Transcranial Direct Current Stimulation (tDCS) in Post-Stroke Working Memory Deficits

After having a stroke, people often have trouble remembering to do something, solving
problems, or following conversations. They can also have trouble concentrating, following
instructions, and multitasking. These can all due to the stroke affecting a brain function
called "working memory". Working memory is defined as the ability to hold a thought in one's
mind for a few seconds in order to remember a task or solve a problem. People have difficulty
returning to their normal lives because of these working memory problems. Currently, there no
proven medical treatments for working memory problems.

Transcranial direct current stimulation (tDCS) is a painless, noninvasive brain stimulation
technique that has been shown in some studies to improve working memory in healthy subjects.
TDCS involves sending a weak electrical current through the head, thereby exciting the brain
underneath. 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 four 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 other three 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 will be receiving all three different types of stimulation. If this study finds a
short term benefit of tDCS for post-stroke working memory deficits, 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).

- Subject reports a decline in attention or short-term memory that began at the time of
their stroke.

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

- Ability to provide informed consent.

- Speak English (required for performing the cognitive tests)

Exclusion Criteria:

- Any other brain disease that can affect cognition (e.g., multiple sclerosis,
dementia).

- Active mental illness such as depression or anxiety

- Large stroke involving cortex under the stimulation site (using subject provided CT or
MRI).

- Currently taking any drugs that are sodium and/or calcium channel blockers not
including amlodipine. This includes some seizure medications along with nicardipine,
nifedipine, nimodipine, verapamil and diltiazem.

- Any history of epilepsy.

- Subject report of recent drug or alcohol abuse - within the past year.

- Subject report of pregnant or breastfeeding.

- Moderate to severe aphasia preventing subject from communicating fully.

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