Effectiveness of rTMS on Working Memory and Inhibitory Impairments in Patients With Post-Stroke Executive Deficits

Considerable efforts have been dedicated to developing effective treatments for post-stroke executive impairment (PSEI), among which repetitive transcranial magnetic stimulation (rTMS) has shown great potential. This study aimed to investigate the therapeutic effects of high-frequency rTMS on working memory (WM) and response inhibition (RI) of executive functions in PSEI patients and the potential neural mechanisms.

In a randomized, double-blind trial, 10 Hz rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) in 32 PSEI patients for 10 days, who were divided into real and sham rTMS groups. The Stroop color-word test (SCWT), digit span test (DST), and functional near-infrared spectroscopy (fNIRS) were used for assessment before and after the intervention. Resting-state functional connectivity (rsFC) and graph theory methods were used to analyze changes in brain function.

Compared to the sham rTMS group, the real rTMS group showed significant reductions in SCWT response time (F = 4.223, p = 0.049) and improvements in DST forward scores (F = 4.739, p = 0.037) after the intervention. Moreover, the real rTMS group demonstrated significant enhancements in rsFC from left DLPFC to the right DLPFC (F = 8.538, p = 0.007) and the right posterior parietal cortex (F = 9.905, p = 0.004), as well as in the Degree Centrality of the left DLPFC (F = 7.144, p = 0.012), which were respectively significantly correlated with reduced SCWT response time and increased DST forward scores.

High-frequency rTMS effectively improves WM and RI performance in patients with PSEI, which may be attributed to the remodeling of specific connectivity patterns and enhancement of local communication efficiency within the frontoparietal network.