title: Does Therapeutic Repetitive Transcranial Magnetic Stimulation Cause Cognitive Enhancing Effects in Patients with Neuropsychiatric Conditions? A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
abstract: Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as a therapeutic intervention for neuropsychiatric illnesses and has demonstrated efficacy for treatment of major depression. However, an unresolved question is whether a course of rTMS treatment results in effects on cognitive functioning. In this systematic review and meta-analysis we aimed to quantitatively determine whether a course of rTMS has cognitive enhancing effects. We examined cognitive outcomes from randomised, sham-controlled studies conducted in patients with neuropsychiatric conditions where rTMS was administered to the dorsolateral prefrontal cortex (DLPFC) across repeated sessions, searched from PubMed/MEDLINE and other databases up until October 2015. Thirty studies met our inclusion criteria. Cognitive outcomes were pooled and examined across the following domains: Global cognitive function, executive function, attention, working memory, processing speed, visual memory, verbal memory and visuospatial ability. Active rTMS treatment was unassociated with generalised gains across the majority of domains of cognitive functioning examined. Secondary analyses revealed a moderate sized positive effect for improved working memory in a small number of studies in patients with schizophrenia (k = 3, g = 0.507, 95 % CI = [0.183-0.831], p < .01). Therapeutic rTMS when administered to the DLPFC in patients with neuropsychiatric conditions does not result in robust cognitive enhancing effects.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia. donel.martin@unsw.edu.au.|Black Dog Institute, Sydney, Australia. donel.martin@unsw.edu.au.
authors.forename: Donel M
authors.initials: DM
authors.lastname: Martin
authors.affiliation: Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.|Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: McClintock
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Forster
authors.affiliation: Black Dog Institute, Sydney, Australia.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Loo
mesh_terms: D003071:Cognition; D006801:Humans; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D050781:Transcranial Magnetic Stimulation
keywords: Cognition; Depression; Neuropsychiatric; Repetitive transcranial magnetic stimulation; Schizophrenia; Working memory