Cognitive and gait effects of repetitive transcranial magnetic stimulation in middle aged and older persons with depression: A systematic review

<h2>ABSTRACT</h2><h3>Background</h3> Late-life depression (LLD) is a growing public health concern with distinct cognitive and somatic symptom profiles compared to early-onset major depressive disorder (MDD). Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive intervention for treatment-resistant depression (TRD), with increasing attention to its cognitive and motor effects. <h3>Methods</h3> This systematic review assessed the impact of rTMS on cognitive and gait outcomes in patients aged ≥50 with MDD or TRD. Literature searches were conducted in MEDLINE, CENTRAL, PsychINFO, and Embase. Seventeen trials involving rTMS and any comparator were included. Study characteristics, stimulation protocols, outcome domains, and adverse events were extracted and synthesized qualitatively. <h3>Results</h3> Global cognitive screening scores (e.g., MMSE, MoCA) largely remained stable, but more sensitive, domain-specific assessments revealed isolated improvements in memory and executive function. A subset of studies demonstrated clinically meaningful gains in gait speed, particularly among participants with baseline mobility limitations. While changes in gait variability were not consistently detected, these findings may nonetheless reflect emerging effects within motor domains. Across all trials, rTMS was well tolerated, with most adverse events being mild and transient; serious events were rare. <h3>Conclusions</h3> rTMS is a well-tolerated intervention with growing evidence for domain-specific cognitive enhancement and functional mobility gains in middle aged and older patients with MDD. Although heterogeneity and small sample sizes limit generalizability, the consistency of improvements in targeted domains signals real therapeutic potential. Future trials that adopt standardized protocols, longer follow-up, and refined outcome measures are poised to further establish rTMS as a valuable component of late-life depression management.