P21: Intermittent theta burst stimulation for treatment of behavioral and psychological symptoms of dementia in Alzheimer’s disease and its effect on the use of antipsychotics – study protocol

Abstract

Behavioral and psychological symptoms of dementia (BPSD), such as agitation, psychosis and depression, develop in the majority of patients with Alzheimer’s disease in the progression of the disease. The management of BPSD, especially in the hospital setting, frequently includes psychopharmacotherapy, particularly second-generation antipsychotics (SGAs). These are associated with significant side effects.

In recent years, repetitive transcranial magnetic stimulation (rTMS) and its accelerated protocols, continuous and intermittent theta burst stimulation (cTBS, iTBS), have proven effective in treating depression. There have also been published studies that showed their effectiveness in Alzheimer’s disease, in both cognition and BPSD.

We will conduct a 6 week, double-blind, randomized, controlled trial in patients with Alzheimer’s disease and BPSD, hospitalized at the University Psychiatric Clinic Ljubljana. The patients in the stimulated group will receive iTBS of the left dorsolateral prefrontal cortex for five days a week, for two consecutive weeks. The patients in the sham group will have the exact same procedural protocol, but will receive sham stimulation form the sham coil. We will evaluate BPSD before and after protocol using various clinical scales. We will look if the doses of the prescribe SGAs in the stimulated group differ from the placebo group and, if so, if the difference persists at the follow-up after four weeks.