iTBS rTMS in Mild Cognitive Impairment

Inclusion Criteria

• Must speak English fluently

• Diagnosis of MCI as defined by:

• Clinical diagnosis by a neurologist

• Neuropsychological testing support of MCI

• Meet criteria for MCI

• Subjective cognitive decline reported by participant and/or an informant

• Objective memory impairment in one or more cognitive domains for age

• Essentially preserved general cognitive function

• Largely intact functional activities

• Does not meet criteria for dementia as judged by a clinician

• Eligible for transcranial magnetic stimulation (TMS) based on safety criteria

• Clinical Dementia Rating=0.5

• Geriatric Depression Scale score less than 6

• Medically stable and in good general health

• Not pregnant, lactating, or of childbearing potential

• Stable medication regimen for at least 4 weeks prior to baseline visit

• Adequate visual and auditory abilities to complete neuropsychological testing

• Ability to provide informed consent

• Have a care partner who is available to accompany the participant to study visits for the duration of the protocol.

Exclusion Criteria

• Inability to communicate in the English language

• Meet criteria for dementia

• Contraindications to TMS or MRI, including patients who have

• conductive, ferromagnetic or other magnetic-sensitive metals implanted in their head or within 30 cm of the treatment coil (e.g., cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils, stents, bullet fragments or jewelry)

• active or inactive implants, including deep brain stimulators, cochlear implants, vagus nerve stimulators or implanted device leads

• Any true positive findings on the TMS safety screening form

• Prior exposure to TMS, electroconvulsive therapy (ECT), or any neurostimulation within the past 12 months

• History of epilepsy or seizures

• Medical conditions that increase risk of seizures

• History of traumatic brain injury

• History of intracranial mass or lesion

• History of stroke, including hemorrhagic stroke and ischemic stroke

• Psychiatric disorders

• Primary psychotic disorder (schizophrenia, schizoaffective, or schizophreniform disorder), any history

• Primary mood disorder (major depressive disorder, bipolar disorder) within the past 12 months

• Substance use disorder (except caffeine and nicotine) within the past 12 months

• Active symptoms of depression, anxiety, mania, psychosis, or substance use (except caffeine and nicotine) within the past year

• Active symptoms of depression will be identified based on geriatric depression scale ≥ 6

• Other active symptoms of psychiatric conditions to be determined by study investigators

• Sleep disorders that are considered clinically significant and not sufficiently treated by the investigative team, including untreated obstructive sleep apnea (apnea-hypopnea index >15), untreated/suboptimally treated REM sleep behavior disorder, untreated/suboptimally treated restless legs syndrome

• Pregnancy or suspected pregnancy

• Participation in another concurrent interventional clinical trial

• Any unstable medical condition

• Inability to provide informed consent

• Inability to adhere to the protocol