Santos, L. A., Lovera, R. A. M., de Carvalho, J. B., & van de Bilt, M. (2020). Efficacy and safety of transcranial direct current stimulation for treating negative symptoms in schizophrenia: A randomized clinical trial. JAMA Psychiatry, 77(2), 121–129.PubMed

Vilalta-Franch, J., López-Pousa, S., Llinàs-Reglà, J., Calvó-Perxas, L., Merino-Aguado, J., & Garre-Olmo, J. (2013). Depression subtypes and 5-year risk of dementia and Alzheimer disease in patients aged 70 years. International Journal of Geriatric Psychiatry, 28(4), 341–350.PubMed

Wechsler, D. (2001). Wechsler test of adult reading: WTAR. Psychological Corporation.

Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., Carlozzi, N. E., Slotkin, J., Blitz, D., & Wallner-Allen, K. (2013). Cognition assessment using the NIH Toolbox. Neurology, 80(11 Supplement 3), S54–S64.PubMedPubMedCentral

Wetherell, J. L., Hershey, T., Hickman, S., Tate, S. R., Dixon, D., Bower, E. S., & Lenze, E. J. (2017). Mindfulness-based stress reduction for older adults with stress disorders and neurocognitive difficulties: A randomized controlled trial. The Journal of Clinical Psychiatry, 78(7), e734–e743.PubMed

Titel: Enhancing Cognition in Older Persons with Depression or Anxiety with a Combination of Mindfulness-Based Stress Reduction (MBSR) and Transcranial Direct Current Stimulation (tDCS): Results of a Pilot Randomized Clinical Trial
Auteurs: Heather Brooks
Hanadi Ajam Oughli
Lojine Kamel
Subha Subramanian
Gwen Morgan
Daniel M. Blumberger
Jeanne Kloeckner
Sanjeev Kumar
Benoit H. Mulsant
Eric J. Lenze
Tarek K. Rajji
Publicatiedatum: 05-10-2021
Uitgeverij: Springer US
Gepubliceerd in: Mindfulness / Uitgave 12/2021
Print ISSN: 1868-8527
Elektronisch ISSN: 1868-8535
DOI: https://doi.org/10.1007/s12671-021-01764-9

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Objectives

Methods

Results

Conclusions

Trial Registration

Log in om toegang te krijgen

Andere artikelen Uitgave 12/2021

Psychobiological Mechanisms Underlying the Mental Health Benefits of Yoga-Based Interventions: a Narrative Review

Negative Mood and Food Craving Strength Among Women with Overweight: Implications for Targeting Mechanisms Using a Mindful Eating Intervention

Correction to: Overcoming Automaticity Through Meditation

Mindfulness-Based Intervention for Children with Mental Health Problems: a 2-Year Follow-up Randomized Controlled Study

Mindfulness for Developing Communities of Practice for Educators in Schools

Correction to: The Centrality of Mindfulness-Related Meditations in Early Buddhist Discourse