{
  "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: 748 measures from 137 studies (5972 participants) were extracted. Real rTMS produced a significant cognitive enhancement (g = 0.28, p < 0.0001, I 2 = 37.3%). This was durable over 2-52 weeks follow-up. There was efficacy across all cognitive domains (g > 0.20, I 2 = 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK",
    "Anatomy & Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, the Netherlands",
    "Department of Pain Medicine, The Walton Centre NHS Foundation Trust, UK",
    "Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, the Netherlands; Medical Psychology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands",
    "Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, the Netherlands; Neurosurgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands",
    "Anatomy & Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands; Corresponding author. Anatomy & Neurosciences Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ahmad M.S. Ali"
    },
    {
      "affs": [
        1
      ],
      "name": "Maxine Gorter"
    },
    {
      "affs": [
        0
      ],
      "name": "Rasheed Zakaria"
    },
    {
      "affs": [
        0
      ],
      "name": "Michael D. Jenkinson"
    },
    {
      "affs": [
        2
      ],
      "name": "Bernhard Frank"
    },
    {
      "affs": [
        3
      ],
      "name": "Martin Klein"
    },
    {
      "affs": [
        4
      ],
      "name": "Philip C. de Witt Hamer"
    },
    {
      "affs": [
        5
      ],
      "name": "Linda Douw"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5m4j4823ytstw.bib",
  "cited_by": 0,
  "doi": "10.1016/j.brs.2026.103226",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S1935861X26002032",
  "id": "5m4j4823ytstw",
  "issns": [
    "1935-861X",
    "1876-4754"
  ],
  "landing_url": "https://doi.org/10.1016/j.brs.2026.103226",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC321-571"
    ],
    [
      "openalex",
      "2808|Transcranial Magnetic Stimulation Studies"
    ]
  ],
  "openalex": "W7222783554",
  "pdf_url": "https://www.brainstimjrnl.com/article/S1935-861X(26)00203-2/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/5m4j4823ytstw.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:44:32Z",
      "native_id": "8335d4acc9fd47b89a44369ed986eb06",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.brs.2026.103226"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2808|Transcranial Magnetic Stimulation Studies",
      "subfield": "neurology"
    }
  ],
  "title": "Transdiagnostic efficacy, durability, and optimal parameters of rTMS for cognitive rehabilitation: A comprehensive meta-analysis",
  "title_text": "Transdiagnostic efficacy, durability, and optimal parameters of rTMS for cognitive rehabilitation: A comprehensive meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:32Z",
  "url": "https://research.draconitic.com/paper/5m4j4823ytstw",
  "venue": "Brain Stimulation",
  "versions": []
}