Work

Transdiagnostic efficacy, durability, and optimal parameters of rTMS for cognitive rehabilitation: A comprehensive meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: AIM: Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising non-invasive neuromodulation technique for cognitive rehabilitation. We evaluated the cognitive effects of rTMS on neurological and psychiatric diseases to determine moderators of efficacy. METHODS: A meta-analysis of Randomized Controlled Trials (RCTs) comparing real versus sham rTMS to July 2025 was performed. Objective cognition reported as primary or secondary outcomes were extracted and Hedges' g effect sizes computed. Univariate and multivariate three-level meta-analyses were performed to estimate pooled effect sizes and assess moderator influence. RESULTS: = 35.8). Neurodegenerative (g = 0.35) and focal (g = 0.44) conditions demonstrated stronger effects than psychiatric conditions (g = 0.20). Although stimulation target was not a significant moderator overall, the Inferior Frontal Gyrus showed the largest effect (g = 0.45), with significant effects also at the left and right DLPFC and left parietal cortex (g = 0.29-0.45), all nodes of the Frontoparietal Network. 1-Hz stimulation produced a significantly larger effect (g = 0.39) than the 10-Hz reference (g = 0.19); 5-Hz, 20-Hz and iTBS were also significantly positive (g = 0.30-0.49). In multivariate models, adding 10 rTMS sessions improved cognitive outcomes (Δg = +0.077), whereas increasing the number of pulses per session trended toward reduced efficacy. All effects were confirmed in a left dorsolateral prefrontal cortex subgroup analysis. Subjective cognition was measured in only 6% of studies. A multivariate prediction tool is introduced: https://amsali.shinyapps.io/tms_cognition_prediction/ CONCLUSION: This meta-analysis demonstrates the sustained efficacy of rTMS in enhancing cognitive function, with small-to-moderate effect sizes across diverse clinical populations and stimulation protocols. However, a significant gap remains regarding whether these objective neurocognitive gains translate into meaningful improvements in subjective cognition or functional outcomes.

Source: Brain stimulation

DOI: 10.1016/j.brs.2026.103226