The Repetitive Transcranial Magnetic Stimulation in Alzheimer’s Disease Patients with Behavioral and Psychological Symptoms: A Case Report
摘要
Introduction. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that is effective in combination with pharmacological treatment in reducing psychiatric and behavioral symptoms in people with Alzheimer’s disease. Currently, in Vietnam, there are not many applications in this field. This report aims to describe a case of a person with moderate-stage Alzheimer’s disease treated for auditory hallucinations using rTMS. Methodology. The patient was a 79-year-old man diagnosed with Alzheimer’s disease based on DSM-5 criteria and had hallucinations for approximately two months. He was being treated daily with Donepezil 10mg and Quetiapine 50 mg, which is the maximum dose he tolerated without any improvement. The treatment protocol consisted of 1 Hz rTMS applied between the T3 and P3 sites, in accordance with the 10–20 EEG system. The intensity of the stimulation was maintained at 90% of the patient’s resting motor threshold. There were nine sessions in total, starting with 480 pulses on the initial day, then 720 pulses on the second day, and 960 pulses for each of the seven subsequent sessions. The Auditory Vocal Hallucination Rating Scale (AVHRS) was completed immediately before and after therapy. Results. The AVHRS score increased by 6 points compared to before therapy, with a decrease in the frequency of symptoms and patient stress. Furthermore, no adverse effects were observed. Conclusion and Discussion. The low pulse frequency of 1 Hz may suppress the effects on neural circuits or induce long-term depression. Therefore, repeated sessions of low-frequency TMS targeting the left temporo-parietal cortex, where auditory hallucinations may be caused by abnormal activation of language perception areas, could represent an innovative, efficacious, and relatively safe approach to managing psychiatric manifestations in people with Alzheimer’s disease. Nonetheless, more research is needed to confirm these findings.