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Alzheimer's Research & Therapy
Published in: Alzheimer's Research & Therapy 1/2018

Open Access 01-12-2018 | Research

The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease

Authors: Alberto Benussi, Antonella Alberici, Clarissa Ferrari, Valentina Cantoni, Valentina Dell’Era, Rosanna Turrone, Maria Sofia Cotelli, Giuliano Binetti, Barbara Paghera, Giacomo Koch, Alessandro Padovani, Barbara Borroni

Published in: Alzheimer's Research & Therapy | Issue 1/2018

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Abstract

Background

Cholinergic dysfunction is a key abnormality in Alzheimer disease (AD) that can be detected in vivo with transcranial magnetic stimulation (TMS) protocols. Although TMS has clearly demonstrated analytical validity, its clinical utility is still debated. In the present study, we evaluated the incremental diagnostic value, expressed in terms of diagnostic confidence of Alzheimer disease (DCAD; range 0–100), of TMS measures in addition to the routine clinical diagnostic assessment in patients evaluated for cognitive impairment as compared with validated biomarkers of amyloidosis.

Methods

One hundred twenty patients with dementia were included and scored in terms of DCAD in a three-step assessment based on (1) demographic, clinical, and neuropsychological evaluations (clinical work-up); (2) clinical work-up plus amyloid markers (cerebrospinal fluid or amyloid positron emission tomographic imaging); and (3) clinical work-up plus TMS intracortical connectivity measures. Two blinded neurologists were asked to review the diagnosis and diagnostic confidence at each step.

Results

TMS measures increased the discrimination of DCAD in two clusters (AD-like vs FTD-like) when added to the clinical and neuropsychological evaluations with levels comparable to established biomarkers of brain amyloidosis (cluster distance of 55.1 for clinical work-up alone, 76.0 for clinical work-up plus amyloid markers, 80.0 for clinical work-up plus TMS). Classification accuracy for the “gold standard” diagnosis (dichotomous - AD vs FTD - variable) evaluated in the three-step assessment, expressed as AUC, increased from 0.82 (clinical work-up alone) to 0.98 (clinical work-up plus TMS) and to 0.99 (clinical work-up plus amyloidosis markers).

Conclusions

TMS in addition to routine assessment in patients with dementia has a significant effect on diagnosis and diagnostic confidence that is comparable to well-established amyloidosis biomarkers.
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Metadata
Title
The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease
Authors
Alberto Benussi
Antonella Alberici
Clarissa Ferrari
Valentina Cantoni
Valentina Dell’Era
Rosanna Turrone
Maria Sofia Cotelli
Giuliano Binetti
Barbara Paghera
Giacomo Koch
Alessandro Padovani
Barbara Borroni
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Alzheimer's Research & Therapy / Issue 1/2018
Electronic ISSN: 1758-9193
DOI
https://doi.org/10.1186/s13195-018-0423-6

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