Gharalari Naeimeh Akbari, Fallahi Solmaz, Nakhjiri Elnaz, Hosseini Leila, Pakkhou Saba, Havaei Naser, Khodakarimi Sina, Shahabi Parviz, Gharehziaaddin Mohsen Jafarzadeh, Zangbar Hamid Soltani
Neurophysiology Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
CNS Neurosci Ther. 2025 Sep;31(9):e70613. doi: 10.1111/cns.70613.
Cognitive flexibility (CF) is a core component of executive function that enables humans to adaptively process and respond effectively to diverse and dynamic contextual needs. The execution of CF-related tasks depends on the collective interaction of various neural circuits in essential brain regions, such as the prefrontal, anterior cingulate, and posterior parietal cortices, which support the harmonic and smooth transition of thoughts and perspectives. Therefore, clarifying the mechanism of CF and introducing non-invasive neuromodulatory methods that enhance CF provides a way for developing new treatment approaches.
This review systematically investigates the application of photobiomodulation (PBM), neurofeedback (NF), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and virtual reality (VR) as non-invasive neuromodulatory techniques for modulating cognitive behaviors related to CF in neuropsychological conditions.
Considering the vital role of CF in executive functions, deficits in CF impair adaptive behavior in neuropsychological conditions such as schizophrenia, autism spectrum disorder (ASD), and age-related cognitive decline. Some technology-based interventions, including PBM, NF, rTMS, tDCS, and VR, have been developed to non-invasively modulate the switching capability and strategies of the mind. These non-invasive interventions provide targeted neuromodulation on neural circuits and have demonstrated a promising effect in improving cognitive processes, including CF.
The present study provides a comprehensive review of the therapeutic consequences of non-invasive neuromodulatory methods on CF in neurological conditions. This insight can offer a perspective for planning various research strategies and clinical approaches aimed at improving CF.
认知灵活性（CF）是执行功能的核心组成部分，使人类能够适应性地处理并有效应对多样且动态的情境需求。执行与CF相关的任务依赖于关键脑区（如前额叶、前扣带回和顶叶后皮质）中各种神经回路的协同作用，这些脑区支持思维和视角的和谐、顺畅转换。因此，阐明CF的机制并引入增强CF的非侵入性神经调节方法为开发新的治疗方法提供了一条途径。
本综述系统研究了光生物调节（PBM）、神经反馈（NF）、重复经颅磁刺激（rTMS）、经颅直流电刺激（tDCS）和虚拟现实（VR）作为非侵入性神经调节技术在神经心理状况下调节与CF相关的认知行为中的应用。
鉴于CF在执行功能中的重要作用，CF缺陷会损害精神分裂症、自闭症谱系障碍（ASD）和与年龄相关的认知衰退等神经心理状况下的适应性行为。已经开发了一些基于技术的干预措施，包括PBM、NF、rTMS、tDCS和VR，以非侵入性地调节思维的转换能力和策略。这些非侵入性干预措施对神经回路进行有针对性的神经调节，并已在改善包括CF在内的认知过程中显示出有前景的效果。
本研究全面综述了非侵入性神经调节方法对神经疾病中CF的治疗效果。这一见解可为规划旨在改善CF的各种研究策略和临床方法提供一个视角。
