Transcranial Direct Current Stimulation (tDCS) with Cognitive Training to Reduce Impulsivity and Weight in Veterans with Obesity: A Clinical Trial

在减肥和非减肥受试者中，冲动与顽固性肥胖有关(Sutin 2011， Filbey 2017，Gunstad 2017，Galioto 2016，Benard 2017)。健康的前额叶皮质(PFC)可能会缓解 过度冲动通过作为把关人提供关键的执行功能来影响食欲调节。 Galioto等人发现，在结构化医学减肥中，执行功能预测减肥成功 计划(Galioto 2016)。在此背景下，改善前额叶执行功能以缓解冲动 对肥胖症的治疗很有价值。改善执行功能的认知训练尚未显示出来 足够的治疗承诺。同样，经颅直流电刺激(Tdcs)，一种非侵入性的 针对PFC的神经调节模式已被证明是安全和耐受性良好的，但还不够 作为单一疗法有效。 将前额神经调节与认知训练相结合可能是新的、有效的前进道路 作为肥胖症治疗的前额神经调节。这两种模式一起增强了 在我们团队成员所做的研究中，有执行功能缺陷的非肥胖受试者(Gilmore 2018)。 有冲动性行为临床病史的30名受试者被招募参加一项假控制方案 将气球模拟风险任务与连续五天的25分钟tDCS相结合，进行决策测试 在背侧PFC上输送2 mA恒流，在右侧PFC上输送阳极 在左边的PFC上有阴极。主动tdcs刺激结合认知训练改进气球 Barratt冲动量表上的模拟风险任务绩效和降低的冲动性。降低风险 决策推广到第二个与风险有关的决策任务，即风险任务，它还没有 在模拟训练期间使用。在最后两个阶段，风险决策的减少持续存在 一个月的跟踪访问。这一证据支持了我们的假设，即tdcs结合大脑训练可以 增强冲动相关患者的执行功能和改善临床结果 条件。像这样的基于神经可塑性的干预措施可能会为 挑战肥胖的临床问题。 我们已经组建了一个研究团队，他们拥有肥胖和神经调节方面的专业知识 在受试者中进行主动与假TDCs结合认知训练的随机双盲试验 肥胖的人报告饮食失控，并参加了一个有组织的团体生活方式指导计划。 我们将确定tdcs结合认知训练是否会降低这些患者的冲动。 肥胖。我们的第二个目标是评估tdcs结合执行功能训练是否能增加体重。 损失。

Impulsivity has been implicated in refractory obesity in bariatric and non-bariatric subjects (Sutin 2011, Filbey 2017, Gunstad 2017, Galioto 2016, Benard 2017). A healthy prefrontal cortex (PFC) may mitigate excess impulsivity effects on appetite regulation by providing critical executive function as a gate-keeper. Galioto et al found that executive function predicts weight loss success in structured medical weight loss programs (Galioto 2016). Given this background, improving prefrontal executive function to mitigate impulsivity would be valuable in obesity treatment. Cognitive training for improvement of executive function has not shown sufficient therapeutic promise. Similarly, transcranial direct current stimulation (tDCS), a noninvasive neuromodulation modality, aimed at the PFC has been shown to be safe and well tolerated but not sufficiently effective as monotherapy. Combining prefrontal neuromodulation with cognitive training may be the novel, effective way forward for prefrontal neuromodulation as obesity therapy. Together, the two modalities enhanced executive function in non-obese subjects with executive function deficits in studies done by members of our team (Gilmore 2018). Thirty subjects with a clinical history of impulsive behavior were recruited for a sham-controlled protocol coupling the balloon analog risk task, a decision-making test, with five consecutive days of 25-minute tDCS treatments in which a 2-mA constant current was delivered over the dorsolateral PFC, anode over right PFC and cathode over the left PFC. Active tDCS stimulation coupled with cognitive training improved Balloon Analog Risk Task performance and reduced impulsivity on the Barratt Impulsiveness Scale. Reduction in risky decision making generalized to a second risk-related decision-making task, the Risk Task, which had not been utilized during the stimulated training sessions. Reduction in risky decision making persisted at the final two month follow up visit. This evidence supports our hypothesis that tDCS coupled with brain training can enhance executive function and improve clinical outcomes in individuals who suffer from impulsivity-related conditions. Neuroplasticity-based interventions such as this may provide novel treatment approaches to the challenging clinical problem of obesity. We have assembled a team of investigators with combined obesity and neuromodulation expertise to conduct a randomized double-blind trial of active vs. sham tDCS combined with cognitive training in subjects with obesity who report out-of-control eating and are enrolling in a structured group lifestyle coaching program. We will determine if tDCS coupled with cognitive training decreases impulsivity in these individuals with obesity. Our second aim is to evaluate whether tDCS coupled with executive function training enhances weight loss.