Transcranial Magnetic Stimulation (TMS) in the Elderly

Journal: Current Psychiatry Reports 20(1) (2018)

Authors: I.G Iriarte, M George

Background:

Repeated daily prefrontal Transcranial Magnetic Stimulation (rTMS) for 4–6 weeks for treating depression was first proposed as a treatment in 1994, and was FDA approved 14 years later in 2008. Almost a decade later, the field is still rapidly developing and changing. Specifically, with respect to its use as a treatment in the elderly, TMS offers unique advantages. Because the electrical stimulation is focal and not systemic, TMS has relatively fewside effects, no deleterious cognitive effects, and no drug-drug interactions, which are problems often found with other treatments in the elderly.

Objective:

This review paper aims to review select applications of Transcranial Magnetic Stimulation (TMS) that have significant relevance in geriatric psychiatry.

Findings:

Small study sizes and parameter variability limit the generalizability of many TMS studies in geriatric patients. Additionally, geriatric patients have unique characteristics that can moderate the efficacy of TMS. Nonetheless, several promising experimental applications in addition to the FDA-approved indication for major depression have emerged. Cognitive impairment, neuropathic pain, and smoking cessation are experimental applications with special significance to the elderly. Cognitive impairment has been researched the most in this population and evidence thus far suggests that TMS has potential therapeutic benefit. There is also evidence to suggest benefit from TMS for neuropathic pain and smoking cessation in working age adults. TMS is consistently reported as a safe and well-tolerated treatment modality with no adverse cognitive side effects.

Conclusions:

TMS is a safe treatment modality that can be effective for certain applications in the elderly. Additional research that specifically includes older subjects is needed to replicate findings and to optimize treatment protocols for this population.

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