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

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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)94
JournalAlzheimer's Research and Therapy
Issue number1
Publication statusPublished - Sep 18 2018


Dive into the research topics of 'The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease'. Together they form a unique fingerprint.

Cite this