title: A review of transcranial magnetic stimulation in the in vivo functional evaluation of central cholinergic circuits in dementia.
abstract: Central cholinergic circuits of human brain can be tested non-invasively by coupling electrical peripheral stimulation with transcranial magnetic stimulation (TMS) of the motor cortex. The short-latency afferent inhibition (SAI) is reduced in cholinergic forms of dementia, such as Alzheimer disease (AD) and dementia with Lewy bodies, while it is normal in non-cholinergic forms of dementia, such as frontotemporal dementia. This finding suggests that this method can be used as a non-invasive additional tool for discriminating between cholinergic and non-cholinergic forms of dementia. Interestingly, SAI was also found to be significantly smaller in early AD patients. Identification of SAI abnormalities that occur early in the course of AD will allow earlier diagnosis and treatment with cholinergic drugs. In patients with vascular dementia, SAI responses varied widely; the number of patients with abnormal SAI conceivably reflects the percentage of subjects with a significant cholinergic dysfunction. It has recently been demonstrated that brain microbleeds have an impact on SAI that is independent of the extent of associated white matter changes and ischemic stroke. Since SAI can be increased by acetylcholinesterase inhibitors, TMS may help in identifying the patients who would be suitable for long-term treatment with cholinergic agents.
authors.affiliation: Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria. raffaele.nardone @ asbmeran-o.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: Nardone
authors.forename: Stefan
authors.initials: S
authors.lastname: Golaszewski
authors.forename: Gunther
authors.initials: G
authors.lastname: Ladurner
authors.forename: Frediano
authors.initials: F
authors.lastname: Tezzon
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
mesh_terms: D000344:Afferent Pathways / Q000503:physiopathology; D000544:Alzheimer Disease / Q000503:physiopathology; D017776:Autonomic Pathways / Q000503:physiopathology; D002540:Cerebral Cortex / Q000187:drug effects / Q000503:physiopathology; D003704:Dementia / Q000175:diagnosis* / Q000503:physiopathology; D015140:Dementia, Vascular / Q000503:physiopathology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000503:physiopathology; D020961:Lewy Body Disease / Q000503:physiopathology; D018727:Muscarinic Antagonists / Q000494:pharmacology; D010275:Parasympathetic Nervous System / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation
chemical_list: D018727:Muscarinic Antagonists