INTRODUCTION: Transcranial magnetic stimulation (TMS) has gained increasing attention as a potential therapeutic strategy in Alzheimer's disease (AD). Among factors determining a clinical response, the choice of the stimulation site represents a key point. In this proof of concept study, we prove the feasibility of a tailored TMS targeting approach for AD, which stems from a network-based perspective. Based on functional imaging, the procedure allows to extract individual optimal targets meanwhile accounting for functional variability. METHODS: Single-subject resting-state fMRI was used to extract individual target coordinates of two networks primarily affected in AD, the default mode and the fronto-parietal network. The localization of these targets was compared to that of traditional group-level approaches and tested against varying degrees of TMS focality. RESULTS: The distance between individual fMRI-derived coordinates and traditionally-defined targets was significant for a focality <12mm, but not for >20mm. Comparison with anatomical labels confirmed a lack of 1:1 correspondence between anatomical and functional targets. DISCUSSION: The proposed network-based fMRI-guided TMS approach allows targeting disorder-specific networks meanwhile accounting for inter-individual functional variability in Alzheimer's disease. This approach might represent a step toward tailored TMS interventions for AD.

中文翻译：

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功能成像可指导基于网络的TMS治疗：针对阿尔茨海默氏病的量身定制医学方法。

引言：经颅磁刺激（TMS）作为阿尔茨海默氏病（AD）的潜在治疗策略已受到越来越多的关注。在决定临床反应的因素中，刺激部位的选择是关键。在此概念验证研究中，我们证明了针对AD量身定制的TMS定位方法的可行性，该方法源于基于网络的观点。基于功能成像，该程序可以提取单个最佳目标，同时考虑功能变异性。方法：使用单对象静止状态功能磁共振成像提取两个主要受AD影响的网络（默认模式和额顶网络）的单个目标坐标。将这些目标的定位与传统的小组级别方法进行了比较，并针对不同程度的TMS焦点进行了测试。结果：对于f <12mm的焦点，单个fMRI派生的坐标与传统定义的目标之间的距离很重要，而对于> 20mm的焦点则不明显。与解剖标记的比较证实了解剖目标与功能目标之间缺乏1：1的对应关系。讨论：拟议的基于网络的功能磁共振成像指导的TMS方法允许针对特定疾病的网络，同时考虑阿尔茨海默氏病的个体间功能变异性。这种方法可能代表朝着针对AD量身定制的TMS干预迈出的一步。但不适用于> 20mm的产品。与解剖标记的比较证实了解剖目标与功能目标之间缺乏1：1的对应关系。讨论：拟议的基于网络的功能磁共振成像指导的TMS方法允许针对特定疾病的网络，同时考虑阿尔茨海默氏病的个体间功能变异性。这种方法可能代表朝着针对AD量身定制的TMS干预迈出的一步。但不适用于> 20mm的产品。与解剖标记的比较证实了解剖目标与功能目标之间缺乏1：1的对应关系。讨论：拟议的基于网络的功能磁共振成像指导的TMS方法允许针对特定疾病的网络，同时考虑阿尔茨海默氏病的个体间功能变异性。这种方法可能代表朝着针对AD量身定制的TMS干预迈出的一步。