Göke Katharina, McClintock Shawn M, Mah Linda, Rajji Tarek K, Lee Hyewon H, Nestor Sean M, Downar Jonathan, Noda Yoshihiro, Daskalakis Zafiris J, Mulsant Benoit H, Blumberger Daniel M
Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Can J Psychiatry. 2025 Jan 29:7067437251315515. doi: 10.1177/07067437251315515.
Late-life depression (LLD) is often accompanied by cognitive impairment, which may persist despite antidepressant treatment. Repetitive transcranial magnetic stimulation (rTMS) is an efficacious treatment for depression, with potential benefits on cognitive functioning. However, research on cognitive effects is inconclusive, relatively sparse in LLD, and predominantly focused on group-level cognitive changes. This study aimed to explore individual-level cognitive changes following rTMS treatment in patients with LLD.
Data were analyzed from 153 patients with LLD from the FOUR-D study (ClinicalTrials.gov identifier: NCT02998580) who received bilateral standard rTMS or theta burst stimulation (TBS) targeting the dorsolateral prefrontal cortex (DLPFC). Cognitive function was assessed pre- and post-treatment using measures of executive function, information processing speed, and learning and memory. Reliable change indices, adjusted for practice effects and test-retest reliability, were employed to evaluate individual-level cognitive changes. Chi-square tests examined if proportions of cognitive improvers differed from expected proportions.
Cognitive performance from baseline to end of treatment remained stable for most patients. Reliably improved performance was observed in 0.0% to 20.0% of participants across cognitive measures, while worsened performance was observed in 0.0% to 2.7%. A small but significant proportion (20.0%) of participants showed improvement in verbal learning.
Bilateral standard rTMS or TBS of the DLPFC in LLD yielded no substantial cognitive enhancing effects, although a small proportion showed improved verbal learning after treatment. Importantly, both interventions were cognitively safe with relatively stable performance across time. Future research is needed to explore approaches to enhance the cognitive benefits of standard rTMS and TBS in patients with LLD.
老年期抑郁症（LLD）常伴有认知障碍，即便接受抗抑郁治疗，这种认知障碍仍可能持续存在。重复经颅磁刺激（rTMS）是一种有效的抑郁症治疗方法，对认知功能可能有潜在益处。然而，关于其认知效应的研究尚无定论，在老年期抑郁症患者中相对较少，且主要集中在群体水平的认知变化上。本研究旨在探讨老年期抑郁症患者接受rTMS治疗后的个体水平认知变化。
对来自FOUR-D研究（ClinicalTrials.gov标识符：NCT02998580）的153例老年期抑郁症患者的数据进行分析，这些患者接受了针对背外侧前额叶皮质（DLPFC）的双侧标准rTMS或theta爆发刺激（TBS）。治疗前后使用执行功能、信息处理速度以及学习和记忆等指标评估认知功能。采用经练习效应和重测信度调整后的可靠变化指数来评估个体水平的认知变化。卡方检验用于检验认知改善者的比例是否与预期比例不同。
大多数患者从基线到治疗结束时的认知表现保持稳定。在各项认知指标上，0.0%至20.0%的参与者表现出可靠的改善，而表现恶化的比例为0.0%至2.7%。一小部分但具有显著意义的参与者（20.0%）在言语学习方面有所改善。
在老年期抑郁症患者中，对DLPFC进行双侧标准rTMS或TBS并未产生实质性的认知增强效果，尽管有一小部分患者在治疗后言语学习有所改善。重要的是，两种干预措施在认知方面都是安全的，随着时间推移表现相对稳定。未来需要开展研究，探索增强标准rTMS和TBS对老年期抑郁症患者认知益处的方法。
