Establishing the feasibility of plasticity-guided rTMS with cognitive training in MCI

Cognitive training is a promising non-pharmacological intervention aimed at slowing/preventing cognitive decline in older adults at risk for dementia, including those with mild cognitive impairment (MCI). A critical goal of cognitive training research is maximizing benefits while minimizing costs (both monetary and time). Transcranial magnetic stimulation (TMS) may improve cognitive training as both an add-on intervention (using repetitive TMS; rTMS) and by providing plasticity markers that can guide the personalization of cognitive training programs. Previous work in our lab has tested the efficacy of transcranial direct current stimulation (tDCS) for improving cognitive training outcomes in MCI: while both groups showed cognitive improvements there was no significant improvement in tDCS+cognitive training vs. sham+cognitive training. Research suggests that rTMS to left dorsolateral prefrontal cortex (l-DLPFC) may be more effective than tDCS at improving cognitive in MCI, therefore, we propose a pilot study to determine the feasibility of a combined rTMS(l-DLPFC)+cognitive training intervention in 8 participants with MCI. We additionally propose to test the feasibility of using TMS-derived measures of plasticity as a predictive biomarker of response to this combined intervention. Using one session for plasticity measurement and 5 sessions of rTMS(l-DLPFC)+cognitive training we aim to test the feasibility of this combined protocol. We hypothesize that participants will be able to adhere to this protocol with no severe or unexpected adverse events. We also hypothesize that plasticity as measured using TMS at baseline will predict cognitive gains over the course of the 5 intervention sessions.