ACHIEVE: Accelerated and Extended-rTMS to Heighten Inhibitory Control Engagement in Veterans
VA Office of Research and Development
Summary
Impaired inhibitory response manifests clinically as increased impulsivity, which leads to poorer affective, cognitive, social, and occupational functioning. Neuropsychiatric disorders prevalent among Veterans, such as Attention Deficit/Hyperactivity Disorder (ADHD), are associated with poor inhibitory control. The mainstay of clinical treatment for ADHD is psychostimulants, yet these medications have significant risks, including dependence and numerous side effects. Thus, novel and non-pharmacological therapeutic strategies are needed. Intermittent Theta Burst Stimulation, a newer form of transcranial magnetic stimulation, has emerged as a promising tool for modulating inhibitory neuronal circuits. This research proposal will investigate the feasibility and acceptability of iTBS on inhibitory control and impulsivity through a randomized controlled trial to inform clinical observations. The long-term goal is to improve impulsivity, social and occupational functioning, and enhance the quality of life for Veterans.
Description
Neuropsychiatric disorders such as Attention Deficit/Hyperactivity Disorder (ADHD), Traumatic Brain Injury (TBI), Posttraumatic Stress Disorder (PTSD), Substance Use Disorder (SUD), and suicidality impose major public health burdens. In 2021, the Centers for Disease Control and Prevention reported a 4% increase in the suicide rate, marking the largest annual rise since 2001, with 14.1 deaths per 100,000 of the United States standard population. Among Veterans, the unadjusted suicide rate escalated from 23.3 per 100,000 in 2001 to 31.7 per 100,000 in 2020, with the highest rates (46.1 per 100,…
Eligibility
- Age range
- 18–65 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Diagnosis of ADHD predominantly hyperactive-impulsive or combined, as outlined in the DSM-5-TR criteria * Maintenance of clinical symptoms despite receiving stable treatment for a minimum of 6 weeks before the study procedures * Capability to comprehend and provide informed consent * For safety reasons, participants must meet established screening criteria to ensure safety during Magnetic Resonance Imaging (MRI) scans * This precaution is taken due to the novel application of iTBS in this specific population, as MRI involves exposure to magnetic fields similar in inte…
Interventions
- DeviceIntermittent Theta-Burst Stimulation
Theta Burst Stimulation is a second-generation TMS modality. iTBS enhances cortical excitability, facilitating synaptic connections through putative long-term potentiation-like effects. In addition, iTBS also stands out given its favorable safety profile and its brief administration time.
- DeviceSham Stimulation
Sham will be administered using equivalent procedures but with a sham coil.
Location
- Providence VA Medical Center, Providence, RIProvidence, Rhode Island