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Hall JD, Green JM, Chen YCA, Liu Y, Zhang H, Sundman MH, Chou YH. Exploring the potential of combining transcranial magnetic stimulation and electroencephalography to investigate mild cognitive impairment and Alzheimer's disease: a systematic review. GeroScience 2024; 46:3659-3693. [PMID: 38356029 PMCID: PMC11226590 DOI: 10.1007/s11357-024-01075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) and electroencephalography (EEG) are non-invasive techniques used for neuromodulation and recording brain electrical activity, respectively. The integration of TMS-EEG has emerged as a valuable tool for investigating the complex mechanisms involved in age-related disorders, such as mild cognitive impairment (MCI) and Alzheimer's disease (AD). By systematically synthesizing TMS-EEG studies, this review aims to shed light on the neurophysiological mechanisms underlying MCI and AD, while also exploring the practical applications of TMS-EEG in clinical settings. PubMed, ScienceDirect, and PsychInfo were selected as the databases for this review. The 22 eligible studies included a total of 592 individuals with MCI or AD as well as 301 cognitively normal adults. TMS-EEG assessments unveiled specific patterns of corticospinal excitability, plasticity, and brain connectivity that distinguished individuals on the AD spectrum from cognitively normal older adults. Moreover, the TMS-induced EEG features were observed to be correlated with cognitive performance and the presence of AD pathological biomarkers. The comprehensive examination of the existing studies demonstrates that the combination of TMS and EEG has yielded valuable insights into the neurophysiology of MCI and AD. This integration shows great potential for early detection, monitoring disease progression, and anticipating response to treatment. Future research is of paramount importance to delve into the potential utilization of TMS-EEG for treatment optimization in individuals with MCI and AD.
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Affiliation(s)
- J D Hall
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Jacob M Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Yu-Chin A Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Yilin Liu
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Hangbin Zhang
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Mark H Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA
| | - Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, 1230 N Cherry Ave., Tucson, AZ, USA.
- Evelyn F McKnight Brain Institute, Arizona Center On Aging, and BIO5 Institute, University of Arizona, Tucson, AZ, USA.
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Moreno-Roco J, del Valle L, Jiménez D, Acosta I, Castillo JL, Dharmadasa T, Kiernan MC, Matamala JM. Diagnostic utility of transcranial magnetic stimulation for neurodegenerative disease: a critical review. Dement Neuropsychol 2024; 17:e20230048. [PMID: 38189033 PMCID: PMC10768644 DOI: 10.1590/1980-5764-dn-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 01/09/2024] Open
Abstract
Neurodegenerative diseases pose significant challenges due to their impact on brain structure, function, and cognition. As life expectancy rises, the prevalence of these disorders is rapidly increasing, resulting in substantial personal, familial, and societal burdens. Efforts have been made to optimize the diagnostic and therapeutic processes, primarily focusing on clinical, cognitive, and imaging characterization. However, the emergence of non-invasive brain stimulation techniques, specifically transcranial magnetic stimulation (TMS), offers unique functional insights and diagnostic potential. TMS allows direct evaluation of brain function, providing valuable information inaccessible through other methods. This review aims to summarize the current and potential diagnostic utility of TMS in investigating neurodegenerative diseases, highlighting its relevance to the field of cognitive neuroscience. The findings presented herein contribute to the growing body of research focused on improving our understanding and management of these debilitating conditions, particularly in regions with limited resources and a pressing need for innovative approaches.
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Affiliation(s)
- Javier Moreno-Roco
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
| | - Lucía del Valle
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
| | - Daniel Jiménez
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
- Hospital del Salvador, Servicio de Neurología, Santiago, Chile
| | - Ignacio Acosta
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
- Hospital del Salvador, Servicio de Neurología, Santiago, Chile
| | - José Luis Castillo
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
| | - Thanuja Dharmadasa
- University of Melbourne, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- The Royal Melbourne Hospital, Department of Neurology, Parkville, Victoria, Australia
- University of Sydney, Brain and Mind Centre, Sydney, Australia
| | - Matthew C. Kiernan
- University of Sydney, Brain and Mind Centre, Sydney, Australia
- Royal Prince Alfred Hospital, Department of Neurology, Sydney, AustraliaArgento
| | - José Manuel Matamala
- Universidad de Chile, Facultad de Medicina, Laboratorio de Neurología y Neurofisiología Traslacional, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Centro de Investigación Clínica Avanzado (CICA) Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Ciencias Neurológicas Oriente, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Departamento de Neurociencias, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Instituto de Neurociencia Biomédica (BNI), Santiago, Chile
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3
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Kopčanová M, Tait L, Donoghue T, Stothart G, Smith L, Flores-Sandoval AA, Davila-Perez P, Buss S, Shafi MM, Pascual-Leone A, Fried PJ, Benwell CSY. Resting-state EEG signatures of Alzheimer's disease are driven by periodic but not aperiodic changes. Neurobiol Dis 2024; 190:106380. [PMID: 38114048 DOI: 10.1016/j.nbd.2023.106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
Electroencephalography (EEG) has shown potential for identifying early-stage biomarkers of neurocognitive dysfunction associated with dementia due to Alzheimer's disease (AD). A large body of evidence shows that, compared to healthy controls (HC), AD is associated with power increases in lower EEG frequencies (delta and theta) and decreases in higher frequencies (alpha and beta), together with slowing of the peak alpha frequency. However, the pathophysiological processes underlying these changes remain unclear. For instance, recent studies have shown that apparent shifts in EEG power from high to low frequencies can be driven either by frequency specific periodic power changes or rather by non-oscillatory (aperiodic) changes in the underlying 1/f slope of the power spectrum. Hence, to clarify the mechanism(s) underlying the EEG alterations associated with AD, it is necessary to account for both periodic and aperiodic characteristics of the EEG signal. Across two independent datasets, we examined whether resting-state EEG changes linked to AD reflect true oscillatory (periodic) changes, changes in the aperiodic (non-oscillatory) signal, or a combination of both. We found strong evidence that the alterations are purely periodic in nature, with decreases in oscillatory power at alpha and beta frequencies (AD < HC) leading to lower (alpha + beta) / (delta + theta) power ratios in AD. Aperiodic EEG features did not differ between AD and HC. By replicating the findings in two cohorts, we provide robust evidence for purely oscillatory pathophysiology in AD and against aperiodic EEG changes. We therefore clarify the alterations underlying the neural dynamics in AD and emphasize the robustness of oscillatory AD signatures, which may further be used as potential prognostic or interventional targets in future clinical investigations.
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Affiliation(s)
- Martina Kopčanová
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK.
| | - Luke Tait
- Centre for Systems Modelling and Quantitative Biomedicine, School of Medical and Dental Sciences, University of Birmingham, UK; Cardiff University Brain Research Imaging Centre, Cardiff, UK
| | - Thomas Donoghue
- Department of Biomedical Engineering, Columbia University, New York, USA
| | | | - Laura Smith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Aimee Arely Flores-Sandoval
- Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, 10117 Berlin, Germany; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Paula Davila-Perez
- Rey Juan Carlos University Hospital (HURJC), Department of Clinical Neurophysiology, Móstoles, Madrid, Spain; Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - Stephanie Buss
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States of America
| | - Peter J Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christopher S Y Benwell
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
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Sundman MH, Avila De Vault BE, Chen AYC, Madhavan L, Fuglevand AJ, Chou YH. The (hyper)excitable brain: what can a ubiquitous TMS measure reveal about cognitive aging? Neurobiol Aging 2023; 132:250-252. [PMID: 37827912 PMCID: PMC10982121 DOI: 10.1016/j.neurobiolaging.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Mark H Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ, USA
| | | | - Allison Yu-Chin Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Lalitha Madhavan
- Departments of Neurology and Molecular and Cellular Biology, College of Medicine, University of Arizona, Tucson, AZ, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ, USA
| | - Andrew J Fuglevand
- Departments of Physiology and Neuroscience, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ, USA; Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ, USA.
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Tik M, Vasileiadi M, Woletz M, Linhardt D, Schuler AL, Williams N, Windischberger C. Concurrent TMS/fMRI reveals individual DLPFC dose-response pattern. Neuroimage 2023; 282:120394. [PMID: 37805020 DOI: 10.1016/j.neuroimage.2023.120394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND TMS is a valuable tool in both research and clinical settings, playing a crucial role in understanding brain-behavior relationships and providing treatment for various neurological and psychiatric conditions. Importantly, TMS over left DLPFC is an FDA approved treatment for MDD. Despite its potential, response variability to TMS remains a challenge, with stimulation parameters, particularly the stimulation intensity, being a primary contributor to these differences. OBJECTIVE The objective of this study was to establish dose-response relationships of TMS stimulation in DLPFC by means of concurrent TMS/fMRI. METHODS Here, we stimulated 15 subjects at different stimulation intensities of 80, 90, 100 and 110 % relative to the motor threshold during concurrent TMS/fMRI. The experiment comprised two sessions: one session to collect anatomical data in order to perform neuronavigation and one session dedicated to dose-response mapping. We calculated GLMs for each intensity level and each subject, as well as at a group-level per intensity. RESULTS On a group level, we show that the strongest BOLD-response was at 100 % stimulation. However, investigating individual dose response-relationships showed differences in response patterns across the group: subjects that responded to subthreshold stimulation, subjects that required above threshold stimulation in order to show a significant BOLD-response and atypical responders. CONCLUSIONS We observed qualitative inter-subject variability in terms of dose-response relationship to TMS over left DLPFC, which hints towards the motor threshold not being directly transferable to the excitability of the DLPFC. Concurrent TMS/fMRI might have the potential to improve response rates to rTMS applications. As such, it may be valuable in the future to consider implementing this approach prior to clinical TMS or validating more cost-effective methods to determine dose and target with respect to changes in clinical symptoms.
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Affiliation(s)
- Martin Tik
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Maria Vasileiadi
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - Michael Woletz
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - David Linhardt
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - Anna-Lisa Schuler
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria
| | - Nolan Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Christian Windischberger
- MR Center of Excellence, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Lazarettgasse 14, Vienna 1090, Austria.
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Agrawal A, Bhattacharya A, Kamble N, Mailankody P, Yadav R, Pal PK. Cortical excitability changes in patients of vascular parkinsonism with cognitive impairment. Parkinsonism Relat Disord 2023; 116:105869. [PMID: 37783026 DOI: 10.1016/j.parkreldis.2023.105869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Vascular parkinsonism (VaP), type of lower body parkinsonism, occurs in relation to ischemic cerebrovascular disease. It can be associated with cognitive impairment. We aimed to study the cortical excitability changes in these patients using transcranial magnetic stimulation (TMS). METHODS We included 20 patients with VaP and 22 healthy controls (HC). All subjects underwent TMS over left motor cortex with recording of resting motor threshold (RMT), central motor conduction time (CMCT), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), contralateral and ipsilateral silent period (SP) along with RMT and CMCT in the contralateral lower limb. Cognitive assessments were done using Montreal cognitive assessment (MoCA) and Addenbrooke's cognitive evaluation III (ACE III). RESULTS Mean age of patients (63.90 ± 7.36 years) was comparable with controls (59.77 ± 6.94 years; p = 0.07). Duration of disease was 2.58 ± 2.57 years. The upper and lower limb RMT of patients (32.45 ± 4.81%; 57.20 ± 11.54%) was significantly low compared to HC (43.64 ± 7.73%; 69.18 ± 14.27%; p < 0.001). There was a significant reduction in SICI in patients (1.87 ± 2.03) compared to HC (0.38 ± 0.29; p < 0.001). In addition, there was a significant prolongation of ipsilateral SP in patients (48.49 ± 24.49) compared to controls (32.04 ± 12.26, p = 0.01). However, there was no significant difference in contralateral SP (p = 0.66) and ICF (p = 0.25) between the two groups. There was a significant prolongation of lower limb CMCT in patients (p < 0.01). There was a positive correlation of SICI with MoCA (r = 0.45, p < 0.05) and ACE-III (r = 0.33, p < 0.05) scores. CONCLUSION Reduction in RMT and SICI in patients with VaP suggests abnormalities in GABAergic neurotransmission that may underlie cognitive impairment observed in them.
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Affiliation(s)
- Aakash Agrawal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India.
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Flores-Sandoval AA, Davila-Pérez P, Buss SS, Donohoe K, O'Connor M, Shafi MM, Pascual-Leone A, Benwell CSY, Fried PJ. Spectral power ratio as a measure of EEG changes in mild cognitive impairment due to Alzheimer's disease: a case-control study. Neurobiol Aging 2023; 130:50-60. [PMID: 37459658 PMCID: PMC10614059 DOI: 10.1016/j.neurobiolaging.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 08/13/2023]
Abstract
Adopting preventive strategies in individuals with subclinical Alzheimer's disease (AD) has the potential to delay dementia onset and reduce healthcare costs. Thus, it is extremely important to identify inexpensive, scalable, sensitive, and specific markers to track disease progression. The electroencephalography spectral power ratio (SPR: the fast to slow spectral power ratio), a measure of the shift in power distribution from higher to lower frequencies, holds potential for aiding clinical practice. The SPR is altered in patients with AD, correlates with cognitive functions, and can be easily implemented in clinical settings. However, whether the SPR is sensitive to pathophysiological changes in the prodromal stage of AD is unclear. We explored the SPR of individuals diagnosed with amyloid-positive amnestic mild cognitive impairment (Aβ+aMCI) and its association with both cognitive function and amyloid load. The SPR was lower in Aβ+aMCI than in the cognitively unimpaired individuals and correlated with executive function scores but not with amyloid load. Hypothesis-generating analyses suggested that aMCI participants with a lower SPR had an increased probability of a positive amyloid positron emission tomography. Future research may explore the potential of this measure to classify aMCI individuals according to their AD biomarker status.
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Affiliation(s)
- Aimee A Flores-Sandoval
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, 10117 Berlin, Germany; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Paula Davila-Pérez
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Clinical Neurophysiology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephanie S Buss
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Kevin Donohoe
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Margaret O'Connor
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research, and Deanna and Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, USA
| | - Christopher S Y Benwell
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | - Peter J Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
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8
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Buss SS, Fried PJ, Macone J, Zeng V, Zingg E, Santarnecchi E, Pascual-Leone A, Bartrés-Faz D. Greater cognitive reserve is related to lower cortical excitability in healthy cognitive aging, but not in early clinical Alzheimer's disease. Front Hum Neurosci 2023; 17:1193407. [PMID: 37576473 PMCID: PMC10413110 DOI: 10.3389/fnhum.2023.1193407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To investigate the relationship between cortico-motor excitability and cognitive reserve (CR) in cognitively unimpaired older adults (CU) and in older adults with mild cognitive impairment or mild dementia due to Alzheimer's disease (AD). Methods Data were collected and analyzed from 15 CU and 24 amyloid-positive AD participants aged 50-90 years. A cognitive reserve questionnaire score (CRQ) assessed education, occupation, leisure activities, physical activities, and social engagement. Cortical excitability was quantified as the average amplitude of motor evoked potentials (MEP amplitude) elicited with single-pulse transcranial magnetic stimulation delivered to primary motor cortex. A linear model compared MEP amplitudes between groups. A linear model tested for an effect of CRQ on MEP amplitude across all participants. Finally, separate linear models tested for an effect of CRQ on MEP amplitude within each group. Exploratory analyses tested for effect modification of demographics, cognitive scores, atrophy measures, and CSF measures within each group using nested regression analysis. Results There was no between-group difference in MEP amplitude after accounting for covariates. The primary model showed a significant interaction term of group*CRQ (R2adj = 0.18, p = 0.013), but no main effect of CRQ. Within the CU group, higher CRQ was significantly associated with lower MEP amplitude (R2adj = 0.45, p = 0.004). There was no association in the AD group. Conclusion Lower cortico-motor excitability is related to greater CRQ in CU, but not in AD. Lower MEP amplitudes may reflect greater neural efficiency in cognitively unimpaired older adults. The lack of association seen in AD participants may reflect disruption of the protective effects of CR. Future work is needed to better understand the neurophysiologic mechanisms leading to the protective effects of CR in older adults with and without neurodegenerative disorders.
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Affiliation(s)
- Stephanie S. Buss
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Peter J. Fried
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Joanna Macone
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Victor Zeng
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emma Zingg
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Program of All-inclusive Care for the Elderly (PACE), Cambridge Health Alliance, Cambridge, MA, United States
| | - Emiliano Santarnecchi
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Precision Neuromodulation Program, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | - David Bartrés-Faz
- Division of Cognitive Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Kopčanová M, Tait L, Donoghue T, Stothart G, Smith L, Sandoval AAF, Davila-Perez P, Buss S, Shafi MM, Pascual-Leone A, Fried PJ, Benwell CS. Resting-state EEG signatures of Alzheimer's disease are driven by periodic but not aperiodic changes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.11.544491. [PMID: 37398162 PMCID: PMC10312609 DOI: 10.1101/2023.06.11.544491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Electroencephalography (EEG) has shown potential for identifying early-stage biomarkers of neurocognitive dysfunction associated with dementia due to Alzheimer's disease (AD). A large body of evidence shows that, compared to healthy controls (HC), AD is associated with power increases in lower EEG frequencies (delta and theta) and decreases in higher frequencies (alpha and beta), together with slowing of the peak alpha frequency. However, the pathophysiological processes underlying these changes remain unclear. For instance, recent studies have shown that apparent shifts in EEG power from high to low frequencies can be driven either by frequency specific periodic power changes or rather by non-oscillatory (aperiodic) changes in the underlying 1/f slope of the power spectrum. Hence, to clarify the mechanism(s) underlying the EEG alterations associated with AD, it is necessary to account for both periodic and aperiodic characteristics of the EEG signal. Across two independent datasets, we examined whether resting-state EEG changes linked to AD reflect true oscillatory (periodic) changes, changes in the aperiodic (non-oscillatory) signal, or a combination of both. We found strong evidence that the alterations are purely periodic in nature, with decreases in oscillatory power at alpha and beta frequencies (AD < HC) leading to lower (alpha + beta) / (delta + theta) power ratios in AD. Aperiodic EEG features did not differ between AD and HC. By replicating the findings in two cohorts, we provide robust evidence for purely oscillatory pathophysiology in AD and against aperiodic EEG changes. We therefore clarify the alterations underlying the neural dynamics in AD and emphasise the robustness of oscillatory AD signatures, which may further be used as potential prognostic or interventional targets in future clinical investigations.
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Affiliation(s)
- Martina Kopčanová
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | - Luke Tait
- Centre for Systems Modelling and Quantitative Biomedicine, School of Medical and Dental Sciences, University of Birmingham, UK
- Cardiff University Brain Research Imaging Centre, Cardiff, UK
| | - Thomas Donoghue
- Department of Biomedical Engineering, Columbia University, New York, USA
| | | | - Laura Smith
- School of Psychology, University of Kent, Kent, UK
| | - Aimee Arely Flores Sandoval
- Charité – Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, 10117, Berlin, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Paula Davila-Perez
- Rey Juan Carlos University Hospital (HURJC), Department of Clinical Neurophysiology, Móstoles, Madrid, Spain
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
| | - Stephanie Buss
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mouhsin M. Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston MA
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S.Y. Benwell
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
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10
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Tăuƫan AM, Casula EP, Pellicciari MC, Borghi I, Maiella M, Bonni S, Minei M, Assogna M, Palmisano A, Smeralda C, Romanella SM, Ionescu B, Koch G, Santarnecchi E. TMS-EEG perturbation biomarkers for Alzheimer's disease patients classification. Sci Rep 2023; 13:7667. [PMID: 37169900 PMCID: PMC10175269 DOI: 10.1038/s41598-022-22978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 05/13/2023] Open
Abstract
The combination of TMS and EEG has the potential to capture relevant features of Alzheimer's disease (AD) pathophysiology. We used a machine learning framework to explore time-domain features characterizing AD patients compared to age-matched healthy controls (HC). More than 150 time-domain features including some related to local and distributed evoked activity were extracted from TMS-EEG data and fed into a Random Forest (RF) classifier using a leave-one-subject out validation approach. The best classification accuracy, sensitivity, specificity and F1 score were of 92.95%, 96.15%, 87.94% and 92.03% respectively when using a balanced dataset of features computed globally across the brain. The feature importance and statistical analysis revealed that the maximum amplitude of the post-TMS signal, its Hjorth complexity and the amplitude of the TEP calculated in the window 45-80 ms after the TMS-pulse were the most relevant features differentiating AD patients from HC. TMS-EEG metrics can be used as a non-invasive tool to further understand the AD pathophysiology and possibly contribute to patients' classification as well as longitudinal disease tracking.
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Affiliation(s)
- Alexandra-Maria Tăuƫan
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- AI Multimedia Lab, Research Center CAMPUS, University Politehnica of Bucharest, 061344, Bucharest, Romania
| | - Elias P Casula
- Santa Lucia Foundation, 00179, Rome, Italy
- Department of Psychology, La Sapienza University, Via dei Marsi 78, 00185, Rome, Italy
| | | | | | | | | | | | | | - Annalisa Palmisano
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Carmelo Smeralda
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Sara M Romanella
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Bogdan Ionescu
- AI Multimedia Lab, Research Center CAMPUS, University Politehnica of Bucharest, 061344, Bucharest, Romania
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, Section of Human Physiology, University of Ferrara, 44121, Ferrara, Italy
- Santa Lucia Foundation, 00179, Rome, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience and Neuromodulation Program & Network Control Laboratory, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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11
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Hugenschmidt CE, Ip EH, Laurita-Spanglet J, Babcock P, Morgan AR, Fanning JT, King K, Thomas JT, Soriano CT. IMOVE: Protocol for a randomized, controlled 2x2 factorial trial of improvisational movement and social engagement interventions in older adults with early Alzheimer's disease. Contemp Clin Trials Commun 2023; 32:101073. [PMID: 36949846 PMCID: PMC10025420 DOI: 10.1016/j.conctc.2023.101073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/02/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
Background In addition to cognitive impairment, people with Alzheimer's disease (PWAD) experience neuropsychiatric symptoms (e.g., apathy, depression), altered gait, and poor balance that further diminish their quality of life (QoL). Here, we describe a unique, randomized, controlled trial to test the hypothesis that both movement and social engagement aspects of a group dance intervention alter the connectivity of key brain networks involved in motor and social-emotional functioning and lead to improved QoL in PWAD. Methods IMOVE (NCT03333837) was a single-center, randomized, controlled 2x2 factorial trial that assigned PWAD/caregiver dyads to one of 4 study conditions (Movement Group, Movement Alone, Social Group, or Usual Care control). The Movement Group participated in twice-weekly group improvisational dance (IMPROVment® Method) classes for 12 weeks. The Movement Alone intervention captured the same dance movement and auditory stimuli as the group class without social interaction, and the Social Group used improvisational party games to recapitulate the fun and playfulness of the Movement Group without the movement. The primary outcome was change in QoL among PWAD. Key secondary outcomes were functional brain network measures assessed using graph-theory analysis of resting-state functional magnetic resonance imaging scans, as well as neuropsychiatric symptoms, gait, and balance. Results A total of 111 dyads were randomized; 89 completed the study, despite interruption and modification of the protocol due to COVID-19 restrictions (see companion paper by Fanning et al.). The data are being analyzed and will be submitted for publication in 2023.
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Affiliation(s)
- Christina E. Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Corresponding author. Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Edward H. Ip
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Phyllis Babcock
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ashley R. Morgan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jason T. Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Kamryn King
- Department of Theatre and Dance, Wake Forest University, Winston-Salem, NC, USA
| | - Jantira T. Thomas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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12
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Samudra N, Ranasinghe K, Kirsch H, Rankin K, Miller B. Etiology and Clinical Significance of Network Hyperexcitability in Alzheimer's Disease: Unanswered Questions and Next Steps. J Alzheimers Dis 2023; 92:13-27. [PMID: 36710680 DOI: 10.3233/jad-220983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cortical network hyperexcitability related to synaptic dysfunction in Alzheimer's disease (AD) is a potential target for therapeutic intervention. In recent years, there has been increased interest in the prevalence of silent seizures and interictal epileptiform discharges (IEDs, or seizure tendency), with both entities collectively termed "subclinical epileptiform activity" (SEA), on neurophysiologic studies in AD patients. SEA has been demonstrated to be common in AD, with prevalence estimates ranging between 22-54%. Converging lines of basic and clinical evidence imply that modifying a hyperexcitable state results in an improvement in cognition. In particular, though these results require further confirmation, post-hoc findings from a recent phase II clinical trial suggest a therapeutic effect with levetiracetam administration in patients with AD and IEDs. Here, we review key unanswered questions as well as potential clinical trial avenues. Specifically, we discuss postulated mechanisms and treatment of hyperexcitability in patients with AD, which are of interest in designing future disease-modifying therapies. Criteria to prompt screening and optimal screening methodology for hyperexcitability have yet to be defined, as does timing and personalization of therapeutic intervention.
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Affiliation(s)
- Niyatee Samudra
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Kamalini Ranasinghe
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Heidi Kirsch
- University of California, San Francisco Comprehensive Epilepsy Center, San Francisco, CA, USA
| | - Katherine Rankin
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
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13
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van den Bos MAJ, Menon P, Vucic S. Cortical hyperexcitability and plasticity in Alzheimer's disease: developments in understanding and management. Expert Rev Neurother 2022; 22:981-993. [PMID: 36683586 DOI: 10.1080/14737175.2022.2170784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiological tool that provides important insights into Alzheimer's Disease (AD). A significant body of work utilizing TMS techniques has explored the pathophysiological relevance of cortical hyperexcitability and plasticity in AD and their modulation in novel therapies. AREAS COVERED This review examines the technique of TMS, the use of TMS to examine specific features of cortical excitability and the use of TMS techniques to modulate cortical function. A search was performed utilizing the PubMed database to identify key studies utilizing TMS to examine cortical hyperexcitability and plasticity in Alzheimer's dementia. We then translate this understanding to the study of Alzheimer's disease pathophysiology, examining the underlying neurophysiologic links contributing to these twin signatures, cortical hyperexcitability and abnormal plasticity, in the cortical dysfunction characterizing AD. Finally, we examine utilization of TMS excitability to guide targeted therapies and, through the use of repetitive TMS (rTMS), modulate cortical plasticity. EXPERT OPINION The examination of cortical hyperexcitability and plasticity with TMS has potential to optimize and expand the window of therapeutic interventions in AD, though remains at relatively early stage of development.
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Affiliation(s)
- Mehdi A J van den Bos
- Brain and Nerve Research Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Parvathi Menon
- Brain and Nerve Research Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Repatriation General Hospital, Sydney, Australia
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14
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Redondo-Camós M, Cattaneo G, Alviarez-Schulze V, Delgado-Gallén S, España-Irla G, Solana-Sanchez J, Perellón-Alfonso R, Albu S, Tormos JM, Pascual-Leone A, Bartres-Faz D. Long-interval intracortical inhibition in primary motor cortex related to working memory in middle-aged adults. Front Psychol 2022; 13:998062. [PMID: 36248602 PMCID: PMC9559215 DOI: 10.3389/fpsyg.2022.998062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Excitability of the primary motor cortex measured with TMS has been associated with cognitive dysfunctions in patient populations. However, only a few studies have explored this relationship in healthy adults, and even fewer have considered the role of biological sex. Methods Ninety-seven healthy middle-aged adults (53 male) completed a TMS protocol and a neuropsychological assessment. Resting Motor Threshold (RMT) and Long-Interval Intracortical Inhibition (LICI) were assessed in the left motor cortex and related to attention, episodic memory, working memory, reasoning, and global cognition composite scores to evaluate the relationship between cortical excitability and cognitive functioning. Results In the whole sample, there was a significant association between LICI and cognition; specifically, higher motor inhibition was related to better working memory performance. When the sample was broken down by biological sex, LICI was only associated with working memory, reasoning, and global cognition in men. No associations were found between RMT and cognitive functions. Conclusion Greater intracortical inhibition, measured by LICI, could be a possible marker of working memory in healthy middle-aged adults, and biological sex plays a critical role in this association.
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Affiliation(s)
- María Redondo-Camós
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Vanessa Alviarez-Schulze
- Departamento de Ciencias del Comportamiento, Escuela de Psicología, Universidad Metropolitana, Caracas, Venezuela
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, i Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Selma Delgado-Gallén
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Goretti España-Irla
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Javier Solana-Sanchez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Ruben Perellón-Alfonso
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, i Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sergiu Albu
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - José M. Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- *Correspondence: Alvaro Pascual-Leone,
| | - David Bartres-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, i Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- David Bartres-Faz,
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15
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Cappon D, den Boer T, Jordan C, Yu W, Metzger E, Pascual-Leone A. Transcranial magnetic stimulation (TMS) for geriatric depression. Ageing Res Rev 2022; 74:101531. [PMID: 34839043 PMCID: PMC8996329 DOI: 10.1016/j.arr.2021.101531] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/04/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The prevalence of treatment-resistant geriatric depression (GD) highlights the need for treatments that preserve cognitive functions and recognize polypharmacy in elderly, yet effectively reduce symptom burden. Transcranial magnetic stimulation (TMS) is a proven intervention for treatment-resistant depression in younger adults but the efficacy of TMS to treat depressed older adults is still unclear. This review provides an updated view on the efficacy of TMS treatment for GD, discusses methodological differences between trials in TMS application, and explores avenues for optimization of TMS treatment in the context of the ageing brain. METHODS A systematic review was conducted to identify published literature on the antidepressant efficacy of TMS for GD. Databases PubMed, Embase, and PsycINFO were searched for English language articles in peer-reviewed journals in March 2021. RESULTS Seven randomized controlled trials (RCTs) (total n = 260, active n = 148, control n = 112) and seven uncontrolled trials (total n = 160) were included. Overall, we found substantial variability in the clinical response, ranging from 6.7% to 54.3%. CONCLUSIONS The reviewed literature highlights large heterogeneity among studies both in terms of the employed TMS dosage and the observed clinical efficacy. This highlights the need for optimizing TMS dosage by recognizing the unique clinical features of GD. We showcase a set of novel approaches for the optimization of the TMS protocol for depression and discuss the possibility for a standardized TMS protocol tailored for the treatment of GD.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Caleb Jordan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Guttmann Institut, Spain
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16
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Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis. Sci Rep 2021; 11:24011. [PMID: 34907209 PMCID: PMC8671542 DOI: 10.1038/s41598-021-03281-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/12/2021] [Indexed: 02/03/2023] Open
Abstract
This study aims to investigate the associative and multivariate relationship between different sociodemographic and clinical variables with cortical excitability as indexed by transcranial magnetic stimulation (TMS) markers in subjects with chronic pain caused by knee osteoarthritis (OA). This was a cross-sectional study. Sociodemographic and clinical data were extracted from 107 knee OA subjects. To identify associated factors, we performed independent univariate and multivariate regression models per TMS markers: motor threshold (MT), motor evoked potential (MEP), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). In our multivariate models, the two markers of intracortical inhibition, SICI and CSP, had a similar signature. SICI was associated with age (β: 0.01), WOMAC pain (β: 0.023), OA severity (as indexed by Kellgren–Lawrence Classification) (β: − 0.07), and anxiety (β: − 0.015). Similarly, CSP was associated with age (β: − 0.929), OA severity (β: 6.755), and cognition (as indexed by the Montreal Cognitive Assessment) (β: − 2.106). ICF and MT showed distinct signatures from SICI and CSP. ICF was associated with pain measured through the Visual Analogue Scale (β: − 0.094) and WOMAC (β: 0.062), and anxiety (β: − 0.039). Likewise, MT was associated with WOMAC (β: 1.029) and VAS (β: − 2.003) pain scales, anxiety (β: − 0.813), and age (β: − 0.306). These associations showed the fundamental role of intracortical inhibition as a marker of adaptation to chronic pain. Subjects with higher intracortical inhibition (likely subjects with more compensation) are younger, have greater cartilage degeneration (as seen by radiographic severity), and have less pain in WOMAC scale. While it does seem that ICF and MT may indicate a more acute marker of adaptation, such as that higher ICF and MT in the motor cortex is associated with lesser pain and anxiety.
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