【摘 要】
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BACKGROUND AND OBJECTIVEAlzheimer′s disease (AD) and frontotemporal dementia (FTD) are the most common neurodegenerative dementias among those 60 years of age or older. The neuropathological hallmark
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BACKGROUND AND OBJECTIVEAlzheimer′s disease (AD) and frontotemporal dementia (FTD) are the most common neurodegenerative dementias among those 60 years of age or older. The neuropathological hallmark of AD is amyloid deposits, while those of FTD are TDP-43 and tau inclusions. As transcranial magnetic stimulation (TMS) has been shown to assess distinct intracortical circuits in the central nervous system, this study was designed to assess the neurophysiologic parameters using TMS to differentiate ADD from FTD.
METHODSSubjects were 80 patients with probable AD and 64 with probable FTD. Neurophysiologic evaluations were performed at the University of Brescia in Rome at the Noninvasive Brain Stimulation Unit, Santa Lucia Foundation. Using a TMS figure-eight coil, the resting motor threshold was determined on the left motor cortex, recorded from the right first dorsal interosseous muscle during full muscle relaxation. Measurements included short-interval intracortical inhibition (SICI) and facilitation (ICF), long-interval intracortical inhibition, short-latency afferent inhibition (SAI), SICI-ICF, long-interval inhibition (LICI) and SAI.
RESULTSAmong patients with AD, significant impairment in the SAI circuitry was noted (P<0.001), with no such impairment noted in patients with FTD. Those with FTD demonstrated impairment in the SICI-ICF (P<0.001). For the SICI-ICF/SAI ratio, the best cutoff score was 0.98, with a sensitivity of 91.8%, a specificity of 88.6%, a positive predictive value of 86.2% and a negative predictive value of 93.3% for distinguishing FTD from AD.
CONCLUSIONThis study found that transcranial magnetic stimulation, a noninvasive study, may be helpful in distinguishing Alzheimer′s disease from frontotemporal dementia.
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