Personalized Multimodal MRI-Guided Theta Burst Brain Stimulation for Effective Memory Enhancement in Mild Cognitive Impairment

Abstract

This dissertation examines the utility of Transcranial Magnetic Stimulation (TMS) in enhancing intervention strategies for mild cognitive impairment (MCI). The research begins by exploring the foundations of TMS and its potential to alter disease progression through neuroplastic mechanisms. It highlights how advancements in neuroimaging significantly improve the specificity of TMS interventions, supporting its application in cognitive enhancement for AD and MCI patients. A significant focus is placed on the evaluation of sensitive cognitive outcome assessments (COAs) that can detect early pathological changes before clinical symptoms become evident. The study particularly emphasizes the role of the Face-Name Associative Memory Exam (FNAME) in identifying subtle cognitive deviations across the MCI spectrum. Through comprehensive analyses, this work demonstrates how functional and structural connectivity influence associative memory, revealing potential biomarkers for early AD intervention(Chen et al., 2022). Further investigations assess the reliability of different rTMS targeting strategies, illustrating that Diffusion Tensor Imaging (DTI)-guided methods provide more consistent outcomes than those guided by resting-state fMRI. This underscores the critical importance of precision in personalizing rTMS therapy to enhance treatment efficacy. Additionally, the responsiveness of rTMS in older adults is explored, with a particular emphasis on the predictive value of baseline functional connectivity within the sensorimotor cortex. This approach highlights the inter-individual variability in TMS effects and the potential for tailored therapeutic strategies based on individual neurophysiological profiles. The dissertation concludes with a synthesis of findings and a discussion of future directions for rTMS research in the management of neurodegenerative diseases. It advocates for the standardization of protocols and the integration of rTMS with other treatment modalities to maximize therapeutic outcomes. The collective insights from this research contribute to a deeper understanding of the neurophysiological underpinnings of cognitive decline and the innovative ways TMS can be employed to mitigate its progression