The population in the United States is aging, which means evidence showing transcranial magnetic stimulation (TMS) treatment for Alzheimer’s disease is more relevant than ever before. New research into transcranial magnetic stimulation (TMS) as a treatment for age-related dementia and cognitive decline associated with Alzheimer’s disease (AD) offers promise for the new public health challenges we face in the 21st century.
Shifting Demographics Mean New Priorities
According to the U.S. Census Bureau, we’ll see a significant milestone in just over a decade. Population experts estimate that by 2034 there will be more people over the retirement age – 77 million – than people under age 18 – 76.5 million.
Here’s how our population has changed in recent years:
2016:
- Under age 18: 73.6 million (22.8%)
- Over age 65: 49.2 million (15.2%)
2021:
- Under age 18: 73.4 million (22.7%)
- Over age 65: 55.8 million (16.8%)
Here’s how data scientists estimate our population will change over the next forty years:
2034 Estimate:
- Under age 18: 76.5 million (18.8%)
- Over age 65: 77.0 million (23.2%)
2060 Estimate:
- Under age 18: 80.1 million (19.8%)
- Over age 65: 94.7 million (23.4%)
That’s a significant shift in the makeup of the country, with implications for all aspects of our society. As our population changes, our national public health priorities will change, too. The demand for basic care for the aging population will increase, as well as the demand for specific care for the health issues we all face as we get older.
In 2023, the leading causes of death for people age 65+ are heart disease, cancer, and COVID-19, and the leading causes of disability are arthritis/rheumatism, back/spine problems, and heart disease. However, there’s another medical condition that we need to prepare to address as the relative proportions of our population change in the years to come: Alzheimer’s disease (AD) and the dementia and cognitive decline associated with AD.
What is Alzheimer’s Disease?
The Centers for Disease Control (CDC) defines Alzheimer’s disease as follows:
“Alzheimer’s disease (AD) is the most common type of dementia, as well as the most common cause of dementia. It’s a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment. AD involves parts of the brain that control thought, memory, and language, and can significantly impair a person’s ability to carry out daily activities.”
One thing many people don’t understand about Alzheimer’s is that changes in the brain that lead to AD symptoms may appear 20 years before the appearance of memory loss, thought problems, or language difficulties. The brain changes associated with AD begin with language and memory. Over time, they can have a significant impact on:
- Mood
- Behavior
- Daily activities like dressing and bathing
- Walking
- Swallowing
When brain damage associated with AD becomes severe enough to impair essential functions such as walking and swallowing, patients become bed-bound and need around-the-clock care. Before patients reach this point, however, one major problem is wandering. A person with AD may walk away from their safe location, then be unable to retrace their steps. In some cases, they may not remember their name, where they live, or their emergency contact information. Research shows that in patients with AD, the phenomenon known as wandering dementia can increase risk of injury or death.
The available data shows the following outcomes for people diagnosed with AD:
- Adults 65+ with AD diagnosis survive an average of 4-8 years
- Some survive for close to 20 years
That’s why this article – and the research we discuss – is important. If we can identify and prevent the changes in the brain that lead to the most severe AD symptoms, we can improve the experience of old age for millions of people.
We’ll talk about the new study that examines the effectiveness of TMS – the innovative treatment we mention above – in a moment. Before we get there, however, we’ll share the latest prevalence figures on AD, discuss the known causes of AD, present the warning signs, risk factors, protective factors, and review the most common current treatments for AD.
Alzheimer’s Disease: Facts and Figures
The Alzheimer’s Association, a non-profit advocacy group that works to raise awareness about Alzheimer’s disease, reports the following rates of AD among adults in the U.S.
Alzheimer’s Disease: Prevalence
- Among older adults:
- 65+: 6.7 million (10.7% of all adults 65+)
- 65-74: 1.79 million (27% of people with AD)
- 75-84: 2.54 million (37.9% of people with AD)
- 85+: 2.37 million 33.3% (35.4% of people with AD)
- By gender:
- Around 67% of people with AD are female
- Close to 20% of women develop AD
- Close to 20% of men develop AD
- Among younger adults (younger-onset AD, ages 30-64)
- About 110 of every 100,000 people
- Around 200,000 total
It’s also important to understand factors surrounding treatment of AD. In addition to the prevalence statistics above, the Alzheimer’s association indicates:
- 40% of people say they’d tell their doctor they experienced cognitive decline or memory loss
- 70% would accept early treatment if early effective treatment and diagnosis became available
In addition, we should know that AD-associated deaths doubled between 2000 and 2019 – mirroring the relative population increases, and that older Black and Hispanic people are more likely to develop AD than older White people. But here’s the statistic that’s most important for healthcare providers – and all of us – to read and understand:
In the absence of medical advances or a cure for AD, experts estimate 12.7 million people in the U.S. will have AD by the year 2050.
Treatment for Alzheimer’s Disease and Cognitive Decline
The National Institute on Aging (NIA) reports that there are several medications approved by the Food and Drug Administration (FDA) for the treatment of Alzheimer’s disease. Due to the complexity of the disease, experts warn that it’s unlikely that one drug, one treatment, or one medication will be appropriate for all people diagnosed with AD.
However, the medications that do exist work best for people in the early stages of AD. These medications are FDA-approved to treat people with mild to moderate AD:
- Galantamine
- Rivastigmine
- Donepezil
- Lecanamab
- Aducnamab
The FDA also recently approved Donepezil and Rivastigmine to treat people with severe AD. Previously, the only medications approved to treat severe AD were Memantine and a combination of Memantine and Donepezil.
That’s why results of a new study – Precuneus Magnetic Stimulation for Alzheimer’s Disease: A Randomized, Sham-Controlled Trial – offer hope for people with AD, people at risk of developing AD, and the millions of people around the country with a loved one experiencing the dementia and cognitive decline associated with AD.
This study examined the impact of a new approach to AD treatment called repetitive transcranial magnetic stimulation (rTMS) on AD-related cognitive decline. TMS is not a medication: it’s one of a class of treatments for mental health and other neurological diagnoses called brain stimulation therapies (BSTs). To learn more about TMS, please read our page here:
Relief TMS
Transcranial magnetic stimulation (TMS) uses targeted electromagnetic pulses to stimulate specific areas of the brain and relieve the symptoms of various mental health diagnoses such as treatment-resistant depression (MDD-TR), anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and others. In most cases, TMS machines deliver noninvasive electromagnetic pulses through a coil placed directly on the scalp.
Can TMS Work for Alzheimer’s Disease?
Previous clinical trials on TMS for AD involved short treatment sessions lasting two to six weeks. In those trials, researchers targeted a brain area called the dorsolateral prefrontal cortex. In contrast, this new study involved a longer treatment protocol that targeted a different area of the brain, the precuneus.
Researchers recruited 50 patients with AD with an average age of 75. They delivered TMS according to the following schedule:
- 24 weeks total
- 2 weeks of once-a-day TMS or placebo, five times per week
- 22 weeks of once-a-week TMS or placebo
To measure the impact of TMS, the study team used one primary outcome metric, and three secondary metrics. These included:
- Primary metric: the Clinical Dementia Rating Scale (CDRS)
- Secondary metrics: the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-CS), the Mini-Mental State Examination (MMSE), and the Alzheimer’s Disease Cooperative Study – Activities of Daily Living scale (ADCS-ADL)
Primary Metric: Clinical Dementia Rating Scale
Patients who received TMS maintained stable scores on the CDRS over the entire study period:
- TMS patient scores on the CDRS decreased by an average of 0.25 points
Patients who received placebo showed a steady worsening of scores on the CDRS over the study period:
- Placebo patient scores on the CDRS decreased by an average of 1.5 points
Secondary Metrics: Clinical Dementia Rating Scale
Compared to patients who received placebo, patients who received TMS showed statistically better scores on all three secondary metrics.
- TMS patient scores on the ADAS-CS decreased by an average of 0.2 points
- Placebo patient scores on the ADAS-CS decreased by an average of 4 points
- TMS patient scores on the MMSE did not decrease
- Placebo patient scores on the MMSE decreased by an average of 2 points
- TMS patient score on the ADCS-ADL scale improved at 12 weeks and returned to baseline at 24 weeks. Overall, there was no average decrease in scores for the TMS group on this metric
- Placebo patient scores on the ADCS-ADL scale decreased by an average of 7.5 points
To understand these scores, it’s important to know that cognitive decline associated with AD can progress rapidly. For context, scores for 30-40 percent of people with AD on the MMSE decrease by an average of four points over six months. When we compare this to the finding that patients in the TMS group showed no decrease in scores on the MMSE over the six-month study period, we see that this TMS protocol may offer real hope for people with AD.
Here’s how the study authors describe the results:
“We conclude that 24 weeks of precuneus rTMS may slow down cognitive and functional decline in Alzheimer’s disease. Repetitive TMS targeting the default mode network could represent a novel therapeutic approach in Alzheimer’s disease patients.”
Transcranial Magnetic Stimulation (TMS) for Alzheimer’s Disease Treatment
In an article in Psychology Today, Dr. Eugene Rubin and Dr. Charels Zorumski recognize that this is an important – “albeit early” – study on a relatively small number of patients. And while this study was longer than previous studies on TMS for AD, they also point out that in the big picture, 24 weeks is a short amount of time.
Here’s what they say needs to happen before TMS for AD becomes a mainstream treatment:
- The results need replication in “larger, multi-site, randomized, double-blind, placebo-controlled studies.”
- The precise protocol – duration, dosing, stimulation parameters – needs both replication and confirmation as “best practice.”
- Duration of symptom relief beyond 24 weeks needs confirmation.
- If duration of symptom relief does not extend past 24 weeks, researchers need to devise protocols for further treatment
If further studies meet these needs, then – according to Rubin and Zorumski – this new approach may be an important step in treatment for AD. Once researchers confirm clinical efficacy, and if TMS receives FDA approval for treating Alzheimer’s disease, the remaining hurdles to clear would revolve around the “availability and scalability.”
We’re confident that if the promise of this new research is fulfilled, the changing dynamics of our general population will ensure that any effective treatment for AD will become available on a large scale. With adults over age 65 on schedule to outnumber children under age 18 by 2034, the demand for effective methods to stop or slow cognitive decline will be in high demand. The benefits of TMS – non-invasive, no systemic side effects, fast-acting, durable – make it a perfect candidate to meet the new public health challenges we’ll face over the next several decades.
