Deep TMS for Comorbid Depression and Cognitive Impairment in Older Adults

Inclusion Criteria:

• meet DSM 5 criteria for Major or Mild Neurocognitive Disorder due to Alzheimer'sdisease with Clinical Dementia Rating Scale (CDR) score of at least 0.5

• have been diagnosed with DSM5 Major Depressive Disorder, with the current episodelonger than 4 weeks but less than 5 years

• did not respond to or did not tolerate antidepressant treatment

• are willing to provide informed consent

• are able to follow the treatment schedule

• are stable on medications for 2 months and are not expected to change medicationduring the entire study period (if they are taking medications)

• have a satisfactory safety screening questionnaire for TMS

• have an informant/study partner who is able to complete study questionnairesregarding the participant

Exclusion Criteria:

• have a metal plate in their head, except in the mouth (such as an ear implant,implanted brain stimulators, aneurysm clips)

• have known increased pressure or a history of increased pressure in their brain,which may increase their risk for having seizures

• have a cardiac pacemaker

• have an implanted medication pump

• have a central venous line

• have a significant heart disease or history of stroke

• Modified Hachinski Score (MHIS) > 3 (to exclude those with significant vascularcomponent to memory loss)

• have a history of any psychotic disorder, bipolar disorder, eating disorder,obsessive compulsive disorder, post-traumatic stress disorder, or dementia otherthan AD

• have a history of substance abuse in the last 6 months

• have a history of stroke or other brain lesions

• have a personal history of epilepsy

• have a family history of epilepsy

• are a pregnant or breast-feeding woman

• are taking psychotropic medications including antidepressant medications,antipsychotics or mood stabilizing medications due to increased risk of seizure

• are taking memantine

• have a history of abnormal MRI of the brain

• have significant hearing loss requiring use of hearing aids

• have untreated hypo- or hyper-thyroidism