Applicable techniques and indicators of diagnostic transcranial magnetic stimulation in cognitive neuroscience
Keywords:
dementia, diagnosis, mild cognitive impairment, transcranial magnetic stimulationAbstract
Transcranial magnetic stimulation (TMS) is an established neurophysiological tool for studying the integrity of the corticomuscular pathway in a wide range of diseases associated with motor dysfunction. This includes, but is not limited only to patients with multiple sclerosis, motor neuron disease, Parkinson's disease, stroke and cranial nerve damages. In the last 20 years, the scientific interest and the number of electrophysiological studies applicable in clinical diagnostics, related to proven abnormalities in cortical functions in individuals affected by dementia have increased. TMS showed high specificity in most dementias associated with Parkinsonian symptoms. Such specificity is also found in some studies with TMS in patients with mild cognitive impairment (MCI) – to differentiate its variants.
There is already evidence in the literature for distinguishing by TMS individuals with MCI, a condition preceding Alzheimer's disease (AD). Other indicators determining GABA-ergic and glutamatergic transmission find abnormalities in patients with underlying pathology such as frontotemporal dementia (FTD). The increased level of cortical excitability in AD and vascular dementia (VD) has been proven. Short-latent afferent inhibition (SAI), as a functional indicator of the state of the central cholinergic pathways is normal in VD and FTD, but is suppressed in AD. No change in cortical excitability was observed in FTD, Parkinson's dementia and Lewy's body dementia. In most dementias associated with
Parkinsonian symptoms, two indicators of TMS for GABAergic cortical inhibition are abnormal. These are the short-interval intracortical inhibition and the contralateral silence period. The ipsilateral silence period (an indicator of the integrity of the corpus callosum) is abnormal in AD.
The relatively nonexpensive, non-invasive and easily applicable techniques of TMS allow their use as an additional marker for the diagnosis of MCI. They can become particularly relevant to cognitive science with the opportunities they offer for screening at-risk groups for dementia.
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