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Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer’s disease, Alzheimer’s disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis

Published online by Cambridge University Press:  08 February 2024

Sandeep R. Pagali*
Affiliation:
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
Rakesh Kumar
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
Allison M. LeMahieu
Affiliation:
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
Michael R. Basso
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Bradley F. Boeve
Affiliation:
Department of Neurology, Mayo Clinic, Rochester, MN, USA
Paul E. Croarkin
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Jennifer R. Geske
Affiliation:
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
Leslie C. Hassett
Affiliation:
Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
John Huston III
Affiliation:
Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MN, USA
Simon Kung
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Brian N. Lundstrom
Affiliation:
Department of Neurology, Mayo Clinic, Rochester, MN, USA
Ronald C. Petersen
Affiliation:
Department of Neurology, Mayo Clinic, Rochester, MN, USA
Erik K. St. Louis
Affiliation:
Department of Neurology, Mayo Clinic, Rochester, MN, USA
Kirk M. Welker
Affiliation:
Department of Radiology (Huston and Welker), Mayo Clinic, Rochester, MN, USA
Gregory A. Worrell
Affiliation:
Department of Neurology, Mayo Clinic, Rochester, MN, USA
Alvaro Pascual-Leone
Affiliation:
Hinda and Arthur Marcus Institute for Aging Research and Deanna, Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA Department of Neurology, Harvard Medical School, Cambridge, MA, USA
Maria I. Lapid
Affiliation:
Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
*
Correspondence should be addressed to: Sandeep R. Pagali, MD, MPH, Division of Hospital Internal Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. E-mail: pagali.sandeep@mayo.edu.

Abstract

Objective:

We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer’s disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment.

Design:

Systematic review, Meta-Analysis

Setting:

We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023.

Participants and interventions:

RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included.

Measurement:

Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423).

Results:

The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer’s Disease Assessment Scale–Cognitive Subscale (SMD = −0.96 [−1.32, −0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity.

Conclusion:

The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.

Type
Review Article
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of International Psychogeriatric Association

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Footnotes

Alvaro Pascual-Leone and Maria I. Lapid are contributing co-senior authors.

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