The Mechanism and Clinical Research on the Effects of rTMS on Cognitive Functions Based on Multi-Scale Fusion

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is increasingly utilized in the treatment of Alzheimer’s disease (AD). However, its regulatory mechanisms remain unclear. This narrative review provides an overview of current international research progress and integrates representative findings from longitudinal and multimodal studies, including evidence from both animal and clinical investigations. It further compares the effects of different stimulation parameters, experimental models, and therapeutic strategies to examine the neuroregulatory effects of rTMS on brain regions involved in learning and memory across multiple levels, encompassing molecular signaling, synaptic plasticity, neural network reorganization, and behavioral outcomes. Furthermore, it summarizes the potential cross-scale mechanisms through which rTMS may alleviate cognitive impairment in AD and discusses current evidence regarding parameter optimization and individualized treatment strategies, alongside multimodal neural signal-based frameworks for clinical efficacy assessment, while emphasizing the rationale for individualized neuromodulation strategies. Overall, this review provides multi-level evidence to elucidate the neural mechanisms underlying rTMS-mediated cognitive improvement in AD, summarizes current advances and remaining challenges in rTMS-based interventions, and highlights important directions for clinical translation and personalized neuromodulation strategies.