iTBS to Relieve Depression and Executive Dysfunction in Older Adults: An Open Label Study
Abstract
BACKGROUND Executive Function Deficits (EFD) accompany depression and are associated with poor outcomes in older adults. We examined whether Intermittent Theta Burst Stimulation (iTBS) could improve depression with EFD. METHODS Thirteen geriatric patients with depression and EFD were enrolled. Open label iTBS was delivered bilaterally over the dorso-lateral-prefrontal-cortex for four weeks. RESULTS Montgomery Asberg Depression Scale scores improved significantly from baseline to treatment-end, mean change in score = 11.82 points, 95% CI = 8.3, 15.4. The Flanker Inhibitory control and attention test showed significant improvement in executive function from baseline to treatment-end, mean change in score = -7.73, 95% CI ( -13.54, -1.92). Side effects included twitching in facial muscles (n = 11), headaches (n = 10) and stimulation discomfort (n = 4). LIMITATIONS Small sample size and lack of a sham comparator. CONCLUSION iTBS improved depression with EFD in older adults. Side effects appeared higher than in previous iTBS studies.
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In the 2020 single-arm study, the Flanker inhibitory control and attention test demonstrated a significant enhancement in executive function.
“Additionally, the Flanker inhibitory control and attention test demonstrated a significant enhancement in executive function.”
From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [16]
In the 2020 single-arm study, open-label bilateral iTBS over the DLPFC for 4 weeks improved Montgomery-Asberg Depression Rating Scale scores from baseline to treatment end in patients with LLD and EFD.
“In the single-arm study published in 2020,16 a total of 13 patients with LLD and EFD were included, and open-label iTBS was administered bilaterally over the DLPFC for a duration of 4 weeks. The study revealed a noteworthy improvement in the Montgomery–Asberg Depression Rating Scale scores from baseline to treatment end.”
From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [16]
Some rTMS studies in late-life depression have reported improvements in attention and immediate memory, executive function, verbal fluency and visuospatial abilities, and global cognitive function.
“Some rTMS studies in LLD have reported improvements in attention and immediate memory, 29 executive function,30,31 verbal fluency and visuospatial abilities, 32 and global cognitive function.”
Cristancho et al. (2020) reported a significant decrease in dysexecutive-behavior from baseline to treatment-end on the FrSBe executive subscale.
“while Cristancho et al. (2020) reported a significant decrease in dysexecutive-behavior from baseline to treatment-end”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cristancho et al., 2020
Neither Cristancho et al. (2020) nor Cristancho et al. (2023) found significant results related to the DCCS.
“Neither study found significant results related to the DCCS”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cristancho et al., 2020
Cristancho et al. (2020) reported significant improvement in performance across timepoints within and between groups on the Flanker Inhibitory Control and Attention Test.
“Cristancho et al. (2020) reported significant improvement in performance across timepoints within and between groups on the Flanker Inhibitory Control and Attention Test”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cristancho et al., 2020
There were findings of neurocognitive enhancement in executive function (Cheng et al., 2016; Cristancho et al., 2020; Scho et al., 2019).
“executive function (Cheng et al., 2016;Cristancho et al., 2020;Scho et al., 2019)”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cristancho et al., 2020
Cristancho et al. (2020) and Cristancho et al. (2023) assessed the impact of TBS on performance on the Frontal Systems Behavioral Scale executive subscale and the NIH Toolbox Dimensional Change Card Sort.
“Cristancho et al. (2020) and Cristancho et al. (2023) also assessed the impact of TBS on performance on the Frontal Systems Behavioral Scale (FrSBe) executive subscale and the NIH Toolbox Dimensional Change Card Sort (DCCS).”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cristancho et al., 2020
NIH Toolbox cognitive measures were used in three studies.
“The NIH Toolbox cognitive measures were also used in three studies (Blumberger et al., 2022;Cristancho et al., 2020;Cristancho et al., 2023).”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cristancho et al., 2020
In five included studies, participants received bilateral TBS.
“In five studies (Blumberger et al., 2022;Cheng et al., 2016;Cristancho et al., 2020;Cristancho et al., 2023;Holczer et al., 2021), participants received bilateral TBS.”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cristancho et al., 2020
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- Authors
- Cristancho, P., Kamel, L., Araque, M., Berger, J., Blumberger, D. M., Miller, J. P., Barch, D. M., & Lenze, E. J.
- Affiliations
- Washington University in St. Louis (US)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Cristancho, Pilar
- ORCID
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 28
- Issue
- 11
- Pages
- 1195-1199
- ISSN
- 1064-7481 (ISSN-L)
- OpenAlex
- W3010161542
- Semantic Scholar
- 45b8d62ddd4a36c5519649848e8abadce2c5f7b2
- Cited by
- 26
- References
- 19
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 8 · 2023: 3 · 2022: 5 · 2021: 2
- FWCI
- 0.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (KL2TR002346)
- National Center for Advancing Translational Sciences
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- intermittent theta burst stimulation, depression, executive dysfunction, older adults, non-invasive brain stimulation, dorsolateral prefrontal cortex, inhibitory control, attention, adverse effects, geriatric depression
- MeSH terms
- Aged, Aged, 80 and over, Depression, Feasibility Studies, Female, Humans, Male, Middle Aged, Prefrontal Cortex, Transcranial Magnetic Stimulation, Executive Function, Cognitive Dysfunction
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