Baseline Functional Connectivity Predicts Who Will Benefit From Neuromodulation: Evidence From Primary Progressive Aphasia

BackgroundUnderstanding individual variability in response to interventions is essential for developing personalized treatment strategies. In rare and clinically heterogeneous conditions like primary progressive aphasia (PPA), predicting treatment response is particularly challenging due to varying clinical manifestations. In this study, we aimed to identify and analyze predictors of individual language response to transcranial direct current stimulation (tDCS) of the left inferior frontal gyrus (IFG), using a novel, robust analytic approach focused on treatment effect heterogeneity.MethodsWe compared the ability of predicting individual effect (active vs sham tDCS during 20-minute sessions on weekdays for 3 weeks; active: 2 mA current across electrodes; sham: current ramped down after 30 seconds), using demographic and clinical patient characteristics (eg, PPA variant and disease progression, baseline language performance) or volumetric fMRI data versus functional connectivity (from resting-state fMRI) in the cohort of 36 patients.ResultsFunctional connectivity alone had the highest predictive value for outcomes, explaining 62% of the variance of the tDCS effect in generalization (semantic fluency) and 75% of the main outcome (written naming), contrasted with