Abstract
Repetitive transcranial magnetic stimulation (rTMS) may be effective for enhancing cognitive functioning. In this review, we aimed to systematically evaluate the effects of rTMS on attention in psychiatric diseases. In particular, we searched PubMed and Embase to examine the effectiveness of rTMS administered to the dorsolateral prefrontal cortex (DLPFC) on this specific cognitive domain. The search identified 24 articles, 21 of which met inclusion and exclusion criteria. Among them, nine were conducted in patients with depression, four in patients with schizophrenia, three in patients with autism spectrum disorder (ASD), two in patients with attention deficit hyperactivity disorder, one each in patients with Alzheimer’s disease and in patients with alcohol or methamphetamine addiction. No evidence for cognitive adverse effects was found in all the included rTMS studies. Several studies showed a significant improvement of attentional function in patients with depression and schizophrenia. The beneficial effects on attention and other executive functions suggest that rTMS has the potential to target core features of ASD. rTMS may influence the attentional networks in alcohol-dependent and other addicted patients. We also reviewed and discussed the studies assessing the effects of rTMS on attention in the healthy population. This review suggests that prefrontal rTMS could exert procognitive effects on attention in patients with many psychiatric disorders.
Highlights
Attention is a cognitive and behavioral process that selectively focuses on individual aspects of subjective or objective information, allowing through voluntary top-down and automatic bottom-up mechanisms to selectively process or inhibit contents from the multiplicity of sensory inputs over different domains [1,2,3]
No major changes in the Continous Performace Task assessing attention and in other cognitive tests were observed in the first study of Speer and colleagues after LF or HF Repetitive transcranial magnetic stimulation (rTMS) administered over the dorsolateral prefrontal cortex (DLPFC) [40]
Later studies assessed attention using psychometric tests, such as the d2 test, the sustained attention in the Cambridge Neuropsychological Test Automated Battery (CANTAB), the Test of Attentional Performance, and failed to find any significant effects of either HL or LF rTMS applied over the DLPFC [38,39,44]
Summary
Attention is a cognitive and behavioral process that selectively focuses on individual aspects of subjective or objective information, allowing through voluntary top-down and automatic bottom-up mechanisms to selectively process or inhibit contents from the multiplicity of sensory inputs over different domains [1,2,3]. Psychiatric disorders can lead to attention deficits. In adult patients with attention deficit hyperactivity disorder (ADHD), cognitive disturbances are more pronounced than in the pediatric population [8] and are most evident as deficiencies of executive functions and attention [9,10]. The selective attention has been shown to be impaired even in situations where behavior is normal; especially a deficit in rapid attention shifting has been observed in behavioral tasks shifting between sensory modalities, spatial locations, and object features [11,12,13]
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