{"doi":"10.1016/j.brs.2021.05.001","title":"Off-label transcranial magnetic stimulation in amnestic mild cognitive impairment and Alzheimer's disease: A twelve-year case series in a single clinic","abstract":"•TMS is well tolerated in patients with chronic neurologic diseases.•Pain at the stimulation site was the most common side effect, with one of 235 patients with transient focal seizures.•TMS treatment was associated with less decline on verbal fluency and naming measures in AD and aMCI patients over years.•Better retention of naming and verbal fluency are clinically meaningful outcomes for patients and their caregivers. BackgroundTranscranial magnetic stimulation (TMS) appears to allay cognitive symptoms in Alzheimer's disease (AD) and mild cognitive impairment (MCI) patients, with multi-site stimulation, higher education, milder severity, ≥5–10 sessions, medication, and cognitive training associated with greater efficacy [1Cotelli M. Manenti R. Cappa S. Geroldi C. Zanetti O. Rossini P. Effect of transcranial magnetic stimulation on action naming in patients with Alzheimer disease.Arch Neurol. 2006; 63: 1602-1604Crossref PubMed Scopus (166) Google Scholar, 2Lin Y. Jiang W. Shan P. Lu M. Wang T. Li R. et al.The role of repetitive transcranial magnetic stimulation (rTMS) in the treatment of cognitive impairment in patients with Alzheimer's disease: a systematic review and meta-analysis.J Neurol Sci. 2019; 398: 184-191Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar, 3Wang X. Mao Z. Ling Z. Yu X. Repetitive transcranial magnetic stimulation for cognitive impairment in Alzheimer's disease: a meta-analysis of randomized controlled trials.J Neurol. 2020; 267: 791-801Crossref PubMed Scopus (26) Google Scholar, 4Holczer A. Nemeth V.L. Vekony T. Vecsei L. Klivenyi P. Must A. Non-invasive brain stimulation in alzheimer's disease and mild cognitive impairment- A state-of-the-art review on methodological characteristics and stimulation parameters.Front Hum Neurosci. 2020; 14: 1-32Crossref PubMed Scopus (20) Google Scholar, 5Sabbagh M. Sadowsky C. Tousi B. Agronin M.E. Alva G. Armon C. et al.Effects of a combined transcranial magnetic stimulation (TMS) and cognitive training intervention in patients with Alzheimer's disease.Alzheimer's Dementia. 2020; 16: 641-650Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar]. However, a European taskforce found only level 3 evidence for TMS in these conditions [[6]J. Lefaucheur, A. Aleman, C. Baeken, D. H. Benninger, J. Brunelin, V. Di Lazzaro and et al., \"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014–2018),\" Clin Neurophysiol, vol. 131, pp. 474-528, 131.Google Scholar]. Additionally, the safety of long-term chronic TMS in neurologic disease is unknown.We compiled 12 years of experience treating MCI, AD, and other neurologic disorders with off-label TMS in a clinic with real-world variability in patient availability, and stimulus parameters based on affected neurocognitive domains. We evaluated safety and tolerability of off-label TMS in neurologic patients and efficacy of TMS on cognition in AD and aMCI.MethodsWe extracted data on all patients who received TMS in our center from 5/1/2008 through 5/30/2020. Patients meeting NINCDS-ADRDA clinical criteria for possible/probable AD or amnestic MCI (aMCI) with standardized neurocognitive evaluations before and after completing at least >5 TMS sessions over 12 months and on standard-of-care AD treatment were compared to matched historical controls from the National Alzheimer's Coordinating Center (NACC). Patients were matched on diagnosis, age at baseline (±2 years), sex, race, years of education, clinical dementia rating scale CDR) score (±0.5 points), and AD treatment usage.We evaluated any change from baseline to follow-up on the only three measures common to both data sets- Controlled Oral Word Association Test (COWAT) animal score, the 30-item Boston Naming Score, and the Wechsler Adult Intelligence Scale-III—digit span.Patients beginning TMS treatment prior to 4/1/2016 received EEG-guided-TMS, while some later patients received MRI-guided-TMS.","journal":"Brain stimulation","year":2021,"id":203478,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9521,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":784700,"name":"Gayatri Devi","orcid":"0000-0002-3367-9123","position":1,"is_corresponding":false},{"id":631756,"name":"Robert A. Tumasian","orcid":null,"position":0,"is_corresponding":true}],"reference_count":12,"raw_metadata":null,"created_at":"2026-07-18T23:51:18.050175Z","pmid":"33971328","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}