Comparative efficacy of intermittent theta burst stimulation and high-frequency repetitive transcranial magnetic stimulation in amnestic mild cognitive impairment patients

Intermittent theta burst stimulation, a derivative of repetitive transcranial magnetic stimulation, has been applied to improve cognitive deficits. However, its efficacy and mechanisms in enhancing cognitive function in patients with amnestic mild cognitive impairment compared with traditional repetitive transcranial magnetic stimulation paradigms remain unclear. This study recruited 48 amnestic mild cognitive impairment patients, assigning them to intermittent theta burst stimulation, repetitive transcranial magnetic stimulation, and sham groups (5 times/wk for 4 wk). Neuropsychological assessments and functional magnetic resonance imaging data were collected pre- and post-treatment. Regarding efficacy, both angular gyrus intermittent theta burst stimulation and repetitive transcranial magnetic stimulation significantly improved general cognitive function and memory compared to the sham group, with no significant difference between the 2 treatment groups. Mechanistically, significant changes in brain activity within the temporoparietal network were observed in both the intermittent theta burst stimulation and repetitive transcranial magnetic stimulation groups, and these changes correlated with improvements in general cognitive and memory functions. Additionally, intermittent theta burst stimulation showed stronger modulation of functional connectivity between the hippocampus, parahippocampal gyrus, and temporal regions compared to repetitive transcranial magnetic stimulation. The intermittent theta burst stimulation and repetitive transcranial magnetic stimulation can improve cognitive function in amnestic mild cognitive impairment patients, but intermittent theta burst stimulation may offer higher efficiency. Intermittent theta burst stimulation and repetitive transcranial magnetic stimulation likely enhance cognitive function, especially memory function, by modulating the temporoparietal network.