Mimura Yu, Tobari Yui, Nakahara Kazuho, Nakajima Shinichiro, Yoshida Kazunari, Mimura Masaru, Noda Yoshihiro
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Neurosci Biobehav Rev. 2023 Dec;155:105451. doi: 10.1016/j.neubiorev.2023.105451. Epub 2023 Nov 4.
Non-Alzheimer's dementia (NAD) accounts for 30% of all neurodegenerative conditions and is characterized by cognitive decline beyond mere memory dysfunction. Diagnosing NAD remains challenging due to the lack of established biomarkers. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiological tool that enables the investigation of cortical excitability in the human brain. Paired-pulse TMS paradigms include short- and long-interval intracortical inhibition (SICI/LICI), intracortical facilitation (ICF), and short-latency afferent inhibition (SAI), which can assess neurophysiological functions of GABAergic, glutamatergic, and cholinergic neural circuits, respectively. We conducted the first systematic review and meta-analysis to compare these TMS indices among patients with NAD and healthy controls. Our meta-analyses indicated that TMS neurophysiological examinations revealed decreased glutamatergic function in patients with frontotemporal dementia (FTD) and decreased GABAergic function in patients with FTD, progressive supranuclear palsy, Huntington's disease, cortico-basal syndrome, and multiple system atrophy-parkinsonian type. In addition, decreased cholinergic function was found in dementia with Lewy body and vascular dementia. These results suggest the potential of TMS as an additional diagnostic tool to differentiate NAD.
非阿尔茨海默病性痴呆（NAD）占所有神经退行性疾病的30%，其特征是认知功能下降，不仅仅是单纯的记忆功能障碍。由于缺乏既定的生物标志物，NAD的诊断仍然具有挑战性。经颅磁刺激（TMS）是一种非侵入性神经生理学工具，可用于研究人脑的皮质兴奋性。成对脉冲TMS范式包括短间隔和长间隔皮质内抑制（SICI/LICI）、皮质内易化（ICF）和短潜伏期传入抑制（SAI），它们可分别评估GABA能、谷氨酸能和胆碱能神经回路的神经生理功能。我们进行了首次系统评价和荟萃分析，以比较NAD患者与健康对照者之间的这些TMS指标。我们的荟萃分析表明，TMS神经生理学检查显示，额颞叶痴呆（FTD）患者的谷氨酸能功能下降，FTD、进行性核上性麻痹、亨廷顿病、皮质基底节综合征和多系统萎缩帕金森型患者的GABA能功能下降。此外，在路易体痴呆和血管性痴呆中发现胆碱能功能下降。这些结果表明TMS作为鉴别NAD的辅助诊断工具的潜力。
