Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature review

Abstract Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder, affecting tens of millions worldwide with projections indicating increasing prevalence in coming decades. Characterized by progressive cognitive decline, AD manifests with varying degrees of executive, language, and...

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Main Authors: Xinlei Zhang, Lingling Zhu, Yuan Li, Hongna Yu, Tao Wang, Xiuli Chu
Format: Article
Language:English
Published: BMC 2025-04-01
Series:European Journal of Medical Research
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Online Access:https://doi.org/10.1186/s40001-025-02493-8
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author Xinlei Zhang
Lingling Zhu
Yuan Li
Hongna Yu
Tao Wang
Xiuli Chu
author_facet Xinlei Zhang
Lingling Zhu
Yuan Li
Hongna Yu
Tao Wang
Xiuli Chu
author_sort Xinlei Zhang
collection DOAJ
description Abstract Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder, affecting tens of millions worldwide with projections indicating increasing prevalence in coming decades. Characterized by progressive cognitive decline, AD manifests with varying degrees of executive, language, and visuospatial impairments that worsen over time, eventually leading to severe psychiatric symptoms, mobility difficulties, sleep disturbances, and incontinence. While pharmacological treatments remain the primary intervention approach, their efficacy often diminishes over time and may produce significant adverse effects. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuromodulation technique, has emerged as a promising alternative or complementary therapy. This literature review examines the therapeutic potential and mechanisms of rTMS in Alzheimer’s disease. Through electromagnetic induction, rTMS can selectively modulate cortical excitability, with high-frequency stimulation (≥ 5 Hz) enhancing neural excitability and low-frequency stimulation (≤ 1 Hz) producing inhibitory effects. Recent clinical evidence demonstrates that rTMS can significantly improve cognitive function, memory, language abilities, and motor performance in AD patients, particularly when administered with optimized parameters targeting key brain regions, such as the dorsolateral prefrontal cortex. The neurobiological mechanisms underlying these effects include enhanced synaptic plasticity, increased expression of neurotrophic factors, modulation of neurotransmitter systems, and reduction of pathological protein aggregation. Meta-analyses indicate that high-frequency protocols (particularly 20 Hz) delivered over at least 3 weeks with a minimum of 20 sessions produce the most significant cognitive improvements, with effects potentially persisting for months post-treatment. Combined approaches integrating rTMS with cognitive training show particular promise through synergistic enhancement of neuroplasticity. Despite encouraging results, standardization of treatment protocols and larger clinical trials are needed to establish definitive guidelines and determine long-term efficacy. This review synthesizes current evidence supporting rTMS as an effective intervention for alleviating clinical symptoms of Alzheimer’s disease while highlighting opportunities for advancing its therapeutic application.
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spelling doaj-art-a7819e87d4a84f2b941b9ef67e45b7c42025-08-20T03:07:40ZengBMCEuropean Journal of Medical Research2047-783X2025-04-0130111710.1186/s40001-025-02493-8Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature reviewXinlei Zhang0Lingling Zhu1Yuan Li2Hongna Yu3Tao Wang4Xiuli Chu5Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical UniversityDepartment of Pain Management, The Affiliated Taian City Central Hospital of Qingdao UniversityDepartment of Rehabilitation, Taian Maternal and Child Health HospitalDepartment of Rehabilitation, Taian Maternal and Child Health HospitalDepartment of Neurology, The Second Affiliated Hospital of Shandong First Medical UniversityDepartment of Neurology, Shanghai Sixth People’S Hospital Affiliated to Shanghai Jiao Tong University School of MedicineAbstract Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder, affecting tens of millions worldwide with projections indicating increasing prevalence in coming decades. Characterized by progressive cognitive decline, AD manifests with varying degrees of executive, language, and visuospatial impairments that worsen over time, eventually leading to severe psychiatric symptoms, mobility difficulties, sleep disturbances, and incontinence. While pharmacological treatments remain the primary intervention approach, their efficacy often diminishes over time and may produce significant adverse effects. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuromodulation technique, has emerged as a promising alternative or complementary therapy. This literature review examines the therapeutic potential and mechanisms of rTMS in Alzheimer’s disease. Through electromagnetic induction, rTMS can selectively modulate cortical excitability, with high-frequency stimulation (≥ 5 Hz) enhancing neural excitability and low-frequency stimulation (≤ 1 Hz) producing inhibitory effects. Recent clinical evidence demonstrates that rTMS can significantly improve cognitive function, memory, language abilities, and motor performance in AD patients, particularly when administered with optimized parameters targeting key brain regions, such as the dorsolateral prefrontal cortex. The neurobiological mechanisms underlying these effects include enhanced synaptic plasticity, increased expression of neurotrophic factors, modulation of neurotransmitter systems, and reduction of pathological protein aggregation. Meta-analyses indicate that high-frequency protocols (particularly 20 Hz) delivered over at least 3 weeks with a minimum of 20 sessions produce the most significant cognitive improvements, with effects potentially persisting for months post-treatment. Combined approaches integrating rTMS with cognitive training show particular promise through synergistic enhancement of neuroplasticity. Despite encouraging results, standardization of treatment protocols and larger clinical trials are needed to establish definitive guidelines and determine long-term efficacy. This review synthesizes current evidence supporting rTMS as an effective intervention for alleviating clinical symptoms of Alzheimer’s disease while highlighting opportunities for advancing its therapeutic application.https://doi.org/10.1186/s40001-025-02493-8Alzheimer’sTranscranial magnetic stimulationCognitive declineMechanismMemory impairment
spellingShingle Xinlei Zhang
Lingling Zhu
Yuan Li
Hongna Yu
Tao Wang
Xiuli Chu
Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature review
European Journal of Medical Research
Alzheimer’s
Transcranial magnetic stimulation
Cognitive decline
Mechanism
Memory impairment
title Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature review
title_full Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature review
title_fullStr Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature review
title_full_unstemmed Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature review
title_short Therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in Alzheimer’s disease: a literature review
title_sort therapeutic potential and mechanisms of repetitive transcranial magnetic stimulation in alzheimer s disease a literature review
topic Alzheimer’s
Transcranial magnetic stimulation
Cognitive decline
Mechanism
Memory impairment
url https://doi.org/10.1186/s40001-025-02493-8
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