The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease
The impact of transcranial magnetic stimulation on diagnostic confidence in patients with Alzheimer disease
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DOI：
10.1186/s13195-018-0423-6
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发表时间：
2018-09-18
影响因子：
9
通讯作者：
Borroni, Barbara
中科院分区：
文献类型：
--
作者：
Benussi, Alberto;Alberici, Antonella;Borroni, Barbara
背景资料：胆碱能功能障碍是阿尔茨海默病（AD）的一个关键异常，可以通过经颅磁刺激（TMS）方案在体内检测。虽然TMS已经清楚地证明了分析的有效性，但其临床实用性仍有争议。在本研究中，我们评估了增量诊断价值，以阿尔茨海默病的诊断置信度表示（DCAD;范围0-100），TMS测量除了常规临床诊断评估的患者评价认知功能障碍相比，验证的生物标志物的淀粉样变性。120名痴呆患者被纳入研究，并在基于（1）人口统计学、临床和神经心理学评估的三步评估中对DCAD进行评分（2）临床检查加淀粉样蛋白标记物（脑脊液或淀粉样蛋白正电子发射断层成像）;和（3）临床检查加TMS皮质内连接测量。要求两名设盲的神经科医生审查每个步骤的诊断和诊断信心。结果：TMS测量增加了两个集群中DCAD的区分度（AD样vs FTD样），当添加到临床和神经心理学评价中时，其水平与脑淀粉样变性的既定生物标志物相当（单独临床检查的聚类距离为55.1，临床检查加淀粉样蛋白标志物的聚类距离为76.0，临床检查加TMS的聚类距离为80.0）。“金标准”诊断的分类准确性在三步评估中评价的（二分- AD vs FID变量），表示为AUC，从0.82（仅临床检查）至0.98（临床检查加TMS）和0.99（临床检查加淀粉样变性标志物）。除常规评估外，TMS对痴呆患者的诊断和诊断置信度具有显著影响，可与成熟的淀粉样变性生物标志物相媲美。
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 FID 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.