Evaluating Alzheimer's disease with the TMS-EEG perturbation complexity index

The Perturbation Complexity Index-State Transitions (PCI^ST) measures the complexity of the brain's response to transcranial magnetic stimulation (TMS) using electroencephalography (EEG) and is sensitive to consciousness, such as minimally conscious states. Individuals with early-stage Alzheimer's disease (AD) show dysfunction of conscious processes, such as attention, working memory, episodic memory, and executive function, with relatively spared unconscious processes, such as procedural memory, operant conditioning, and priming. We sought to test the hypothesis that PCI^ST would be reduced in AD compared to healthy aging. We assessed 28 participants with AD and 27 healthy controls (HC), measuring cognition with the Montreal Cognitive Assessment (MoCA) and disease severity with the Clinical Dementia Rating scale-Global (CDR-Global) and Sum of Boxes (CDR-SB). Results indicated lower PCI^ST in the AD group (M = 20.1) compared to controls (M = 28.2) across both the motor cortex (M1) and inferior parietal lobule (IPL) TMS stimulation sites, suggesting that PCI^ST may reflect the impaired conscious cognitive processes and functional capacity seen in AD. We therefore speculate that cortical dementias involve alterations in cortical complexity that may relate to deterioration of their conscious processes. This research opens the avenue for future studies in individuals with cortical dementia to examine the relationship between conscious processes, global measures of consciousness, and their underlying neuroanatomical correlates, in addition to enhancing our understanding of dementia and suggesting possible therapeutic strategies.