Diagnostic contribution and therapeutic perspectives of transcranial magnetic stimulation in dementia. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Di Lazzaro, Vincenzo; Bella, Rita; Benussi, Alberto; Bologna, Matteo; Borroni, Barbara; Capone, Fioravante; Chen, Kai-Hsiang S.; Chen, Robert; Chistyakov, Andrei V.; Classen, Joseph; Kiernan, Matthew C.; Koch, Giacomo; Lanza, Giuseppe; Lefaucheur, Jean-Pascal; Matsumoto, Hideyuki; Nguyen, Jean-Paul; Orth, Michael; Pascual-Leone, Alvaro; Rektorova, Irena; Simko, Patrik; Taylor, John-Paul; Tremblay, Sara; Ugawa, Yoshikazu; Dubbioso, Raffaele; Ranieri, Federico
• Is Part Of: Clinical neurophysiology. Volume 132:Issue 10(2021)
• Page Start: 2568
• Page End: 2607
• Publication Date: 2021-10
• Subjects: Brain stimulation -- Cortical excitability -- Plasticity -- Biomarker -- Connectivity -- Precision medicine; AD Alzheimer's disease -- ALS Amyotrophic lateral sclerosis -- AMT Active motor threshold -- APOE Apolipoprotein E -- BDNF Brain-derived neurotrophic factor -- BOLD blood oxygen level- dependent -- CADASIL Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy -- CBI Cerebellar-brain inhibition -- CBS Cortico-basal syndrome -- CJD Creutzfeldt–Jakob disease -- CMCT Central motor conduction time -- CSF Cerebrospinal fluid -- CSP Cortical silent period -- cTBS continuous theta burst stimulation -- DLB Dementia with Lewy Bodies -- DLPFC Dorsolateral pre-frontal cortex -- fMRI Functional magnetic resonance imaging -- FTD Frontotemporal dementia -- FTLD Frontotemporal lobar degeneration -- GRN Granulin -- GSS Gerstmann–Sträussler–Scheinker disease -- HD Huntington's disease -- HF High-frequency -- ICF Intracortical facilitation -- iNPH idiopathic normal pressure hydrocefalus -- iSP Ipsilateral silent period -- IHI Inter-hemispheric inhibition -- ISI Interstimulus interval -- iTBS Intermittent theta burst stimulation -- LF Low-frequency -- LTP Long-term potentiation -- LTD Long-term depression -- M1 Primary motor cortex -- MCI Mild cognitive impairment -- MEP Motor evoked potential -- MMSE Mini-mental state examination -- MSA Multiple system atrophy -- MS Multiple sclerosis -- PAS Paired associative stimulation -- PDD Parkinson's disease dementia -- PPC Posterior parietal cortex -- PRD Parkinsonism-related dementia -- PSP Progressive supranuclear palsy -- RBD REM sleep behaviour disorder -- RCT Randomized control trial -- MT Resting motor threshold -- rTMS Repetitive transcranial magnetic stimulation -- SAI Short-latency afferent inhibition -- SCD Subjective cognitive decline -- SICI Short-interval intracortical inhibition -- SIVD Subcortical ischemic vascular dementia -- TEP TMS-evoked electroencephalographic potential -- TMS Transcranial magnetic stimulation -- VaD Vascular dementia -- VCI Vascular cognitive impairment; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2021.05.035
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: This review presents the contribution of TMS to the management of dementia. TMS can be used as a biomarker of the excitability and function of cerebral cortex in dementia. Increasing evidence supports the beneficial effects of rTMS in Alzheimer's disease-related dementias at mild/early stage. Abstract: Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such as excitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of the pathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.