Transdiagnostic Efficacy, Durability, and Optimal Parameters of rTMS for Cognitive Rehabilitation: A Comprehensive Meta-Analysis

Published online October 17, 2026. Across 137 randomized studies, rTMS produced a small average improvement on objective cognitive tests that persisted at reported follow-up. Whether those test changes translate into noticeable everyday benefit remains uncertain.

Ali AM, Gorter M, Zakaria R, Jenkinson MD, Frank B, Klein M, de Witt Hamer PC, Douw L.
Brain Stimulation · Publication date: 2026-10-17
Added to site: 2026-10-19
DOI: 10.1016/j.brs.2026.103226

First published online October 17, 2026. Added to Neurofeedback.com October 19, 2026.

Modalities

rTMS, iTBS, TMS

Clinical focus

Cognitive rehabilitation, Durability, Protocol moderators

Population

People with neurological or psychiatric conditions included in randomized rTMS trials

Sample

137 studies, 5,972 participants and 748 objective cognitive measures

Intervention / method

The review pooled objective cognitive outcomes from randomized real-versus-sham rTMS trials and examined diagnosis, cognitive domain, target, frequency, session count and follow-up as moderators.

Comparator

Real rTMS versus sham rTMS

Clinician summary

The pooled objective-cognition effect was g = 0.28 (P < .0001; I2 37.3%) and remained significant across 2 to 52 weeks of follow-up. Effects varied by diagnosis and protocol. Subjective cognition appeared in only 6% of studies, leaving a major functional-meaning gap.

How to interpret the findings

The synthesis combines diverse diagnoses, cognitive domains, protocols and secondary outcomes. Moderator and ranking results are observational across studies and should not be treated as prescriptive optimization rules. Functional outcomes and subjective cognition were rarely measured, and complete risk-of-bias and safety details were unavailable in the checked abstract.

Equipment and disclosures

The included trials used multiple stimulation systems; this summary does not attribute the evidence to a single manufacturer. No BrainMaster attribution.

AMSA reported honoraria from Brainlab. Funding was not identified in the checked abstract or Crossref record. No indexed correction, retraction or concern relation appeared in the retained PubMed or Crossref records; this is a bounded check. AI-assisted review.

Related evidence

Compare findings from the same clinical area, including mixed results.