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Cognitive effects of focal neuromodulation in neurological and psychiatric disorders

Nature Reviews Psychology volume 3, pages 242–260 (2024)Cite this article

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Abstract

Focal direct-to-brain neuromodulation approaches, such as repetitive transcranial magnetic stimulation (TMS), deep brain stimulation (DBS) and ablative techniques, hold tremendous therapeutic promise for challenging-to-treat neurological and psychiatric disorders. These interventions modulate brain circuits that contribute to clinical symptoms and overlap with the networks that support cognition. Depending on the reason for the intervention — whether it aims to improve clinical symptoms or cognitive symptoms — focal neuromodulation techniques might indirectly or directly affect cognitive processes. In this Review, we examine the effects of repetitive TMS, DBS and ablative techniques on post-intervention cognition in patients with psychiatric disorders (major depressive disorder, obsessive–compulsive disorder and schizophrenia) and neurological conditions (Parkinson disease, essential tremor and Alzheimer disease). Our findings indicate that focal neuromodulation is generally safe from a cognitive standpoint and, in some cases, can improve aspects of cognition. We conclude with methodological recommendations aimed at advancing our knowledge of the cognitive effects associated with focal neuromodulation approaches.

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Fig. 1: Neuromodulation techniques.
Fig. 2: Targets for repetitive transcranial magnetic stimulation.
Fig. 3: Targets for deep brain stimulation.
Fig. 4: Targets for ablative techniques.

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Authors and Affiliations

  1. Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada

    Micaela Wiseman, Isabella J. Sewell, Sean M. Nestor, Peter Giacobbe, Clement Hamani, Nir Lipsman & Jennifer S. Rabin

  2. Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada

    Sean M. Nestor, Peter Giacobbe, Clement Hamani, Nir Lipsman & Jennifer S. Rabin

  3. Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Sean M. Nestor, Peter Giacobbe & Nir Lipsman

  4. Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Clement Hamani & Nir Lipsman

  5. Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Jennifer S. Rabin

  6. Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada

    Jennifer S. Rabin

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M.W. and I.J.S. researched data for the article. J.S.R., M.W., I.J.S. and N.L. wrote the article. All authors contributed substantially to the discussion of the content and reviewed and/or edited the manuscript before submission.

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Wiseman, M., Sewell, I.J., Nestor, S.M. et al. Cognitive effects of focal neuromodulation in neurological and psychiatric disorders. Nat Rev Psychol 3, 242–260 (2024). https://doi.org/10.1038/s44159-024-00291-3

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