Diagnosis of Mild Cognitive Impairment Due to Alzheimer's Disease with Transcranial Magnetic Stimulation

作者：Padovani Alessandro; Benussi Alberto; Cantoni Valentina; Dell'Era Valentina; Cotelli Maria Sofia; Caratozzolo Salvatore; Turrone Rosanna; Rozzini Luca; Alberici Antonella; Altomare Daniele; Depari Alessandro; Flammini Alessandra; Frisoni Giovanni B; Borroni Barbara^*

来源：Journal of Alzheimer's Disease, 2018, 65(1): 221-230.

DOI：10.3233/JAD-180293

• Alzheimer's disease
• dementia
• mild cognitive impairment
• short interval intracortical inhibition
• short latency afferent inhibition
• transcranial magnetic stimulation

Background: Considering the increasing evidence that disease-modifying treatments for Alzheimer's disease (AD) must be administered early in the disease course, the development of diagnostic tools capable of accurately identifying AD at early disease stages has become a crucial target. In this view, transcranial magnetic stimulation (TMS) has become an effective tool to discriminate between different forms of neurodegenerative dementia.
Objective: To determine whether a TMS multi-paradigm approach can be used to correctly identify mild cognitive impairment (MCI) due to AD (AD MCI).
Methods: A sample of 69 subjects with MCI were included and classified as AD MCI or MCI unlikely due to AD (non-AD MCI) based on 1) extensive neurological and neuropsychological evaluation, 2) MRI imaging, and 3) cerebrospinal fluid analysis or/and amyloid PET imaging. A paired-pulse TMS multi-paradigm approach assessing short interval intracortical inhibition-facilitation (SICI-ICF), dependent on GABAergic and glutamatergic intracortical circuits, respectively, and short latency afferent inhibition (SAI), dependent on cholinergic circuits, was performed.
Results: We observed a significant impairment of SAI and unimpaired SICI and ICF in AD MCI as compared to non-AD MCI. According to ROC curve analysis, the SICI-ICF / SAI index differentiated ADMCI from non-AD MCI with a specificity of 87.9% and a sensitivity of 94.4%.
Conclusions: The assessment of intracortical connectivity with TMS could aid in the characterization of MCI subtypes, correctly identifying AD pathophysiology. TMS can be proposed as an adjunctive, non-invasive, inexpensive, and time-saving screening tool in MCI differential diagnosis.

• 出版日期2018