rTMS for enhancing cognitive reserve: A case report

• rTMS targeting the DLPFC improves cognitive flexibility and processing speed. • Motor evoked potentials showed a modulation of cortical excitability after rTMS. • Quality of life improved significantly, with reduced fatigue and stabilised mood. • Long-term treatment showed neuroplasticity in age-related cognitive decline. • rTMS showed potential as a non-invasive method to improve cognitive reserve. Understanding the mechanisms underlying brain ageing and age-related pathologies is crucial for addressing cognitive decline. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) have gained prominence due to their ability to modulate neurophysiological, affective and cognitive brain functions. In this case study, we present a 61-year-old woman who suffered from mood disturbances, sleep disturbances, fatigue and cognitive decline. A comprehensive neuropsychological assessment was performed to evaluate mood, cognition and quality of life. The elderly woman underwent rTMS treatment targeting the left dorsolateral prefrontal cortex (DLPFC), a region critical for executive functions and mood regulation. Significant improvements were observed in attention, processing speed, and cognitive flexibility, as evidenced by reductions in completion times on the Trail Making Test (TMT). In addition to clinical and cognitive outcomes, cortical excitability was assessed through motor-evoked potentials (MEPs) before and after the intervention. Modulation of MEPs amplitude was observed post-treatment, suggesting neurophysiological changes potentially linked to the normalization of cortical activity. Our findings suggest that rTMS may be a well-tolerated and potentially effective intervention for improving cognitive function and stabilizing mood in older adults experiencing age-related cognitive decline and mood disorders.