{"doi":"10.1101/2025.09.18.676960","title":"Accelerated rTMS for Enhancing Intact Cognition: An Examination of Dose Effects on Electrocortical Indicators of Attention and Working Memory","abstract":"<jats:title>ABSTRACT</jats:title>\n                <jats:sec>\n                  <jats:title>BACKGROUND AND AIMS</jats:title>\n                  <jats:p>Improvements in cognition (e.g., attention, working memory) are common after repetitive trans-cranial magnetic stimulation (rTMS) treatment and have also been observed in non-clinical samples. This study investigated whether rTMS can enhance cognitive resilience in individuals who perform in high-stress environments using cognitive measures and electroencephalography (EEG) to explore potential neural mechanisms of rTMS-induced cognitive change.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS</jats:title>\n                  <jats:p>40 college-educated adults not reporting cognitive or psychiatric concerns underwent a 5-day accelerated (10 sessions/ day) rTMS treatment and pre-post cognitive assessment. Participants were assigned to 1 of 10 doses defined as number of active vs. sham stimulation sessions/ day (total active pulses = 3,000 – 30,000). To assess cognitive effects, standard batteries (NIH Toolbox, Spaceflight Cognitive Assessment Tool for Windows [WinSCAT]) were administered – and a subset (n=21) also did an N-Back working memory task with EEG measurement – before, immediately after, and 1 month after rTMS. For all indices, linear and quadratic correlations of pre-to-post-rTMS change with dose were examined to test if an optimal dose was achieved.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS</jats:title>\n                  <jats:p>\n                    From pre- to post-rTMS, participants improved in fluid cognition (working memory, processing speed) as measured by NIH toolbox,\n                    <jats:italic>t</jats:italic>\n                    (39)=8.4,\n                    <jats:italic>p</jats:italic>\n                    &lt;.001,\n                    <jats:italic>d</jats:italic>\n                    =1.3, and WinSCAT,\n                    <jats:italic>t</jats:italic>\n                    (39)=4.1,\n                    <jats:italic>p</jats:italic>\n                    &lt;.001,\n                    <jats:italic>d</jats:italic>\n                    =.65; and, improvement in the latter related linearly to rTMS dose,\n                    <jats:italic>r</jats:italic>\n                    (39)=.40,\n                    <jats:italic>p</jats:italic>\n                    =.01. Regarding EEG, subjects who received high (6+ active sessions/day) also showed increased amplitudes of an event-related marker of stimulus-directed attention (P300) whether it was elicited by simple task targets,\n                    <jats:italic>t</jats:italic>\n                    (10)=3.1,\n                    <jats:italic>p</jats:italic>\n                    =.01,\n                    <jats:italic>d</jats:italic>\n                    =.95, or task-unrelated noise stimuli played during the task as probes of peripheral attention,\n                    <jats:italic>t</jats:italic>\n                    (10)=3.6,\n                    <jats:italic>p</jats:italic>\n                    =.005,\n                    <jats:italic>d</jats:italic>\n                    =1.1. Additionally, there were linear relationships between change magnitude and rTMS dose for simple task target-related,\n                    <jats:italic>r</jats:italic>\n                    (20)=.45,\n                    <jats:italic>p</jats:italic>\n                    =.04, and peripheral noise-related,\n                    <jats:italic>r</jats:italic>\n                    (20)=.54,\n                    <jats:italic>p</jats:italic>\n                    =.009, P300s.\n                  </jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>CONCLUSIONS</jats:title>\n                  <jats:p>rTMS improved fluid reasoning abilities and also changed how dynamic attention is deployed during high-demand challenges as a potential mediator of fluid cognition improvements. While linear dose-response relationships support that changes were rTMS-elicited, absence of a response curve asymptote also suggests that still-higher doses could be warranted to achieve maximal effects in non-clinical samples.</jats:p>\n                </jats:sec>","journal":null,"year":null,"id":656112,"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":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1712703,"name":"Colin Bowyer","orcid":null,"position":1,"is_corresponding":false},{"id":1712705,"name":"Kevin Caulfield","orcid":null,"position":2,"is_corresponding":false},{"id":1712706,"name":"Donna Roberts","orcid":null,"position":3,"is_corresponding":false},{"id":258809,"name":"Lisa M. McTeague","orcid":"0000-0003-4475-9425","position":4,"is_corresponding":false},{"id":961340,"name":"Christopher T. Sege","orcid":"0000-0003-0040-0939","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Accelerated rTMS for Enhancing Intact Cognition: An Examination of Dose Effects on Electrocortical Indicators of Attention and Working Memory","abstract":"<jats:title>ABSTRACT</jats:title>\n                <jats:sec>\n                  <jats:title>BACKGROUND AND AIMS</jats:title>\n                  <jats:p>Improvements in cognition (e.g., attention, working memory) are common after repetitive trans-cranial magnetic stimulation (rTMS) treatment and have also been observed in non-clinical samples. This study investigated whether rTMS can enhance cognitive resilience in individuals who perform in high-stress environments using cognitive measures and electroencephalography (EEG) to explore potential neural mechanisms of rTMS-induced cognitive change.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS</jats:title>\n                  <jats:p>40 college-educated adults not reporting cognitive or psychiatric concerns underwent a 5-day accelerated (10 sessions/ day) rTMS treatment and pre-post cognitive assessment. Participants were assigned to 1 of 10 doses defined as number of active vs. sham stimulation sessions/ day (total active pulses = 3,000 – 30,000). To assess cognitive effects, standard batteries (NIH Toolbox, Spaceflight Cognitive Assessment Tool for Windows [WinSCAT]) were administered – and a subset (n=21) also did an N-Back working memory task with EEG measurement – before, immediately after, and 1 month after rTMS. For all indices, linear and quadratic correlations of pre-to-post-rTMS change with dose were examined to test if an optimal dose was achieved.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS</jats:title>\n                  <jats:p>\n                    From pre- to post-rTMS, participants improved in fluid cognition (working memory, processing speed) as measured by NIH toolbox,\n                    <jats:italic>t</jats:italic>\n                    (39)=8.4,\n                    <jats:italic>p</jats:italic>\n                    &lt;.001,\n                    <jats:italic>d</jats:italic>\n                    =1.3, and WinSCAT,\n                    <jats:italic>t</jats:italic>\n                    (39)=4.1,\n                    <jats:italic>p</jats:italic>\n                    &lt;.001,\n                    <jats:italic>d</jats:italic>\n                    =.65; and, improvement in the latter related linearly to rTMS dose,\n                    <jats:italic>r</jats:italic>\n                    (39)=.40,\n                    <jats:italic>p</jats:italic>\n                    =.01. Regarding EEG, subjects who received high (6+ active sessions/day) also showed increased amplitudes of an event-related marker of stimulus-directed attention (P300) whether it was elicited by simple task targets,\n                    <jats:italic>t</jats:italic>\n                    (10)=3.1,\n                    <jats:italic>p</jats:italic>\n                    =.01,\n                    <jats:italic>d</jats:italic>\n                    =.95, or task-unrelated noise stimuli played during the task as probes of peripheral attention,\n                    <jats:italic>t</jats:italic>\n                    (10)=3.6,\n                    <jats:italic>p</jats:italic>\n                    =.005,\n                    <jats:italic>d</jats:italic>\n                    =1.1. Additionally, there were linear relationships between change magnitude and rTMS dose for simple task target-related,\n                    <jats:italic>r</jats:italic>\n                    (20)=.45,\n                    <jats:italic>p</jats:italic>\n                    =.04, and peripheral noise-related,\n                    <jats:italic>r</jats:italic>\n                    (20)=.54,\n                    <jats:italic>p</jats:italic>\n                    =.009, P300s.\n                  </jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>CONCLUSIONS</jats:title>\n                  <jats:p>rTMS improved fluid reasoning abilities and also changed how dynamic attention is deployed during high-demand challenges as a potential mediator of fluid cognition improvements. While linear dose-response relationships support that changes were rTMS-elicited, absence of a response curve asymptote also suggests that still-higher doses could be warranted to achieve maximal effects in non-clinical samples.</jats:p>\n                </jats:sec>","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"19162232","pmcid":null,"openalex_id":"https://openalex.org/W4414378424","authors":[],"funders":[],"total_grants":0,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[],"oa_status":"green","license":"cc-by-nc-nd","oa_locations":[{"url":"https://www.biorxiv.org/content/biorxiv/early/2025/09/19/2025.09.18.676960.full.pdf","host_type":"repository"},{"url":"https://www.biorxiv.org/content/biorxiv/early/2025/09/19/2025.09.18.676960.full.pdf","host_type":"repository"},{"url":"https://syndication.highwire.org/content/doi/10.1101/2025.09.18.676960","host_type":"publisher"},{"url":"https://doi.org/10.1101/2025.09.18.676960","host_type":"repository"}],"fields_of_study":["Muscle activation and electromyography studies"],"mesh_terms":[],"keywords":["Working memory","Cognition","Electroencephalography","Task (project management)","Cognitive test","Elementary cognitive task","Brain stimulation","Effects of sleep deprivation on cognitive performance"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-11T19:52:17.998278Z","pmid":null,"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":[]}