Auricular transcutaneous vagal nerve stimulation in the treatment of Alzheimer's disease
Mehinagić, Kendall Lenore
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Alzheimer’s disease is the most common cause of dementia worldwide. As the disease course progresses, it can be debilitating to the patient and provide a large burden for their families and caregivers alike. As our population ages, it more important than ever to find safe and efficacious strategies to combat the cognitive effects of Alzheimer’s disease. While there have been many recent advances surrounding early identification of the disease including the use of PET imaging with specific targeted ligands or CSF analysis for biomarkers, there has been less progress in the development of disease modifying therapies to halt or reverse the symptoms. Vagus nerve stimulation has been a standard in therapy for drug-resistant epilepsy and depression for many years. It has been proven to be effective and has led to drastic improvement in many patients’ lives whose diseases were refractory to standard medications. There is evidence that stimulation of the vagal nerve leads to a physiologic response that also supports long term potentiation of memory within the hippocampus, though trials have been limited by sample size in the past due to the necessity of surgical implantation of the vagal nerve stimulator device. The recent development of non- invasive vagal nerve stimulation removes this limitation. This non-invasive strategy takes advantage of the auricular branch of the vagus nerve innervation of the ear to access the vagal pathway. The following work includes a proposal for a randomized control study to investigate the cognitive benefits of non-invasive vagal nerve stimulation of the auricular branch of the vagus nerve in a cohort of patients with MCI due to Alzheimer’s disease. This trial is planned for patients of neurology or gerontology practices associated with Boston Medical Center, Massachusetts General Hospital, Beth Israel Hospital, and Brigham and Women’s Hospital. Outcomes of this study will be the change in Mini- Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-Cog) score over a two-year intervention time.