Taylor Joy L, Bhatt Priyanka, Hernandez Beatriz, Iv Michael, Adamson Maheen M, Heath Alesha, Yesavage Jerome A, McNerney Margaret Windy
Sierra-Pacific Mental Illness Research Education Clinical Center (MIRECC), US Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA 94305, USA.
Sierra-Pacific Mental Illness Research Education Clinical Center (MIRECC), US Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA 94304, USA.
Neuroimage Clin. 2025 Jun 6;47:103819. doi: 10.1016/j.nicl.2025.103819.
Transcranial magnetic stimulation (TMS) is a promising non-pharmacological intervention for treatment of mild cognitive impairment (MCI) and early Alzheimer's disease (AD). Yet, we know little about precisely where stimulation would be ideal to improve cognitive function.
To examine the network functional connectivity (fc) characteristics of prefrontal and parietal stimulation sites, given that these sites have led to improved cognitive function in TMS studies involving MCI-AD and unimpaired participants.
Resting-state functional MRI data were acquired from 32 MCI participants at the baseline visit of an ongoing TMS trial and used to compute connectivity with prefrontal and parietal stimulation locations, selected on the basis of previous TMS studies. The TMS seed maps were examined for extent of spatial overlap with eight canonical networks. After identifying the network most likely to be targeted by TMS, we applied strategies that may provide purer targeting. Finally, we examined network connectivity in relation to participants' behavioral characteristics because of the potential for TMS treatment to be personalized.
The prefrontal TMS seed map overlapped primarily with the salience network. The prefrontal site is also notable for its anti-correlated connectivity with the AD-vulnerable posterior cingulate cortex (PCC). The parietal TMS seed map showed the expected strong positive connectivity with the PCC and other default network regions. Nonetheless, this particular parietal site may simultaneously modulate the fronto-parietal network. Strategies to improve network targeting and to personalize TMS are reported as secondary findings.
These results can be applied to network-targeted brain stimulation for MCI and early AD treatment. Greater precision and personalization of TMS offer the promise of achieving better outcomes for individuals with MCI or mild AD dementia.
经颅磁刺激（TMS）是一种很有前景的非药物干预手段，用于治疗轻度认知障碍（MCI）和早期阿尔茨海默病（AD）。然而，我们对刺激改善认知功能的理想位置知之甚少。
鉴于在涉及MCI-AD患者和认知未受损参与者的TMS研究中，前额叶和顶叶刺激部位能改善认知功能，故研究这些刺激部位的网络功能连接（fc）特征。
在一项正在进行的TMS试验的基线访视中，从32名MCI参与者获取静息态功能磁共振成像数据，并用于计算与前额叶和顶叶刺激部位的连接，这些部位是根据之前的TMS研究选定的。检查TMS种子图与八个典型网络的空间重叠程度。在确定最可能被TMS靶向的网络后，我们应用了可能提供更精准靶向的策略。最后，由于TMS治疗具有个性化的潜力，我们研究了与参与者行为特征相关的网络连接。
前额叶TMS种子图主要与突显网络重叠。前额叶部位还因其与AD易损的后扣带回皮质（PCC）的反相关连接而值得注意。顶叶TMS种子图显示与PCC和其他默认网络区域有预期的强正连接。尽管如此，这个特定的顶叶部位可能同时调节额顶叶网络。作为次要发现，报告了改善网络靶向和TMS个性化的策略。
这些结果可应用于针对MCI和早期AD治疗的网络靶向脑刺激。TMS更高的精准度和个性化有望为MCI或轻度AD痴呆患者带来更好的治疗效果。
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