Systematic review and meta-analysis of intermittent theta burst stimulation therapy for improving cognitive function in the elderly population

Abstract

Intermittent theta-burst stimulation (iTBS) is an effective neuromodulation approach for major depressive disorder (MDD). With population aging, age-related cognitive decline has become an increasingly heavy social burden. However, the intervention effect of iTBS on cognitive function in the elderly remains unclear. This meta-analysis searched Chinese and English databases from database inception to November 5, 2025. Randomized controlled trials (RCTs) enrolling an elderly population and comparing iTBS with sham stimulation were included. Pooled effect sizes were calculated using standardized mean differences (SMDs). Subgroup analyses, sensitivity analyses, and publication bias assessments were performed. 20 RCTs were included, involving participants with major depressive disorder, Alzheimer’s disease, Parkinson’s disease/Parkinson’s disease dementia, cerebrovascular disease, and healthy older adults. Pooled analyses showed that iTBS yielded higher scores than sham stimulation in memory (SMD = 0.80, 95% confidence interval [CI] 0.34 to 1.26), spatial/visuospatial function (SMD = 0.42, 95% CI 0.18 to 0.66), and attention (SMD = 0.51, 95% CI 0.10 to 0.92). The pooled estimate for language was large but highly heterogeneous and sensitive to influential single studies, indicating limited robustness. The pooled effect for global cognition was small and became borderline/non-significant in leave-one-out analyses, suggesting that this finding should be interpreted cautiously. iTBS may benefit certain cognitive domains—particularly memory, spatial/visuospatial function, and attention. Additionally, iTBS can improve cognitive function in patients with Alzheimer’s disease anda cerebrovascular disese, while its effects on healthy individuals, those with depression, and Parkinson’s patients are limited.