<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03828734</url>
  </required_header>
  <id_info>
    <org_study_id>18-1789</org_study_id>
    <secondary_id>R01MH111889</secondary_id>
    <nct_id>NCT03828734</nct_id>
  </id_info>
  <brief_title>Modulation of Cognitive Control Signals in Prefrontal Cortex by Rhythmic Transcranial Magnetic Stimulation</brief_title>
  <official_title>Modulation of Alpha and Theta Oscillations in a Cognitive Control Retrospective Cue Task With Frequency Specific Rhythmic Transcranial Magnetic Stimulation</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of North Carolina, Chapel Hill</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Institute of Mental Health (NIMH)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>University of North Carolina, Chapel Hill</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>Yes</is_fda_regulated_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      Purpose: In this study, the investigators will provide causal evidence for the role of alpha&#xD;
      and theta oscillations in cognitive control.&#xD;
&#xD;
      Participants: Participants must be healthy, between the ages of 18 and 35, right handed, able&#xD;
      to provide informed consent, willing to comply with all study procedures, and be available&#xD;
      for the duration of the study, speak and understand English.&#xD;
&#xD;
      Procedures: Alpha and theta brain oscillations will be measured and then entrained using&#xD;
      frequency specific rhythmic TMS during a retrospective cued cognitive control task.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Neural oscillations are proposed to be a mechanism of coordinating information processing&#xD;
      across distributed regions of cortex. Different neural oscillations may correspond to&#xD;
      different underlying neural computations. Noninvasive brain stimulation allows experimenters&#xD;
      to modulate specific neural oscillations by targeting particular frequency bands. By&#xD;
      collecting simultaneous electroencephalography (EEG), rhythmic transcranial magnetic&#xD;
      stimulation (TMS) has been previously demonstrated to entrain neural oscillations at the&#xD;
      frequency of stimulation. Furthermore, when the frequency of entrained neural oscillations is&#xD;
      matched to the frequency of endogenous activity in a cognitive task, the brain stimulation&#xD;
      improves behavioral performance. Therefore, noninvasive brain stimulation is a promising tool&#xD;
      for improving cognition by inducing optimal neural activity via externally applied&#xD;
      electromagnetic fields; e.g. cognitive control improvements.&#xD;
&#xD;
      Previous evidence has implicated neural activity in the alpha band (8-12 Hz) in information&#xD;
      suppression and activity in the theta band (4-7 Hz) in information prioritization. Cognitive&#xD;
      control task paradigms have been shown to elicit distinct activity in both of these bands. In&#xD;
      this task, the stimuli are lateralized to the right and left visual field during encoding.&#xD;
      After a short delay, a cue informs participants which stimuli (right or left) will be tested.&#xD;
      Previous evidence found that alpha activity in parietal cortex is generated contralateral to&#xD;
      irrelevant stimuli-supporting the role of alpha in information suppression-while theta&#xD;
      activity in frontal cortex increases with the number of stimuli to be remembered-supporting&#xD;
      the role of theta in information prioritization.&#xD;
&#xD;
      For the current study, the investigators propose to deliver rhythmic trains of TMS in either&#xD;
      alpha frequency, theta frequency, or an arrhythmic control to modulate neural processing&#xD;
      during a cognitive control task. By collecting simultaneous EEG with TMS, the investigators&#xD;
      will be able to measure the entrained oscillations from rhythmic TMS. The goal of this&#xD;
      experiment is to enhance the observed theta and alpha activity that is seen with the&#xD;
      successful prioritization and suppression of information. To provide causal evidence that&#xD;
      parietal cortex generates alpha activity and frontal cortex generates theta activity, the&#xD;
      investigators will apply rhythmic TMS stimulation to two scalp locations: the anterior middle&#xD;
      frontal gyrus and inferior intraparietal sulcus. By applying alpha frequency, theta&#xD;
      frequency, and arrhythmic TMS at each location, the investigators will be able to examine the&#xD;
      causal relationship of frontal theta oscillations in information prioritization and parietal&#xD;
      alpha oscillations in information suppression.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">February 13, 2019</start_date>
  <completion_date type="Actual">November 22, 2019</completion_date>
  <primary_completion_date type="Actual">November 22, 2019</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Crossover Assignment</intervention_model>
    <primary_purpose>Basic Science</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Number of Remembered Items</measure>
    <time_frame>1 week</time_frame>
    <description>Participants make a button press on a keyboard to indicate if the probed items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators calculate the percent correct for non-match conditions, defined as the hit rate, and the percent incorrect for match conditions, defined as the false alarm rate. The number of remembered items, often referred to as working memory capacity, is calculated as the number of items to be remembered (2, 3, or 4) times the hit rate minus the false alarm rate, divided by one minus the false alarm rate. The range of values is 0 to 4 where larger values mean better performance. For TMS to frontal cortex, working memory capacity is reported when the participant was cued to the right. For TMS to parietal cortex, working memory capacity is reported when the participant was cued to the left.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Amplitude of Neural Oscillations</measure>
    <time_frame>1 week</time_frame>
    <description>The electrical activity of the brain is recorded during performance of the task and brain stimulation. The investigators will perform Morlet wavelet convolution on the recorded electrical signal to calculate the amplitude of neural oscillations in the frequency bands: theta (4-7 hertz) and alpha (8-12 hertz). The amplitude of neural oscillations is reported during the second half of stimulation in the region that is being stimulated. The amplitude is normalized for each participant as the percent change from the amplitude during the baseline period (before the task begins). For TMS to frontal cortex the amplitude of theta oscillations are reported and for TMS to parietal cortex the amplitude of alpha oscillations are reported.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Response Time</measure>
    <time_frame>1 week</time_frame>
    <description>Participants make a button press on a keyboard to indicate if the probe items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators will calculate the response time of this choice as the difference between the time of the button press and presentation of the probe. For TMS to frontal cortex, response time is reported when the participant was cued to the right. For TMS to parietal cortex, response time is reported when the participant was cued to the left.</description>
  </primary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">58</enrollment>
  <condition>Executive Function</condition>
  <arm_group>
    <arm_group_label>TMS to frontal cortex followed by TMS to parietal cortex</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants will receive TMS while performing a cognitive control task. In their first stimulation session, the TMS coil will be placed over the frontal cortex on the scalp. In their second session, the TMS coil will be placed over the parietal cortex on the scalp. During every session, subjects receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>TMS to parietal cortex followed by TMS to frontal cortex</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants will receive TMS while performing a cognitive control task. In their first stimulation session, the TMS coil will be placed over the parietal cortex on the scalp. In their second session, the TMS coil will be placed over the frontal cortex on the scalp. During every session, subjects receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
  </arm_group>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Theta TMS</intervention_name>
    <description>TMS will be administered at the frequency of each subject's endogenous theta oscillation (4-7Hz)</description>
    <arm_group_label>TMS to frontal cortex followed by TMS to parietal cortex</arm_group_label>
    <arm_group_label>TMS to parietal cortex followed by TMS to frontal cortex</arm_group_label>
    <other_name>MagProX100</other_name>
  </intervention>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Alpha TMS</intervention_name>
    <description>TMS will be administered at the frequency of each subject's endogenous alpha oscillation (8-12 Hz)</description>
    <arm_group_label>TMS to frontal cortex followed by TMS to parietal cortex</arm_group_label>
    <arm_group_label>TMS to parietal cortex followed by TMS to frontal cortex</arm_group_label>
    <other_name>MagProX100</other_name>
  </intervention>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Arrhythmic TMS</intervention_name>
    <description>TMS will be administered arrhythmically; i.e. a sequence of pulses with randomized timing</description>
    <arm_group_label>TMS to frontal cortex followed by TMS to parietal cortex</arm_group_label>
    <arm_group_label>TMS to parietal cortex followed by TMS to frontal cortex</arm_group_label>
    <other_name>MagProX100</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Healthy&#xD;
&#xD;
          -  Between the ages of 18 and 35&#xD;
&#xD;
          -  Right handed&#xD;
&#xD;
          -  Able to provide informed consent&#xD;
&#xD;
          -  Willing to comply with all study procedures&#xD;
&#xD;
          -  Available for the duration of the study&#xD;
&#xD;
          -  Speak and understand English.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Attention Deficit Hyperactivity Disorder (currently under treatment)&#xD;
&#xD;
          -  Neurological disorders and conditions, including, but not limited to: History of&#xD;
             epilepsy Seizures (except childhood febrile seizures) -Dementia&#xD;
&#xD;
          -  History of stroke&#xD;
&#xD;
          -  Parkinson's disease&#xD;
&#xD;
          -  Multiple sclerosis&#xD;
&#xD;
          -  Cerebral aneurysm&#xD;
&#xD;
          -  Brain tumors&#xD;
&#xD;
          -  Medical or neurological illness or treatment for a medical disorder that could&#xD;
             interfere with study participation (e.g., unstable cardiac disease, HIV/AIDS,&#xD;
             malignancy, liver or renal impairment)&#xD;
&#xD;
          -  Prior brain surgery -Any brain devices/implants, including cochlear implants and&#xD;
             aneurysm clips -Cardiac pacemaker -Any other implanted electronic device -History of&#xD;
             current traumatic brain injury -(For females) Pregnancy or breast feeding -Anything&#xD;
             that, in the opinion of the investigator, would place the participant at increased&#xD;
             risk or preclude the participant's full compliance with or completion of the study&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>35 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Flavio Frohlich, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of North Carolina, Chapel Hill</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>University of North Carolina at Chapel Hill</name>
      <address>
        <city>Chapel Hill</city>
        <state>North Carolina</state>
        <zip>27516</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Albouy P, Weiss A, Baillet S, Zatorre RJ. Selective Entrainment of Theta Oscillations in the Dorsal Stream Causally Enhances Auditory Working Memory Performance. Neuron. 2017 Apr 5;94(1):193-206.e5. doi: 10.1016/j.neuron.2017.03.015. Epub 2017 Mar 23.</citation>
    <PMID>28343866</PMID>
  </reference>
  <reference>
    <citation>Roux F, Uhlhaas PJ. Working memory and neural oscillations: alpha-gamma versus theta-gamma codes for distinct WM information? Trends Cogn Sci. 2014 Jan;18(1):16-25. doi: 10.1016/j.tics.2013.10.010. Epub 2013 Nov 19.</citation>
    <PMID>24268290</PMID>
  </reference>
  <reference>
    <citation>Fries P. Rhythms for Cognition: Communication through Coherence. Neuron. 2015 Oct 7;88(1):220-35. doi: 10.1016/j.neuron.2015.09.034.</citation>
    <PMID>26447583</PMID>
  </reference>
  <reference>
    <citation>Hanslmayr S, Matuschek J, Fellner MC. Entrainment of prefrontal beta oscillations induces an endogenous echo and impairs memory formation. Curr Biol. 2014 Apr 14;24(8):904-9. doi: 10.1016/j.cub.2014.03.007. Epub 2014 Mar 27.</citation>
    <PMID>24684933</PMID>
  </reference>
  <reference>
    <citation>Klimesch W, Sauseng P, Hanslmayr S. EEG alpha oscillations: the inhibition-timing hypothesis. Brain Res Rev. 2007 Jan;53(1):63-88. doi: 10.1016/j.brainresrev.2006.06.003. Epub 2006 Aug 1.</citation>
    <PMID>16887192</PMID>
  </reference>
  <reference>
    <citation>Popov T, Popova P, Harkotte M, Awiszus B, Rockstroh B, Miller GA. Cross-frequency interactions between frontal theta and posterior alpha control mechanisms foster working memory. Neuroimage. 2018 Nov 1;181:728-733. doi: 10.1016/j.neuroimage.2018.07.067. Epub 2018 Jul 31.</citation>
    <PMID>30075276</PMID>
  </reference>
  <reference>
    <citation>Reinhart RMG. Disruption and rescue of interareal theta phase coupling and adaptive behavior. Proc Natl Acad Sci U S A. 2017 Oct 24;114(43):11542-11547. doi: 10.1073/pnas.1710257114. Epub 2017 Oct 9.</citation>
    <PMID>29073084</PMID>
  </reference>
  <reference>
    <citation>Romei V, Thut G, Silvanto J. Information-Based Approaches of Noninvasive Transcranial Brain Stimulation. Trends Neurosci. 2016 Nov;39(11):782-795. doi: 10.1016/j.tins.2016.09.001. Epub 2016 Sep 30.</citation>
    <PMID>27697295</PMID>
  </reference>
  <reference>
    <citation>Thut G, Veniero D, Romei V, Miniussi C, Schyns P, Gross J. Rhythmic TMS causes local entrainment of natural oscillatory signatures. Curr Biol. 2011 Jul 26;21(14):1176-85. doi: 10.1016/j.cub.2011.05.049. Epub 2011 Jun 30.</citation>
    <PMID>21723129</PMID>
  </reference>
  <reference>
    <citation>Wallis G, Stokes M, Cousijn H, Woolrich M, Nobre AC. Frontoparietal and Cingulo-opercular Networks Play Dissociable Roles in Control of Working Memory. J Cogn Neurosci. 2015 Oct;27(10):2019-34. doi: 10.1162/jocn_a_00838. Epub 2015 Jun 4.</citation>
    <PMID>26042457</PMID>
  </reference>
  <reference>
    <citation>Wang XJ. Neurophysiological and computational principles of cortical rhythms in cognition. Physiol Rev. 2010 Jul;90(3):1195-268. doi: 10.1152/physrev.00035.2008.</citation>
    <PMID>20664082</PMID>
  </reference>
  <reference>
    <citation>Wolinski N, Cooper NR, Sauseng P, Romei V. The speed of parietal theta frequency drives visuospatial working memory capacity. PLoS Biol. 2018 Mar 14;16(3):e2005348. doi: 10.1371/journal.pbio.2005348. eCollection 2018 Mar.</citation>
    <PMID>29538384</PMID>
  </reference>
  <reference>
    <citation>Rouder JN, Morey RD, Morey CC, Cowan N. How to measure working memory capacity in the change detection paradigm. Psychon Bull Rev. 2011 Apr;18(2):324-30. doi: 10.3758/s13423-011-0055-3.</citation>
    <PMID>21331668</PMID>
  </reference>
  <verification_date>December 2019</verification_date>
  <study_first_submitted>January 29, 2019</study_first_submitted>
  <study_first_submitted_qc>January 31, 2019</study_first_submitted_qc>
  <study_first_posted type="Actual">February 4, 2019</study_first_posted>
  <results_first_submitted>September 18, 2020</results_first_submitted>
  <results_first_submitted_qc>October 23, 2020</results_first_submitted_qc>
  <results_first_posted type="Actual">November 19, 2020</results_first_posted>
  <last_update_submitted>October 23, 2020</last_update_submitted>
  <last_update_submitted_qc>October 23, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">November 19, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>June 10, 2019</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/34/NCT03828734/Prot_SAP_000.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <group_list>
        <group group_id="P1">
          <title>TMS to Frontal Cortex Followed by TMS to Parietal Cortex</title>
          <description>Participants will receive transcranial magnetic stimulation (TMS) while performing a cognitive control task. In the first stimulation session, the TMS coil will be placed over the frontal cortex on the scalp. In the second session, the TMS coil will be placed over the parietal cortex on the scalp. During every session, participants receive Alpha TMS, Theta TMS, and Arrhythmic TMS.</description>
        </group>
        <group group_id="P2">
          <title>TMS to Parietal Cortex Followed by TMS to Frontal Cortex</title>
          <description>Participants will receive TMS while performing a cognitive control task. In their first stimulation session, the TMS coil will be placed over the parietal cortex on the scalp. In their second session, the TMS coil will be placed over the frontal cortex on the scalp. During every session, participants receive Alpha TMS, Theta TMS, and Arrhythmic TMS.</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Baseline</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="32"/>
                <participants group_id="P2" count="26"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="32"/>
                <participants group_id="P2" count="26"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
                <participants group_id="P2" count="0"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
        <period>
          <title>Pre-Randomization (1 Week)</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="32"/>
                <participants group_id="P2" count="26"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="29"/>
                <participants group_id="P2" count="25"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="3"/>
                <participants group_id="P2" count="1"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
        <period>
          <title>First Intervention</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="29"/>
                <participants group_id="P2" count="25"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="25"/>
                <participants group_id="P2" count="25"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="4"/>
                <participants group_id="P2" count="0"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
        <period>
          <title>First Washout (1 Week)</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="25"/>
                <participants group_id="P2" count="25"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="25"/>
                <participants group_id="P2" count="24"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
                <participants group_id="P2" count="1"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
        <period>
          <title>Second Intervention</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="25"/>
                <participants group_id="P2" count="24"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="25"/>
                <participants group_id="P2" count="24"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
                <participants group_id="P2" count="0"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>All Participants</title>
          <description>Participants will receive TMS while performing a cognitive control task. In one stimulation session, the TMS coil will be placed over the frontal cortex on the scalp. In another session, the TMS coil will be placed over the parietal cortex on the scalp. During every session, participants receive Alpha TMS, Theta TMS, and Arrhythmic TMS.</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="58"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="22.2" spread="3.83"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="39"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="19"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Ethnicity (NIH/OMB)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Hispanic or Latino</title>
                  <measurement_list>
                    <measurement group_id="B1" value="9"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Not Hispanic or Latino</title>
                  <measurement_list>
                    <measurement group_id="B1" value="48"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Unknown or Not Reported</title>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race (NIH/OMB)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>American Indian or Alaska Native</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Asian</title>
                  <measurement_list>
                    <measurement group_id="B1" value="16"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Native Hawaiian or Other Pacific Islander</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Black or African American</title>
                  <measurement_list>
                    <measurement group_id="B1" value="3"/>
                  </measurement_list>
                </category>
                <category>
                  <title>White</title>
                  <measurement_list>
                    <measurement group_id="B1" value="31"/>
                  </measurement_list>
                </category>
                <category>
                  <title>More than one race</title>
                  <measurement_list>
                    <measurement group_id="B1" value="3"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Unknown or Not Reported</title>
                  <measurement_list>
                    <measurement group_id="B1" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Region of Enrollment</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>United States</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="58"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Number of Remembered Items</title>
          <description>Participants make a button press on a keyboard to indicate if the probed items are matched or non-matched to the items held in memory after a retrospective cue. The percent correct for non-match conditions is defined as the hit rate, and the percent incorrect for match condition is defined as the false alarm rate. The number of remembered items, often referred to as working memory capacity, is calculated as the number of items presented (2, 3, or 4) times the hit rate minus the false alarm rate, divided by one minus false alarm rate. Range of values is 0 to 4 where larger is better.</description>
          <units>number of remembered items</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="1.8039" spread="0.4988"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Response Time</title>
          <description>Participants make a button press on a keyboard to indicate if the probe items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators will calculate the response time of this choice as the difference between the time of the button press and presentation of the probe. A faster response time represents better performance.</description>
          <units>seconds</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="0.8225" spread="0.1605"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Number of Remembered Items</title>
        <description>Participants make a button press on a keyboard to indicate if the probed items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators calculate the percent correct for non-match conditions, defined as the hit rate, and the percent incorrect for match conditions, defined as the false alarm rate. The number of remembered items, often referred to as working memory capacity, is calculated as the number of items to be remembered (2, 3, or 4) times the hit rate minus the false alarm rate, divided by one minus the false alarm rate. The range of values is 0 to 4 where larger values mean better performance. For TMS to frontal cortex, working memory capacity is reported when the participant was cued to the right. For TMS to parietal cortex, working memory capacity is reported when the participant was cued to the left.</description>
        <time_frame>1 week</time_frame>
        <population>54 participants were randomized into the experiment arms. 5 participants did not complete both arms and are excluded from analysis. In addition, data from 2 participant was corrupted and 5 participants were excluded due to poor task performance. Analysis was run on 42 participants.</population>
        <group_list>
          <group group_id="O1">
            <title>TMS to Frontal Cortex</title>
            <description>Participants receive TMS to frontal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
          </group>
          <group group_id="O2">
            <title>TMS to Parietal Cortex</title>
            <description>Participants receive TMS to parietal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
          </group>
        </group_list>
        <measure>
          <title>Number of Remembered Items</title>
          <description>Participants make a button press on a keyboard to indicate if the probed items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators calculate the percent correct for non-match conditions, defined as the hit rate, and the percent incorrect for match conditions, defined as the false alarm rate. The number of remembered items, often referred to as working memory capacity, is calculated as the number of items to be remembered (2, 3, or 4) times the hit rate minus the false alarm rate, divided by one minus the false alarm rate. The range of values is 0 to 4 where larger values mean better performance. For TMS to frontal cortex, working memory capacity is reported when the participant was cued to the right. For TMS to parietal cortex, working memory capacity is reported when the participant was cued to the left.</description>
          <population>54 participants were randomized into the experiment arms. 5 participants did not complete both arms and are excluded from analysis. In addition, data from 2 participant was corrupted and 5 participants were excluded due to poor task performance. Analysis was run on 42 participants.</population>
          <units>number of remembered items</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="42"/>
                <count group_id="O2" value="42"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Theta TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.863" spread="0.613"/>
                    <measurement group_id="O2" value="1.754" spread="0.524"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Alpha TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.796" spread="0.495"/>
                    <measurement group_id="O2" value="1.797" spread="0.572"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Arrhythmic TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.803" spread="0.381"/>
                    <measurement group_id="O2" value="1.864" spread="0.469"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>0.263</p_value>
            <method>ANOVA</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Amplitude of Neural Oscillations</title>
        <description>The electrical activity of the brain is recorded during performance of the task and brain stimulation. The investigators will perform Morlet wavelet convolution on the recorded electrical signal to calculate the amplitude of neural oscillations in the frequency bands: theta (4-7 hertz) and alpha (8-12 hertz). The amplitude of neural oscillations is reported during the second half of stimulation in the region that is being stimulated. The amplitude is normalized for each participant as the percent change from the amplitude during the baseline period (before the task begins). For TMS to frontal cortex the amplitude of theta oscillations are reported and for TMS to parietal cortex the amplitude of alpha oscillations are reported.</description>
        <time_frame>1 week</time_frame>
        <population>54 participants were randomized into the experiment arms. 5 participants did not complete both arms and are excluded from analysis. In addition, data from 2 participant was corrupted and 5 participants were excluded due to poor task performance. Analysis was run on 42 participants.</population>
        <group_list>
          <group group_id="O1">
            <title>TMS to Frontal Cortex</title>
            <description>Participants receive TMS to frontal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
          </group>
          <group group_id="O2">
            <title>TMS to Parietal Cortex</title>
            <description>Participants receive TMS to parietal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
          </group>
        </group_list>
        <measure>
          <title>Amplitude of Neural Oscillations</title>
          <description>The electrical activity of the brain is recorded during performance of the task and brain stimulation. The investigators will perform Morlet wavelet convolution on the recorded electrical signal to calculate the amplitude of neural oscillations in the frequency bands: theta (4-7 hertz) and alpha (8-12 hertz). The amplitude of neural oscillations is reported during the second half of stimulation in the region that is being stimulated. The amplitude is normalized for each participant as the percent change from the amplitude during the baseline period (before the task begins). For TMS to frontal cortex the amplitude of theta oscillations are reported and for TMS to parietal cortex the amplitude of alpha oscillations are reported.</description>
          <population>54 participants were randomized into the experiment arms. 5 participants did not complete both arms and are excluded from analysis. In addition, data from 2 participant was corrupted and 5 participants were excluded due to poor task performance. Analysis was run on 42 participants.</population>
          <units>microvolts</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="42"/>
                <count group_id="O2" value="42"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Theta TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.443" spread="1.227"/>
                    <measurement group_id="O2" value="-0.201" spread="0.505"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Alpha TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.489" spread="0.412"/>
                    <measurement group_id="O2" value="0.241" spread="1.045"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Arrhythmic TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.944" spread="0.705"/>
                    <measurement group_id="O2" value="-0.132" spread="0.600"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>&lt;0.000001</p_value>
            <method>ANOVA</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Response Time</title>
        <description>Participants make a button press on a keyboard to indicate if the probe items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators will calculate the response time of this choice as the difference between the time of the button press and presentation of the probe. For TMS to frontal cortex, response time is reported when the participant was cued to the right. For TMS to parietal cortex, response time is reported when the participant was cued to the left.</description>
        <time_frame>1 week</time_frame>
        <population>54 participants were randomized into the experiment arms. 5 participants did not complete both arms and are excluded from analysis. In addition, data from 2 participant was corrupted and 5 participants were excluded due to poor task performance. Analysis was run on 42 participants.</population>
        <group_list>
          <group group_id="O1">
            <title>TMS to Frontal Cortex</title>
            <description>Participants receive TMS to frontal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
          </group>
          <group group_id="O2">
            <title>TMS to Parietal Cortex</title>
            <description>Participants receive TMS to parietal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
          </group>
        </group_list>
        <measure>
          <title>Response Time</title>
          <description>Participants make a button press on a keyboard to indicate if the probe items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators will calculate the response time of this choice as the difference between the time of the button press and presentation of the probe. For TMS to frontal cortex, response time is reported when the participant was cued to the right. For TMS to parietal cortex, response time is reported when the participant was cued to the left.</description>
          <population>54 participants were randomized into the experiment arms. 5 participants did not complete both arms and are excluded from analysis. In addition, data from 2 participant was corrupted and 5 participants were excluded due to poor task performance. Analysis was run on 42 participants.</population>
          <units>seconds</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="42"/>
                <count group_id="O2" value="42"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Theta TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.728" spread="0.157"/>
                    <measurement group_id="O2" value="0.714" spread="0.154"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Alpha TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.711" spread="0.162"/>
                    <measurement group_id="O2" value="0.710" spread="0.162"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Arrhythmic TMS</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.720" spread="0.155"/>
                    <measurement group_id="O2" value="0.717" spread="0.166"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>0.399</p_value>
            <method>ANOVA</method>
          </analysis>
        </analysis_list>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>Adverse events were systematically assessed after the 3 hour session for both arms. Each session was 1 week apart. Thus, adverse events were monitored for approximately 1 week.</time_frame>
      <group_list>
        <group group_id="E1">
          <title>TMS to Frontal Cortex</title>
          <description>Participants receive TMS to frontal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
        </group>
        <group group_id="E2">
          <title>TMS to Parietal Cortex</title>
          <description>Participants receive TMS to parietal cortex while performing a cognitive control task. During every session, participants receive Theta TMS, Alpha TMS, and Arrhythmic TMS.</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="53"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="53"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="50"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <default_assessment>Systematic Assessment</default_assessment>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="25" subjects_at_risk="53"/>
                <counts group_id="E2" subjects_affected="25" subjects_at_risk="50"/>
              </event>
            </event_list>
          </category>
          <category>
            <title>Ear and labyrinth disorders</title>
            <event_list>
              <event>
                <sub_title>Ringing or buzzing noise</sub_title>
                <counts group_id="E1" events="0" subjects_affected="0" subjects_at_risk="53"/>
                <counts group_id="E2" events="0" subjects_affected="0" subjects_at_risk="50"/>
              </event>
            </event_list>
          </category>
          <category>
            <title>General disorders</title>
            <event_list>
              <event>
                <sub_title>Sleepiness</sub_title>
                <counts group_id="E1" events="10" subjects_affected="10" subjects_at_risk="53"/>
                <counts group_id="E2" events="9" subjects_affected="9" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Trouble concentrating</sub_title>
                <counts group_id="E1" events="11" subjects_affected="11" subjects_at_risk="53"/>
                <counts group_id="E2" events="6" subjects_affected="6" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Dizziness</sub_title>
                <counts group_id="E1" events="2" subjects_affected="2" subjects_at_risk="53"/>
                <counts group_id="E2" events="0" subjects_affected="0" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Flickering lights</sub_title>
                <counts group_id="E1" events="0" subjects_affected="0" subjects_at_risk="53"/>
                <counts group_id="E2" events="1" subjects_affected="1" subjects_at_risk="50"/>
              </event>
            </event_list>
          </category>
          <category>
            <title>Skin and subcutaneous tissue disorders</title>
            <event_list>
              <event>
                <sub_title>Headache</sub_title>
                <counts group_id="E1" events="11" subjects_affected="11" subjects_at_risk="53"/>
                <counts group_id="E2" events="11" subjects_affected="11" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Neck pain</sub_title>
                <counts group_id="E1" events="1" subjects_affected="1" subjects_at_risk="53"/>
                <counts group_id="E2" events="1" subjects_affected="1" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Scalp pain</sub_title>
                <counts group_id="E1" events="9" subjects_affected="9" subjects_at_risk="53"/>
                <counts group_id="E2" events="8" subjects_affected="8" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Tingling</sub_title>
                <counts group_id="E1" events="3" subjects_affected="3" subjects_at_risk="53"/>
                <counts group_id="E2" events="2" subjects_affected="2" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Burning sensation</sub_title>
                <counts group_id="E1" events="3" subjects_affected="3" subjects_at_risk="53"/>
                <counts group_id="E2" events="2" subjects_affected="2" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Local redness</sub_title>
                <counts group_id="E1" events="2" subjects_affected="2" subjects_at_risk="53"/>
                <counts group_id="E2" events="2" subjects_affected="2" subjects_at_risk="50"/>
              </event>
              <event>
                <sub_title>Itching</sub_title>
                <counts group_id="E1" events="0" subjects_affected="0" subjects_at_risk="53"/>
                <counts group_id="E2" events="2" subjects_affected="2" subjects_at_risk="50"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>All Principal Investigators ARE employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <point_of_contact>
      <name_or_title>Justin Riddle, PhD</name_or_title>
      <organization>University of North Carolina at Chapel Hill</organization>
      <phone>919-966-4755</phone>
      <email>justin_riddle@med.unc.edu</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03828734
org study id: 18-1789
secondary id: R01MH111889
nct id: NCT03828734
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: Yes
is us export: No
Purpose: In this study, the investigators will provide causal evidence for the role of alpha
      and theta oscillations in cognitive control.

      Participants: Participants must be healthy, between the ages of 18 and 35, right handed, able
      to provide informed consent, willing to comply with all study procedures, and be available
      for the duration of the study, speak and understand English.

      Procedures: Alpha and theta brain oscillations will be measured and then entrained using
      frequency specific rhythmic TMS during a retrospective cued cognitive control task.
Neural oscillations are proposed to be a mechanism of coordinating information processing
      across distributed regions of cortex. Different neural oscillations may correspond to
      different underlying neural computations. Noninvasive brain stimulation allows experimenters
      to modulate specific neural oscillations by targeting particular frequency bands. By
      collecting simultaneous electroencephalography (EEG), rhythmic transcranial magnetic
      stimulation (TMS) has been previously demonstrated to entrain neural oscillations at the
      frequency of stimulation. Furthermore, when the frequency of entrained neural oscillations is
      matched to the frequency of endogenous activity in a cognitive task, the brain stimulation
      improves behavioral performance. Therefore, noninvasive brain stimulation is a promising tool
      for improving cognition by inducing optimal neural activity via externally applied
      electromagnetic fields; e.g. cognitive control improvements.

      Previous evidence has implicated neural activity in the alpha band (8-12 Hz) in information
      suppression and activity in the theta band (4-7 Hz) in information prioritization. Cognitive
      control task paradigms have been shown to elicit distinct activity in both of these bands. In
      this task, the stimuli are lateralized to the right and left visual field during encoding.
      After a short delay, a cue informs participants which stimuli (right or left) will be tested.
      Previous evidence found that alpha activity in parietal cortex is generated contralateral to
      irrelevant stimuli-supporting the role of alpha in information suppression-while theta
      activity in frontal cortex increases with the number of stimuli to be remembered-supporting
      the role of theta in information prioritization.

      For the current study, the investigators propose to deliver rhythmic trains of TMS in either
      alpha frequency, theta frequency, or an arrhythmic control to modulate neural processing
      during a cognitive control task. By collecting simultaneous EEG with TMS, the investigators
      will be able to measure the entrained oscillations from rhythmic TMS. The goal of this
      experiment is to enhance the observed theta and alpha activity that is seen with the
      successful prioritization and suppression of information. To provide causal evidence that
      parietal cortex generates alpha activity and frontal cortex generates theta activity, the
      investigators will apply rhythmic TMS stimulation to two scalp locations: the anterior middle
      frontal gyrus and inferior intraparietal sulcus. By applying alpha frequency, theta
      frequency, and arrhythmic TMS at each location, the investigators will be able to examine the
      causal relationship of frontal theta oscillations in information prioritization and parietal
      alpha oscillations in information suppression.
allocation: Randomized
intervention model: Crossover Assignment
primary purpose: Basic Science
masking: None (Open Label)
measure: Number of Remembered Items
time frame: 1 week
description: Participants make a button press on a keyboard to indicate if the probed items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators calculate the percent correct for non-match conditions, defined as the hit rate, and the percent incorrect for match conditions, defined as the false alarm rate. The number of remembered items, often referred to as working memory capacity, is calculated as the number of items to be remembered (2, 3, or 4) times the hit rate minus the false alarm rate, divided by one minus the false alarm rate. The range of values is 0 to 4 where larger values mean better performance. For TMS to frontal cortex, working memory capacity is reported when the participant was cued to the right. For TMS to parietal cortex, working memory capacity is reported when the participant was cued to the left.
measure: Amplitude of Neural Oscillations
time frame: 1 week
description: The electrical activity of the brain is recorded during performance of the task and brain stimulation. The investigators will perform Morlet wavelet convolution on the recorded electrical signal to calculate the amplitude of neural oscillations in the frequency bands: theta (4-7 hertz) and alpha (8-12 hertz). The amplitude of neural oscillations is reported during the second half of stimulation in the region that is being stimulated. The amplitude is normalized for each participant as the percent change from the amplitude during the baseline period (before the task begins). For TMS to frontal cortex the amplitude of theta oscillations are reported and for TMS to parietal cortex the amplitude of alpha oscillations are reported.
measure: Response Time
time frame: 1 week
description: Participants make a button press on a keyboard to indicate if the probe items are matched or non-matched to the items held in memory after a retrospective cue is presented. The investigators will calculate the response time of this choice as the difference between the time of the button press and presentation of the probe. For TMS to frontal cortex, response time is reported when the participant was cued to the right. For TMS to parietal cortex, response time is reported when the participant was cued to the left.
arm group label: TMS to frontal cortex followed by TMS to parietal cortex
arm group type: Experimental
description: Participants will receive TMS while performing a cognitive control task. In their first stimulation session, the TMS coil will be placed over the frontal cortex on the scalp. In their second session, the TMS coil will be placed over the parietal cortex on the scalp. During every session, subjects receive Theta TMS, Alpha TMS, and Arrhythmic TMS.
arm group label: TMS to parietal cortex followed by TMS to frontal cortex
arm group type: Experimental
description: Participants will receive TMS while performing a cognitive control task. In their first stimulation session, the TMS coil will be placed over the parietal cortex on the scalp. In their second session, the TMS coil will be placed over the frontal cortex on the scalp. During every session, subjects receive Theta TMS, Alpha TMS, and Arrhythmic TMS.
intervention type: Device
intervention name: Theta TMS
description: TMS will be administered at the frequency of each subject's endogenous theta oscillation (4-7Hz)
arm group label: TMS to frontal cortex followed by TMS to parietal cortex
arm group label: TMS to parietal cortex followed by TMS to frontal cortex
other name: MagProX100
intervention type: Device
intervention name: Alpha TMS
description: TMS will be administered at the frequency of each subject's endogenous alpha oscillation (8-12 Hz)
arm group label: TMS to frontal cortex followed by TMS to parietal cortex
arm group label: TMS to parietal cortex followed by TMS to frontal cortex
other name: MagProX100
intervention type: Device
intervention name: Arrhythmic TMS
description: TMS will be administered arrhythmically; i.e. a sequence of pulses with randomized timing
arm group label: TMS to frontal cortex followed by TMS to parietal cortex
arm group label: TMS to parietal cortex followed by TMS to frontal cortex
other name: MagProX100
criteria: 
gender: All
minimum age: 18 Years
maximum age: 35 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Flavio Frohlich, PhD
role: Principal Investigator
affiliation: University of North Carolina, Chapel Hill
facility: 
country: United States
citation: Albouy P, Weiss A, Baillet S, Zatorre RJ. Selective Entrainment of Theta Oscillations in the Dorsal Stream Causally Enhances Auditory Working Memory Performance. Neuron. 2017 Apr 5;94(1):193-206.e5. doi: 10.1016/j.neuron.2017.03.015. Epub 2017 Mar 23.
PMID: 28343866
citation: Roux F, Uhlhaas PJ. Working memory and neural oscillations: alpha-gamma versus theta-gamma codes for distinct WM information? Trends Cogn Sci. 2014 Jan;18(1):16-25. doi: 10.1016/j.tics.2013.10.010. Epub 2013 Nov 19.
PMID: 24268290
citation: Fries P. Rhythms for Cognition: Communication through Coherence. Neuron. 2015 Oct 7;88(1):220-35. doi: 10.1016/j.neuron.2015.09.034.
PMID: 26447583
citation: Hanslmayr S, Matuschek J, Fellner MC. Entrainment of prefrontal beta oscillations induces an endogenous echo and impairs memory formation. Curr Biol. 2014 Apr 14;24(8):904-9. doi: 10.1016/j.cub.2014.03.007. Epub 2014 Mar 27.
PMID: 24684933
citation: Klimesch W, Sauseng P, Hanslmayr S. EEG alpha oscillations: the inhibition-timing hypothesis. Brain Res Rev. 2007 Jan;53(1):63-88. doi: 10.1016/j.brainresrev.2006.06.003. Epub 2006 Aug 1.
PMID: 16887192
citation: Popov T, Popova P, Harkotte M, Awiszus B, Rockstroh B, Miller GA. Cross-frequency interactions between frontal theta and posterior alpha control mechanisms foster working memory. Neuroimage. 2018 Nov 1;181:728-733. doi: 10.1016/j.neuroimage.2018.07.067. Epub 2018 Jul 31.
PMID: 30075276
citation: Reinhart RMG. Disruption and rescue of interareal theta phase coupling and adaptive behavior. Proc Natl Acad Sci U S A. 2017 Oct 24;114(43):11542-11547. doi: 10.1073/pnas.1710257114. Epub 2017 Oct 9.
PMID: 29073084
citation: Romei V, Thut G, Silvanto J. Information-Based Approaches of Noninvasive Transcranial Brain Stimulation. Trends Neurosci. 2016 Nov;39(11):782-795. doi: 10.1016/j.tins.2016.09.001. Epub 2016 Sep 30.
PMID: 27697295
citation: Thut G, Veniero D, Romei V, Miniussi C, Schyns P, Gross J. Rhythmic TMS causes local entrainment of natural oscillatory signatures. Curr Biol. 2011 Jul 26;21(14):1176-85. doi: 10.1016/j.cub.2011.05.049. Epub 2011 Jun 30.
PMID: 21723129
citation: Wallis G, Stokes M, Cousijn H, Woolrich M, Nobre AC. Frontoparietal and Cingulo-opercular Networks Play Dissociable Roles in Control of Working Memory. J Cogn Neurosci. 2015 Oct;27(10):2019-34. doi: 10.1162/jocn_a_00838. Epub 2015 Jun 4.
PMID: 26042457
citation: Wang XJ. Neurophysiological and computational principles of cortical rhythms in cognition. Physiol Rev. 2010 Jul;90(3):1195-268. doi: 10.1152/physrev.00035.2008.
PMID: 20664082
citation: Wolinski N, Cooper NR, Sauseng P, Romei V. The speed of parietal theta frequency drives visuospatial working memory capacity. PLoS Biol. 2018 Mar 14;16(3):e2005348. doi: 10.1371/journal.pbio.2005348. eCollection 2018 Mar.
PMID: 29538384
citation: Rouder JN, Morey RD, Morey CC, Cowan N. How to measure working memory capacity in the change detection paradigm. Psychon Bull Rev. 2011 Apr;18(2):324-30. doi: 10.3758/s13423-011-0055-3.
PMID: 21331668
responsible party type: Sponsor
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
point of contact: 