Motor cortex excitability in Alzheimer's disease: A transcranial magnetic stimulation study
Florinda Ferreri MD
Department of Neurology, University Campus Biomedico
Search for more papers by this authorFlavia Pauri MD, PhD
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
Dipartimento di Neurologia e Otorinolaringoiatria, Università La Sapienza, Rome, Italy
Search for more papers by this authorPatrizio Pasqualetti PhD
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
Search for more papers by this authorRita Fini Tech
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
Search for more papers by this authorGloria Dal Forno MD
Department of Neurology, University Campus Biomedico
Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD
Search for more papers by this authorCorresponding Author
Paolo Maria Rossini MD, PhD
Department of Neurology, University Campus Biomedico
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
IRCCS Centro S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy
Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina 39, 00186 Rome, ItalySearch for more papers by this authorFlorinda Ferreri MD
Department of Neurology, University Campus Biomedico
Search for more papers by this authorFlavia Pauri MD, PhD
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
Dipartimento di Neurologia e Otorinolaringoiatria, Università La Sapienza, Rome, Italy
Search for more papers by this authorPatrizio Pasqualetti PhD
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
Search for more papers by this authorRita Fini Tech
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
Search for more papers by this authorGloria Dal Forno MD
Department of Neurology, University Campus Biomedico
Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD
Search for more papers by this authorCorresponding Author
Paolo Maria Rossini MD, PhD
Department of Neurology, University Campus Biomedico
AFaR, CRCCS, Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina
IRCCS Centro S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy
Department of Neuroscience, Hospital Fatebenefratelli, Isola Tiberina 39, 00186 Rome, ItalySearch for more papers by this authorAbstract
Motor deficits affect patients with Alzheimer's disease only at later stages. Recent studies demonstrate that the primary motor cortex is affected by neuronal degeneration accompanied by the formation of amyloid plaques and neurofibrillary tangles. It is conceivable that neuronal loss is compensated by reorganization of the neural circuitries occurring along the natural course of the disease, thereby maintaining motor performances in daily living. Cortical motor output to upper limbs was tested via motor-evoked potentials from forearm and hand muscles elicited by transcranial magnetic stimulation of motor cortex in 16 patients with mild Alzheimer's disease without motor deficits. Motor cortex excitability was increased, and the center of gravity of motor cortical output, as represented by excitable scalp sites, showed a frontal and medial shift, without correlated changes in the site of maximal excitability (hot-spot). This may indicate functional reorganization, possibly after the neuronal loss in motor areas. Hyperexcitability might be caused by a dysregulation of the intracortical GABAergic inhibitory circuitries and selective alteration of glutamatergic neurotransmission. Such findings suggest that motor cortex hyperexcitability and reorganization allows prolonged preservation of motor function during the clinical course of Alzheimer's disease.
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