Transcutaneous Electrical Nerve Stimulation for Dementia

Original Editor - Tolulope Adeniji

Top Contributors - Tolulope Adeniji and Kim Jackson

Description

Although Transcutaneous electrical nerve stimulation is known for non-pharmacological pain control, some scholars have shown that it may also be used for brain stimulation in people with dementia[1][2]. Applying TENS electrodes to the head is called Cranial Electrical Nerve Stimulation (CES) or Transcranial Stimulation and is one of the techniques used to stimulate the brain of a person with dementia.[1]. Despite recent evidence that CES alone or in combination with physiotherapy improves certain functional activities in person with possible cognitive impairment[3], yet, trans-cranial electrical nerve stimulation is not a common practice among physiotherapists who are one of the experts in dementia management. Accordingly, this paper will provide information on the CES method of application to stimulate the brain of a person with dementia.

Dementia(Major Neurocognitive disorder)

DSM-5 details on the definition and diagnosis of neurocognitive disorders.[4] Dementia, now referred to as a major neurocognitive disorder under DSM-5 for neurocognitive disorder, is an impairment in one or more cognitive domains with impaired functional status[4], which is of concern to both patient and patient relative. A cognitive impairment without significant effect on a person with dementia's  activities of daily living is considered mild neurocognitive impairment.Neuropsychological and behavioral characteristics such as anxiety, depression and sleep disturbances are prominent features of dementia.[5][6] Such symptoms, including neurocognitive dysfunction, may be enhanced by using transcranial electrical nerve stimulation.[1][7][8].

Cognitive Impairment Assessment

Evaluating a person with dementia requires standardized neuropsychological assessment tools. Among these tools, the most common universally used is Mini Mental State Examination[9] and for functional status, Functional Activities Questionnaire (FAQ) for older adults might be used[10]. In addition, these tools can be used to monitor the progress of the intervention of a person with major neurocognitive impairment.

Cranial Electrical Nerve Stimulation (CES) intervention

Scholars argued that TENS could stimulate the brain and improve both cognitive impairment and neuropsychological characteristics of the dementia.[1] However, the use of electrotherapy modalities such as TENS requires a skin sensation test to determine whether the intervention is appropriate. Furthermore, the application of CES requires a number of parameters  and this depend  on the objectives to be achieved[8] [11]. Moreno-Duarte,[8] argued that low-level transcranial electrical nerve stimulation is the most documented intensity level of CES application and four methods exist for this: transcranial direct current stimulation (tDCS), transcranial pulsed current stimulation (tPCS), transcranial alternating current stimulation (tACS) and transcranial random noise stimulation (tRNS) (see Figure 1 for more information). Although there is still some controversy regarding the use of CES among people with dementia, there is support for the evidence that the use of CES combined with physiotherapy or not improve cognitive, physical and behavioral characteristics of a person with dementia.[3][12]

Figure 1

CES in Physiotherapy Practice for Brain Stimulation

Transcranial direct current stimulation (tDCS) is a widely reported type of cranial electrical nerve stimulation in Physiotherapy.[2]. Schabrun[2] noted that with different TENS parameters for different conditons, tDCS could improve both neurological and musculoskeletal conditons. Also, Yotnuengnit et al., [3] reported that tDCS improves gait speed and step length among patients with Parkinson disease. While CES may be beneficial in stimulating a person with a brain dementia, further studies are needed in patients with cognitive impairment to determine the efficacy of this intervention.

Resources

References

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