A rTMS and Virtual Reality Based Cognitive Rehabilitation Program for MCI

The primary objective of this pilot study is to assess if combined treatment with repetitive transcranial magnetic stimulation (rTMS) and immersive virtual reality mediated cognitive training program (iVCT) improves cognitive, emotional, and functional abilities in participants with mild cognitive impairment (MCI) compared to usual care. Secondary objective of the study is assess if rTMS+iVCT treatment improves caregiver burden.

Older Veterans (N=50) age ≥ 55 years with mild cognitive impairment will be recruited. All participants will be screened for suitability for the rTMS and iVCT treatments. Those eligible (N=30) will complete a baseline assessment of their cognitive, emotional, and functional abilities and caregiver burden (Visit 1). Participants (N=30) will be randomly assigned to a rTMS group, rTMS+iVCT group, and control group.. Participants in the rTMS group will receive rTMS treatment daily for 5 days of the week for 2 weeks. Participants in the rTMS+iVCT group will receive rTMS treatment followed by 30-60 minutes of iVCT intervention daily for 5 days of the week for 2 weeks. Participants in the control group will receive usual care. All testing will be repeated posttreatment at 2 weeks (Visit 2) and at 3 months(Visit 3) .

Innovations include combination of two non-pharmacological interventions and the inclusion of 3-month post-treatment testing to assess the durability of changes. Feedback will be gathered to improve the treatment program. Assuming positive findings, this research will help establish a new treatment modality for improving the cognitive, emotional, and functional abilities in MCI.

Inclusion criteria

• age 55 and over
• previous diagnosis of Mild Cognitive Impairment
• Score of 18 or over on the MoCA during pre-screening procedures.

Exclusion criteria

• below 55 years old
• Do not pass the TMS Adult Safety Screening
• Taking medications known to increase risk of seizure
• Taking ototoxic medications
• Those with implanted device
• History of bipolar disorder
• History of Tourette's syndrome or presence of motor tics
• History of seizures/ seizures in first degree relatives
• History of stroke, aneurysm, or cranial neurosurgery
• Current alcohol related disorder needing medical treatment
• History of abnormal electroencephalogram (EEG)
• History of motion sickness, nausea, vomiting, seizures, or migraine
• Significant balance/gait impairments/history of falls
• History of hyperacusis or photophobia