Abstract
Background: This study evaluates the cognitive performance of 265 patients (nmales =31, Mage = 43.8 years, SD = 17.66) primarily diagnosed with MDD, using THINC-it subtests: (Choice Reaction Time Identification Task (CRT), One-Back Test (NBack), Digit Symbol Substitution Test (DSST), Trail Making Test-Part B (TMT) and Perceived Deficits Questionnaire for Depression-5-Item (PDQ-5-D)) before and after an acute course of rTMS in a natural, clinical setting. Methods: Patients treated for five days a week for 7-8 weeks over the right dorsolateral prefrontal cortex (dlPFC) at 1 Hz for 360 pulses followed by left dlPFC stimulation at 20 Hz for 1200 pulses. PHQ-9 & GAD-7 were completed weekly while CHRT, QIDS, & Zung were given pre/post treatment course. Results: 57.36% of patients achieved remission (≥ 70% improvement on PHQ-9) and significant moderate effect was found after rTMS in overall performance on the CRT (d = -.38, p < .001), TMT (d = -.39, p < .001), & PDQ-5-D (d = -.82, p < .001). Significant smaller effect was found in the NBack correct responses (d = -.24, p = .0005), NBack longer streak (d = -.27, p = .0000), DSST best reaction time (d = .15, p = .05), DSST nodes completed (d = -.21, p = .0004), DSST longest streak (d = -.16, p = .04), TMT errors (d = .23, p = .004), and TMT longest streak (d = -.20, p = .01). Conclusions: Detrimental cognitive effects were not observed or reported. Cognitive performance after TMS suggests patients’ executive function, working memory, processing speed, and attention may have improved. Funding: Patients who were already seeking TMS treatment were financially responsible for their acute courses of TMS treatment. Therapy may have been covered by insurance and/or privately paid for by the patient. Tablets used to conduct the assessments and for TMS therapy documentation are privately owned by our company, a private clinical practice. THINC-it Cognitive Screener is a free application used as part of our standard of care for all patients.
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