Transcranial Direct Current Stimulation (tDCS) in Chronic Post-Stroke Apathy

Post-stroke apathy is a condition where people show reduced emotions and reduced activity
after their stroke, beyond that expected from their degree of weakness. It can occur with, or
without, depression, and is associated with more disability and slower recovery. It is
thought to be due to dysfunction of the front of the brain (prefrontal cortex). Importantly,
there are no proven medical treatments for post-stroke apathy.

Transcranial direct current stimulation (tDCS) is a painless, noninvasive brain stimulation
technique that has the potential for alleviating post-stroke apathy. TDCS involves sending a
weak electrical current through the head, thereby exciting the brain underneath. This offers
potential advantages over medications as tDCS directly targets the brain, while medications
need to travel through the bloodstream to reach the brain. TDCS is not an FDA-approved
treatment for any condition, but previous trials have shown it may benefit movement and
language recovery after stroke, as well as improve thinking ability. Studies have shown tDCS
to be very safe with no serious adverse events in over 10,000 subjects studied.

This pilot study will involve three visits to Stony Brook University Hospital. The first is a
baseline session where subjects perform all outcome measures but no tDCS is performed other
than for familiarization. The second and third sessions are the stimulation sessions where
subjects undergo the intervention for 20 minutes to test tDCS effects on the outcome
measures. The effects of tDCS for a single session are expected to only last for few hours.
Subjects are to receive one type of stimulation in one session and another type in the other
session. If this study finds a short term benefit of tDCS for post-stroke apathy it will
support a full clinical trial where multiple sessions of tDCS will be given and may provide a
long-term benefit.

Inclusion Criteria:

- Clinical diagnosis of stroke and radiographically proven ischemic or hemorrhagic
stroke (MRI required for ischemic stroke, CT sufficient for hemorrhagic stroke)

- Stroke occurred at least one month prior to first stimulation session

- Ability to provide informed consent

- Availability of a family member / caregiver who knew the subject before the stroke and
interacts with the subject on at least a weekly basis

- Score of 6 or higher in initial apathy testing using Apathy Inventory - Clinician
score

- Speak English (required for quantifying apathy and performing the cognitive tests)

Exclusion Criteria:

- Other potential cause of apathy including some neurodegenerative diseases, some
psychiatric diseases, and anti-dopamine medication

- Prior brain injury (e.g., Traumatic Brain Injury (TBI), stroke) without full motor and
cognitive recovery based on patient, family or clinician report

- Active medical illness (e.g., infection, delirium, etc.) that might affect arousal and
cognitive function

- Hypoarousal (inability to maintain eye opening without stimulation) from any cause
(e.g., stroke, sleep deprivation)

- Any history of epilepsy

- Recent drug or alcohol abuse - within the past year

- Pregnant or breastfeeding

- Moderate to severe aphasia preventing subject from communicating fully

- Any pacemakers, intracranial electrodes, implanted defibrillators, or any other
electrical implants