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Objective: To assess whether 1) repetitive transcranial magnetic stimulation (rTMS) can ameliorate aphasia in Alzheimer9s disease (AD) patients and 2) whether there are changes in activation patterns in relevant cortical areas using functional brain imaging subsequent to rTMS. Background Among the earliest manifestations of AD are deficits in language that significantly impair patients9 quality of life. Currently approved agents for slowing progression of AD do not target aphasia. Studies have demonstrated beneficial effects of rTMS in improving cognition and language deficits in patients with neurological disorders. rTMS may be a potential therapeutic tool to help improve aphasia in AD patients. Design/Methods: Eleven AD patients with aphasia underwent 4 sessions of rTMS applied to the dorsolateral prefrontal cortex at a frequency of 10-15 Hz over two weeks. They underwent standardized cognitive tests at baseline, immediately after completing the course of rTMS, and 4-weeks after the last rTMS treatment. All patients underwent concomitant functional MRI (fMRI) scans at the time of the tests while performing cognitive paradigms in the scanner. Results: All patients completed the cognitive portions of the study. Three patients could not tolerate imaging and therefore did not complete the imaging portion of the study. There was improvement in verbal and non-verbal agility on testing that was seen 4-weeks post-treatment relative to baseline (p Conclusions: These preliminary results suggest that rTMS may serve as an effective adjunctive treatment for aphasia found in AD patients. Further research using control stimulation is needed. Disclosure: Dr. Devi has nothing to disclose. Dr. Levine has nothing to disclose. Dr. Voss has nothing to disclose. Dr. de Boisblanc has nothing to disclose. Dr. Heier has nothing to disclose. Dr. Halper has nothing to disclose.

The Ia alloantigens as measures of different alleles of loci in the major histocompatibility complex were determined in patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). The Ia specificities of reagents used were defined by their pattern of reaction with lymphoblastoid lines derived from normal donors homozygous for HLA-D determinants. The reagent specificities included those associated with a single Dw type as well as those reacting with a single specificity shared by several Dw types. Patients with RA had a marked elevation in the frequency of alloantigens detected by reagent sera that recognize various determinants shared by cell lines from HLA-Dw4, Dw7, or Dw10 individuals (Ia 4-7-10). The frequency of mixed lymphocyte culture alleles Dw4 and Dw10 was found to be increased; however this elevation did not approach the higher frequency for the serologically determined antigens of the Ia 4-7-10 group. In contrast, patients with SLE had an increased frequency of reactions with the reagent alloantisera defined by reactions with either HLA-Dw2 or Dw3 positive cell lines. The data suggest that immunogenetic factors are relevant to both groups of patients, but that these are entirely distinct for each disease.

The design of neurorehabilitation therapy to treat subjects with altered consciousness provides opportunities and challenges to professionals involved with the care for these severely ill patients. While there is an increased interest in determining methods to restore consciousness in these patients, the process is complex and challenging, due in part to the diverse aetiology of these states of consciousness, and also to the intricate cerebral connectivity involved in their treatment. The present case study examines a patient who showed signs of emergence from the vegetative state after neurorehabilitation using The Combined Method Therapy (CMT). In this case, neurorehabilitation therapy was applied simultaneously with pharmacological treatment, stimulation, and neuroimaging techniques to help adjust drug dosage. The results of this study suggest that this combined approach to treatment promoted connectivity among posterior and anterior cortical regions aiding emergence from the vegetative state.