# Exploring cortical excitability modulation to promote cognitive resilience in aging: an rTMS study protocol

## TL;DR

This study explores how brain stimulation with rTMS can improve cognitive resilience in older adults by modulating cortical excitability.

## Contribution

The novel contribution is a detailed protocol for using high-frequency rTMS to modulate cortical excitability and assess cognitive and emotional outcomes in aging.

## Key findings

- A preliminary feasibility phase with four participants showed tolerability and safety of the rTMS protocol.
- The study aims to characterize cortical excitability changes and their relationship to cognitive outcomes in older adults.
- The protocol includes comprehensive neuropsychological assessments and safety monitoring procedures.

## Abstract

Promoting cognitive resilience in aging is essential for preserving autonomy and quality of life. Non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), have shown promise in enhancing neuroplasticity and cognitive functioning in older adults. This study protocol outlines the methodological framework for an investigation designed to examine whether high-frequency rTMS applied over the left dorsolateral prefrontal cortex (DLPFC) can modulate cortical excitability (CE) and characterize changes in cognitive and emotional functioning in healthy older individuals. The protocol provides detailed descriptions of stimulation parameters, safety monitoring procedures, and assessment tools. Cortical excitability will be measured using transcranial magnetic stimulation–derived motor-evoked potentials (MEPs), while cognitive and emotional outcomes will be assessed with a comprehensive neuropsychological battery. A preliminary feasibility phase with four participants was conducted to refine procedures and assess tolerability, safety, and data acquisition reliability. The study aims to determine the feasibility and signal characterization of cortical excitability modulation within a crossover framework and to explore the potential relationship between CE modulation and behavioral outcomes. Observations from this pilot phase will inform procedural refinement and the design of a larger ongoing trial.