Repetitive Transcranial Magnetic Stimulation for Elderly Patients with Cognitive Impairment: A Meta Analysis of Randomized Controlled Trials
Objective: This meta-analysis of randomized controlled trials (RCTs) examines the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive function in elderly patients (aged 55 or older) and identifies potential influencing factors.
Methods: Searches of Embase, Web of Science, Cochrane Library, PubMed, CNKI, and Wanfang identified RCT studies evaluating the Impact of rTMS on cognition in older adults. The search spanned the period from the database's inception to 15 December 2024. Following the study identification and data extraction by two independent reviewers, the risk of bias was assessed with the Cochrane RoB tool. Data synthesis and subgroup analysis were performed via SMD, WMD, and 95% CIs to evaluate the effects of rTMS and its influencing factors. The review protocol was prospectively registered in PROSPERO (CRD42020187336)
Results: A total of 13 studies, including 14 trials with 655 patients, were analyzed. Compared to the control group, real rTMS significantly improved cognition in elderly patients (Global Cognitive Function: SMD, 0.56;95% CI 0.33,0.79; p<0.0001; MMSE: WMD,2.04;95% CI 1.54,2.53; p<0.0001; ADAS-Cog: WMD, -2.59;95% CI -3.63, -1.54; p<0.0001; MoCA: WMD,2.46; 95% CI 1.47, 3.45; p<0.0001). Subgroup analysis revealed that participants receiving rTMS combined with cognitive training demonstrated more significant improvements than those receiving rTMS alone (WMD: 0.51; 95% CI: 0.26,0.76; p < 0.0001). Additionally, other subgroup analyses—including rTMS stimulating sites (multiple vs. single sites), education years (≥10 vs. <10 years), and rTMS frequency (5/10/20 Hz vs. iTBS (intermittent theta-burst stimulation)—showed no significant differences (p > 0.05).
Conclusion: Both standalone rTMS and rTMS combined with cognitive training—which varied across studies and included both computerized paradigms (face-name associative memory training, mirror neuron system therapy, VR interactions) and individualized one-on-one training—demonstrated significant efficacy in improving global cognitive function in elderly patients with mild to moderate symptoms. As a safe and well-tolerated intervention, rTMS demonstrates considerable potential for reliable clinical application.
DOI: 10.29245/2572.942X/2025/4.1326 View / Download Pdf