EEG Microstate Differences Between Alzheimer’s Disease, Frontotemporal Dementia, and Healthy Controls Using 4 and 7 Clustering Classes with a Ratio Approach

Background and Objectives: Alzheimer’s disease (AD) and frontotemporal dementia (FTD) present overlapping clinical and neuroanatomical features, complicating early diagnosis. Therefore, this study evaluated whether EEG microstate analysis can provide reliable markers to distinguish patients with dementia from healthy controls. Materials and Methods: Resting-state EEG was recorded from 36 AD patients, 23 FTD patients, and 29 healthy controls. Preprocessing and microstate analysis were conducted using the MICROSTATELAB pipeline in EEGLAB. Clustering solutions ranging from four to seven classes were tested, with grand mean fitting and variance thresholds. Temporal parameters (duration, occurrence, and coverage) and their ratio-normalized forms were compared across groups using ANCOVA and nonparametric tests. Associations with Mini-Mental State Examination (MMSE) scores were assessed by regression analyses. Results: The four- and seven-class clustering solutions achieved high variance overlap with published microstate templates. In the four-class solution, temporal parameters of microstates B and D significantly differentiated controls from dementia groups, while in the seven-class solution, microstates C and G were the most informative. Ratio-normalized parameters improved group discrimination and were associated with MMSE scores. Conclusions: EEG microstates capture disease-related alterations in large-scale brain dynamics that differentiate patients with dementia from healthy individuals.