Exploring the Therapeutic Impact of Repetitive Transcranial Magnetic Stimulation (rTMS) in Individuals With Alzheimer's Disease: A Comprehensive Narrative Review

Abstract

Alzheimer's disease (AD) is a progressive neurodegenerative disorder marked by cognitive deterioration and behavioral symptoms, significantly impacting patients and caregivers. Behavioral and psychological symptoms of dementia (BPSD), including agitation, depression, and apathy, are common in AD and complicate its management. Conventional treatments, such as cholinesterase inhibitors and antipsychotics, offer limited benefits and often carry adverse effects. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulatory technique, has emerged as a promising alternative by modulating cortical excitability and promoting neuroplasticity. This narrative review aims to evaluate the current literature on the therapeutic effects of rTMS in AD, with a focus on its impact on cognitive function and behavioral symptoms. A comprehensive literature search was conducted across PubMed, MEDLINE, PsycINFO, Embase, and the Cochrane Library. Studies were selected based on predefined inclusion and exclusion criteria, with quality assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Findings indicate that high-frequency rTMS can improve memory, language, and executive functions, while also reducing neuropsychiatric symptoms such as agitation and depression. Mechanistically, rTMS appears to influence cortical plasticity, neurotransmitter regulation, and neurotrophic factor expression. Despite these encouraging outcomes, heterogeneity in study design, stimulation protocols, and patient populations limit generalizability. Further research through large-scale, standardized, multicentric trials is necessary to confirm its efficacy and define optimal therapeutic parameters. In conclusion, rTMS holds promise as an adjunctive intervention in AD, potentially improving cognitive and behavioral outcomes while offering a favorable safety profile.

Keywords: alzheimer's disease; behavioral and psychological symptoms of dementia (bpsd); non-pharmacological interventions; repetitive transcranial magnetic stimulation (rtms); theta burst stimulation (tbs).