P06.12.b the Cognitive Benefits of Rtms: A Meta-Analysis Across Health and Disease

BACKGROUND Cognitive deficits are common across numerous neurological and psychiatric conditions, including patients with brain tumors. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive neuromodulation technique; however, its efficacy for improving cognitive functioning remains to be established. This study aimed to assess the effectiveness of rTMS in enhancing cognitive functioning through a meta-analysis. MATERIAL AND METHODS A PRISMA systematic search was conducted to identify randomized controlled trials comparing active versus sham (placebo) rTMS, with cognitive outcomes reported as either primary or secondary endpoints in individuals with psychiatric/neurological conditions or healthy volunteers. A random-effects meta-analysis was performed to estimate the effect sizes of rTMS on global cognition, cognitive screeners (MMSE/MoCA) and specific cognitive domains, including attention, memory, information processing speed, working memory, executive function, language, and social cognition. RESULTS A total of 108 studies were included, comprising 4265 participants (2173 active, 2092 sham). Active rTMS was associated with a statistically significant improvement in overall cognitive functioning compared to sham, with a pooled effect size of Hedges’ g = 0.27 (95% CI: 0.22-0.31). Significant cognitive improvements were observed across all domains, with small-to-moderate effect sizes (Hedges’g range: 0.15-0.79). The strongest evidence for beneficial effects of rTMS was found for executive functioning (g = 0.15, 95% CI: 0.07-0.24), language (g = 0.36, 95% CI: 0.27-0.44), and memory functioning (g = 0.29, 95% CI: 0.18-0.40). However, substantial heterogeneity in effect sizes was observed across studies (I²= 10.3-92.6%), indicating that a proportion of the variability in results is likely due to differences in study populations, treatment protocols, or cognitive outcomes. CONCLUSION This meta-analysis supports the transdiagnostic efficacy of rTMS for cognitive improvement, with small to moderate effects observed across a broad spectrum of populations and cognitive domains. These findings highlight the clinical utility of rTMS as a cognitive intervention - potentially also in brain tumor patients, for whom preliminary studies to this effect are underway.