Effectiveness of the prefrontal repetitive transcranial magnetic stimulation on cognitive profiles in depression, schizophrenia, and Alzheimer's disease: A systematic review
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective clinical intervention for various neuropsychiatric diseases. However, it is still unclear whether rTMS has an effect on cognitive functioning. In this review, we aimed to systematically evaluate the cognitive effects of rTMS in depression, schizophrenia, and Alzheimer's disease. We searched PubMed (1996-2018) under the set terms to review randomized controlled trials (RCT) to examine the effectiveness of rTMS administered to the dorsolateral prefrontal cortex (DLPFC) and evaluated cognitive functions in patients with depression, schizophrenia, and Alzheimer's disease. Two authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. The search identified 579 articles, 31 of which met inclusion and exclusion criteria. Among them, 15 were conducted in patients with depression, 11 in patients with schizophrenia, and 5 in patients with Alzheimer's disease. Specifically, 6 studies demonstrated a significant improvement of executive function across these diseases. Further, no evidence for cognitive adverse effects was found in these included rTMS studies. Although the heterogeneity between studies in terms of cognitive measures applied, stimulation parameters, and participants limits the ability to generalize conclusions, this review demonstrated that prefrontal rTMS could exert pro-cognitive effects on executive function and attention in some patients with depression but inconsistent cognitive impacts in any of the examined domains especially in patients with schizophrenia and Alzheimer's disease. The results warrant further rTMS studies that include systematic assessment of cognition across various neuropsychiatric diseases.
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These findings reinforce the literature demonstrating the cognitive safety of rTMS, supporting its use in treating late-life depression without the risk of cognitive decline.
“These findings reinforce the extensive literature demonstrating the cognitive safety of rTMS, 55 supporting its use in treating LLD without the risk of cognitive decline.”
Evidence for pro-cognitive effects of TMS is limited and mixed, especially for MCI, schizophrenia, and bipolar disorder.
“However, evidence is limited and mixed, especially for MCI, schizophrenia, and bipolar disorder (see Iimori et al., 2019 andKim et al., 2019 for reviews of modalities, mechanisms, and limitations).”
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 Iimori et al., 2019
A recent systematic review found it difficult to draw firm conclusions regarding effects of brain stimulation on attention in depression, with several studies not finding effects on Stroop tasks or sustained attention.
“However, a recent systematic review found it difficult to draw firm conclusions regarding effects of brain stimulation on attention in depression with several studies not finding effects on Stroop tasks or sustained attention136.”
From Paying attention to attention in depression (2019) · cites this paper as [136]
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- Authors
- Iimori, T., Nakajima, S., Miyazaki, T., Tarumi, R., Ogyu, K., Wada, M., Tsugawa, S., Masuda, F., Daskalakis, Z. J., Blumberger, D. M., Mimura, M., & Noda, Y.
- Affiliations
- Keio University (JP)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Noda, Yoshihiro
- ORCID
- Venue
- Progress in Neuro-Psychopharmacology and Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 88
- Pages
- 31-40
- ISSN
- 0278-5846 (ISSN-L)
- OpenAlex
- W2810028637
- Cited by
- 94
- References
- 79
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 11 · 2023: 16 · 2022: 9 · 2021: 17 · 2020: 13 · 2019: 8 · 2018: 1
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Progress in Neuro-Psychopharmacology and Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institute of Health Research
- Japan Society for the Promotion of Science
- Japan Research Foundation for Clinical Pharmacology
- Naito Foundation
- Takeda Science Foundation
- Daiichi Sankyo
- 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
- repetitive transcranial magnetic stimulation, dorsolateral prefrontal cortex, cognitive function, executive function, attention, depression, schizophrenia, Alzheimer's disease, neuropsychiatric disorders, cognitive side effects
- MeSH terms
- Alzheimer Disease, Cognition Disorders, Depression, Humans, Schizophrenia, Prefrontal Cortex, Transcranial Magnetic Stimulation
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