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J Neurol Neurosurg Psychiatry. 2018 Dec;89(12):1237-1242. doi: 10.1136/jnnp-2017-317879. Epub 2018 Jul 21.

Transcranial magnetic stimulation predicts cognitive decline in patients with Alzheimer's disease.

Author information

1
Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.
2
Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy.
3
Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy g.koch@hsantalucia.it.
4
Stroke Unit, Tor Vergata Policlinic, Rome, Italy.
#
Contributed equally

Abstract

OBJECTIVE:

To determine the ability of transcranial magnetic stimulation (TMS) in detecting synaptic impairment in patients with Alzheimer's disease (AD) and predicting cognitive decline since the early phases of the disease.

METHODS:

We used TMS-based parameters to evaluate long-term potentiation (LTP)-like cortical plasticity and cholinergic activity as measured by short afferent inhibition (SAI) in 60 newly diagnosed patients with AD and 30 healthy age-matched subjects (HS). Receiver operating characteristic (ROC) curves were used to assess TMS ability in discriminating patients with AD from HS. Regression analyses examined the association between TMS-based parameters and cognitive decline. Multivariable regression model revealed the best parameters able to predict disease progression.

RESULTS:

Area under the ROC curve was 0.90 for LTP-like cortical plasticity, indicating an excellent accuracy of this parameter in detecting AD pathology. In contrast, area under the curve was only 0.64 for SAI, indicating a poor diagnostic accuracy. Notably, LTP-like cortical plasticity was a significant predictor of disease progression (p=0.02), while no other neurophysiological, neuropsychological and demographic parameters were associated with cognitive decline. Multivariable analysis then promoted LTP-like cortical plasticity as the best significant predictor of cognitive decline (p=0.01). Finally, LTP-like cortical plasticity was found to be strongly associated with the probability of rapid cognitive decline (delta Mini-Mental State Examination score ≤-4 points at 18 months) (p=0.04); patients with AD with lower LTP-like cortical plasticity values showed faster disease progression.

CONCLUSIONS:

TMS-based assessment of LTP-like cortical plasticity could be a viable biomarker to assess synaptic impairment and predict subsequent cognitive decline progression in patients with ADs.

KEYWORDS:

AD; TMS; clinical progression; plasticity

PMID:
30464028
DOI:
10.1136/jnnp-2017-317879

Conflict of interest statement

Competing interests: None declared.

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