Long-term, home-based transcranial direct current stimulation coupled with computerized cognitive training in frontotemporal dementia: A case report

Abstract

We present the case of a 62-year-old woman with probable behavioral variant of frontotemporal dementia (bvFTD) with cognitive/language deficits who demonstrated improved performance on cognitive/language testing and in functional tasks following long-term, home-based transcranial direct current stimulation (tDCS) coupled with computerized cognitive training (CCT). The patient underwent home-based tDCS (anode on the left prefrontal cortex and cathode on the right homologue) for 46 sessions over 10 weeks along with CCT. On post-treatment testing, the patient improved by 3 points on the Mini-Mental State Exam (MMSE) (23 to 26). She also showed improvement on several cognitive/language tasks, such as immediate recall of single words and word pairs, total accurate words in sentence repetition, delayed recall, semantic processing, and sentence level comprehension. There was no decline in several other cognitive and language tasks. Family members reported subjective improvements in expressiveness, communication, and interaction with others as well as increased attention to grooming and style which contrasted with her pre-treatment condition. This report suggests that home-based tDCS combined with CCT for an extended period may slow decline, and improve cognitive/language performance and everyday function in FTD.

Keywords: Frontotemporal dementia; behavioral variant frontotemporal dementia; case report; transcranial direct current stimulation.

Figure 1.

Baseline performance on the Montreal Cognitive Assessment.

Figure 2.

Saggital, coronal, and axial MRI showing diffuse, bilateral atrophy and a small left inferior frontal cavernoma.

Figure 3.

Cortical gray matter volumes of the whole brain (top) and by lobe (bottom) in the left and right hemispheres compared to healthy controls before and after tDCS with computerized cognitive training. Y-axis indicates the values of gray matter volume normalized by individuals’ intracranial volume. All of the patient’s values are significantly lower than the control group (p<1 × 10⁻⁴) except for the insula cortex bilaterally (ps > .1), evaluated by Crawford’t test.