Rewiring the aging brain: the impact of rTMS on cognitive function and mood.

Non-invasive brain stimulation techniques, like repetitive transcranial magnetic stimulation (rTMS), have gained prominence for their ability to modulate neurophysiological, affective, and cognitive brain functions in brain ageing. This study assessed the efficacy of rTMS in improving age-related impairments, by targeting the left dorsolateral prefrontal cortex (DLPFC). A 61-year-old woman experiencing mood deflection, sleep disturbances, fatigue, and cognitive decline. The woman underwent rTMS treatment targeting the left DLPFC. The treatment protocol involved delivering 800 pulses per session at 10 Hz and 120% motor threshold. She underwent 36 sessions over three months, with three sessions per week using neuronavigation. A neuropsychological assessment was conducted at baseline and after 12 weeks. In addition to cognitive and mood assessments, cortical excitability was measured through motor evoked potentials (MEPs) recorded before and after the treatment. Results showed a modulation of MEP amplitudes post-treatment, which may reflect adaptive inhibitory processes linked to the therapeutic effects of rTMS Following rTMS treatment, the EQ-5D-5L index increased by 0.159, indicating an improvement in health-related quality of life. Perceived health improved by 10 points, and the FAS score decreased by 6 points, reflecting a significant reduction in fatigue. The BDI-II score decreased by 7 points, indicating an improvement in mood, which became subclinical. BAI score decreased by 10 points. Cognitive assessments showed positive changes, with the ACE-R score increasing by 5 points and the MMSE score increasing by 2.5 points. TMT scores also improved significantly: Part A decreased by 7.16 seconds, indicating enhanced cognitive processing speed and attention, and Part B decreased by 4.02 seconds, indicating improved cognitive flexibility and executive function. Our results indicate an improvement in general cognitive functions, a reduction in fatigue, and mood stabilization, culminating in improved quality of life. The cognitive improvements observed align with current literature on the efficacy of rTMS. Targeted rTMS treatment of the DLPFC correlates directly with improved performance on the TMT underscoring the efficacy of this intervention in enhancing specific cognitive domains. These changes in TMT scores, combined with the observed modulation in cortical excitability, highlight the impact of rTMS on brain function and its potential to mitigate age-related cognitive decline.