TMS follow-up study in patients with vascular cognitive impairment-no dementia.

Vascular cognitive impairment-no dementia (VCI-ND) is a condition at risk for future dementia and should be the target of preventive strategies. Recently, an enhanced intracortical facilitation observed in VCI-ND patients was proposed as a candidate neurophysiological marker of the disease process. The aim of this study was to monitor the excitability of the motor cortex and the functioning of excitatory/inhibitory intracortical circuits in patients with VCI-ND after a follow-up period of approximately 2 years, in order to pick out early markers of disease progression into dementia. Nine patients and 9 age-matched controls were re-evaluated for single and paired pulse TMS measures of cortical excitability, as well as for neuropsycological and functional assessment. Compared to the first evaluation, patients showed a decrease of the median resting motor threshold (rMT). Patients exhibited a significant worsening at Stroop Color-Word Test Interference scores without substantial functional impairment. Our study represents the first evidence of a decrease of rMT in VCI-ND patients during the progression of cognitive impairment. This result might be considered an index of motor cortex plasticity and interpreted as a compensatory mechanism for the loss of motor cortex neurons.