Visuomotor integration in early Alzheimer's disease: A TMS study

Cortical visuomotor integration is altered in Alzheimer's disease (AD), even at an early stage of the disease. The aim of this study was to assess the connections between the primary visual (V1) and motor (M1) areas in patients with early AD using a paired-pulse, twin-coil transcranial magnetic stimulation (TMS) technique. Visuomotor connections (VMCs) were assessed in 13 subjects with probable AD and 16 healthy control subjects. A conditioning stimulus over the V1 phosphene hotspot was followed at interstimulus intervals (ISIs) of 18 and 40 ms by a test stimulus over M1, to elicit motor evoked potentials (MEPs) in the contralateral first dorsal interosseous muscle. Significant effects due to VMCs, consisting of enhanced MEP suppression at ISI of 18 and 40 ms, were observed in the AD patients. Patients with AD showed an excessive inhibitory response of the right M1 to inputs travelling from V1 at given ISIs. This study provides neurophysiological evidence of altered functional connectivity between visual and motor areas in AD. •Visuomotor connections were assessed in 13 CE patients and 16 controls.•AD patients showed an excessive inhibitory response of M1 to inputs travelling from V1.•These findings suggest altered functional connectivity between visual and motor areas in AD.•The twin-coil TMS represents a reliable approach in exploring the AD pathophysiology.