[Non-invasive brain stimulation in neurology : Transcranial direct current stimulation to enhance cognitive functioning].

Transcranial direct current stimulation (tDCS) has been successfully used in neuroscientific research to modulate cognitive functions. Recent studies suggested that improvement of behavioral performance is associated with tDCS-induced modulation of neuronal activity and connectivity. Thus, tDCS may also represent a promising tool for reconstitution of cognitive functions in the context of memory decline related to Alzheimer's disease or aphasia following stroke; however, evidence from randomized sham-controlled clinical trials is still scarce. Initial results of tDCS-induced behavioral improvement in patients with Alzheimer's dementia and its precursors indicated that an intense memory training combined with tDCS may be effective. Early interventions in the stage of mild cognitive impairment could be crucial but further evidence is needed to substantiate this. In patients with aphasia following stroke tDCS was applied to the left and right hemispheres, with varying results depending on the severity of the symptoms and polarity of the stimulation. Patients with mild aphasia can benefit from tDCS of the language dominant hemisphere while in patients with severe aphasia tDCS of right hemispheric homologous brain language areas may be particularly relevant. Moreover, recent studies suggested that an intervention in the subacute phase of aphasia could be most promising. In summary, tDCS could provide the exciting possibility to reconstitute cognitive functions in patients with neurological disorders. Future studies have to elucidate whether tDCS can be used in the clinical routine to prevent further cognitive decline in neurodegenerative diseases and whether beneficial effects from experimental studies translate into long-term improvement in activities of daily life.