The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease
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 e...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | Alzheimer’s Research & Therapy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13195-018-0423-6 |
| _version_ | 1831760748402966528 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Alberto Benussi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-22T04:35:50Z |
| format | Article |
| id | doaj.art-5b46b8482da445c5abfd1af1b81dfdb2 |
| institution | Directory Open Access Journal |
| issn | 1758-9193 |
| language | English |
| last_indexed | 2024-12-22T04:35:50Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Alzheimer’s Research & Therapy |
| spelling | doaj.art-5b46b8482da445c5abfd1af1b81dfdb22022-12-21T18:38:53ZengBMCAlzheimer’s Research & Therapy1758-91932018-09-0110111010.1186/s13195-018-0423-6The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer diseaseAlberto Benussi0Antonella Alberici1Clarissa Ferrari2Valentina Cantoni3Valentina Dell’Era4Rosanna Turrone5Maria Sofia Cotelli6Giuliano Binetti7Barbara Paghera8Giacomo Koch9Alessandro Padovani10Barbara Borroni11Neurology Unit, Department of Clinical and Experimental Sciences, University of BresciaNeurology Unit, Department of Clinical and Experimental Sciences, University of BresciaIRCCS Centro San Giovanni di Dio FatebenefratelliNeurology Unit, Department of Clinical and Experimental Sciences, University of BresciaNeurology Unit, Department of Clinical and Experimental Sciences, University of BresciaNeurology Unit, Department of Clinical and Experimental Sciences, University of BresciaNeurology Unit, Ospedale VallecamonicaIRCCS Centro San Giovanni di Dio FatebenefratelliNuclear Medicine Unit, Spedali Civili BresciaNon Invasive Brain Stimulation Unit, IRCCS Santa Lucia FoundationNeurology Unit, Department of Clinical and Experimental Sciences, University of BresciaNeurology Unit, Department of Clinical and Experimental Sciences, University of BresciaAbstract 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.http://link.springer.com/article/10.1186/s13195-018-0423-6Alzheimer diseaseFrontotemporal dementiaTranscranial magnetic stimulationPET amyloidDiagnosisConfidence |
| spellingShingle | 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 The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease Alzheimer’s Research & Therapy Alzheimer disease Frontotemporal dementia Transcranial magnetic stimulation PET amyloid Diagnosis Confidence |
| title | The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease |
| title_full | The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease |
| title_fullStr | The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease |
| title_full_unstemmed | The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease |
| title_short | The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease |
| title_sort | impact of transcranial magnetic stimulation on diagnostic confidence in patients with alzheimer disease |
| topic | Alzheimer disease Frontotemporal dementia Transcranial magnetic stimulation PET amyloid Diagnosis Confidence |
| url | http://link.springer.com/article/10.1186/s13195-018-0423-6 |
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