Abstract
Introduction Repetitive transcranial magnetic stimulation (rTMS) is a proven therapeutic treatment for treatment resistant depression and is in increasing clinical use throughout the world. Based upon the proven effects in depressed patients, researchers have additionally similarly investigated potential therapeutic effects in other clinical populations, for example, schizophrenia. Despite the large number of clinical trials conducted using rTMS, however, it remains unclear whether rTMS treatment additionally has cognitive enhancing effects. Objectives To determine whether therapeutic rTMS when administered to the dorsolateral prefrontal cortex (DLPFC) is associated with cumulative, or lasting, cognitive improvement. Materials and methods A systematic review and meta-analysis was conducted of randomised, sham-controlled studies conducted in patients with neuropsychiatric conditions who received therapeutic rTMS administered to the DLPFC. Cognitive outcomes at post treatment 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. Results Thirty-one studies met our inclusion criteria. Active rTMS treatment was not associated with generalised gains across the majority of domains of cognitive functioning examined. Secondary analyses revealed a moderate sized positive effect for improved working memory specific only to studies in patients with schizophrenia ( k = 3, g = 0.507, 95% CI = [0.183–0.831], p Conclusions Therapeutic rTMS when administered to the DLPFC in patients with neuropsychiatric conditions does not result in robust cumulative cognitive enhancing effects. However, there was a moderate sized effect for improved working memory in a few studies conducted in patients with schizophrenia, indicating potential specificity of cognitive effects.
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