Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such asexcitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of thepathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.

Applied Neuroscience Research Group Central European Institute of Technology Masaryk University Brno Czech Republic; Department of Neurology St Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic

Applied Neuroscience Research Group Central European Institute of Technology Masaryk University Brno Czech Republic; Faculty of Medicine Masaryk University Brno Czech Republic

Centre for Neurodegenerative Disorders Department of Clinical and Experimental Sciences University of Brescia Brescia Italy

Department of Cellular and Molecular Medicine Faculty of Medicine University of Ottawa ON Canada; Royal Ottawa Institute of Mental Health Research Ottawa ON Canada

Department of Human Neurophysiology School of Medicine Fukushima Medical University Fukushima Japan

Department of Human Neurosciences Sapienza University of Rome Italy; IRCCS Neuromed Pozzilli IS Italy

Department of Medical and Surgical Sciences and Advanced Technologies Section of Neurosciences University of Catania Catania Italy

Department of Neurology Mitsui Memorial Hospital Tokyo Japan

Department of Neurology National Taiwan University Hospital Hsin Chu Branch Hsin Chu Taiwan

Department of Neurology Royal Prince Alfred Hospital Brain and Mind Centre University of Sydney Sydney New South Wales Australia

Department of Neurology University Hospital Leipzig Leipzig University Medical Center Germany

Department of Neurosciences Reproductive Sciences and Odontostomatology University of Naples Federico 2 Naples Italy

Department of Surgery and Medical Surgical Specialties University of Catania Catania Italy; Department of Neurology IC Oasi Research Institute IRCCS Troina Italy

Division of Neurology Department of Medicine University of Toronto Toronto Canada; Division of Brain Imaging and Behaviour Krembil Brain Institute Toronto Canada

ENT Team EA4391 Faculty of Medicine Paris Est Créteil University Créteil France; Clinical Neurophysiology Unit Department of Physiology Henri Mondor Hospital Assistance Publique Hôpitaux de Paris Créteil France

Hinda and Arthur Marcus Institute for Aging Research Center for Memory Health Hebrew SeniorLife USA; Department of Neurology Harvard Medical School Boston MA USA; Guttmann Brain Health Institute Universitat Autonoma Barcelona Spain

Laboratory of Clinical Neurosciences Rambam Medical Center Haifa Israel

Non Invasive Brain Stimulation Unit Department of Behavioral and Clinical Neurology Santa Lucia Foundation IRCCS Rome Italy; Department of Neuroscience and Rehabilitation University of Ferrara Ferrara Italy

Pain Center clinique Bretéché groupe ELSAN Multidisciplinary Pain Palliative and Supportive care Center UIC 22 CAT2 and Laboratoire de Thérapeutique University Hospital Nantes France

Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK

Unit of Neurology Department of Neuroscience Biomedicine and Movement Sciences University of Verona Verona Italy

Unit of Neurology Neurophysiology Neurobiology Department of Medicine Università Campus Bio Medico di Roma Rome Italy

University Hospital of Old Age Psychiatry and Psychotherapy University of Bern Bern Switzerland; Swiss Huntington's Disease Centre Siloah Bern Switzerland

Citace poskytuje Crossref.org

Physiology-inspired bifocal fronto-parietal tACS for working memory enhancement

Non-invasive stimulation for treating cognitive impairment in Alzheimer disease

Is the vertex a good control stimulation site? Theta burst stimulation in healthy controls