Abstract
FRONTIERS IN MEDICAL CASE REPORTS - Volume 7; Issue 1, (Jan-Feb, 2026)
Pages: 01-10
Spectral EEG-Guided Adaptive Neuromodulation for Age-Related Cognitive Changes: A Longitudinal Case Report
Yatharth Mahajan, Mark Odron, Vipul Reddy, Krrishika Saxena, Netra Ramanatham, Brianna Dela Cruz, Athreykrishna Parla, Charles Vigilia, Kenneth Blum, Rajendra D. Badgaiyan, Keerthy Sunder
Category:Clinical Case Reports
Abstract:
Targeted interventions for age-related cognitive changes in older adults are complicated by co-occurring factors such as depression, anxiety, executive dysfunction, and treatment heterogeneity, necessitating strategies that integrate cognitive, affective, and functional symptom management. This case report explores functional, affective, sleep, and quality of life outcomes following EEG-spectra-guided personalized repetitive transcranial magnetic stimulation (PrTMS, PeakLogic, Inc., San Diego, CA) for a patient experiencing age-related cognitive changes. Weekly assessments showed improvements in perceived cognitive function, sleep, mood, and quality of life, quantified via Perceived Deficits Questionnaire - Depression (PDQ-D5), Sleep Condition Indicator (SCI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Our findings show promise that EEG-spectra-guided PrTMS is potentially beneficial for addressing age-related cognitive and functional changes. Furthermore, our findings show longitudinal symptom improvements consistent with engagement of adaptive neuroplasticity. Further large-scale, randomized and blinded studies are recommended to validate our observations on the feasibility of PrTMS for age-related cognitive changes.
Keywords: Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS), Dorsolateral Prefrontal Cortex (DLPFC), Neuromodulation, Normal Cognitive Aging, Perceived Deficits Questionnaire - Depression (PDQ-D5), Spectral Electroencephalography (EEG)
References:
Abdel-Aziz K, Larner AJ. Six-item cognitive impairment test (6CIT): pragmatic diagnostic accuracy study for dementia and MCI. Int Psychogeriatr 2015; 27: 991-997.
Becker Lee A. "Effect size (ES)." (2000): 2000.
Cao ZG, Yang M. Repetitive Transcranial Magnetic Stimulation for Elderly Patients with Cognitive Impairment: A Meta Analysis of Randomized Controlled Trials. J Neurol Neuromedicine 2025; 9: 1-21
Guo Z, Jiang Y, He J, Jiang N. Repetitive transcranial magnetic stimulation may promote the reversion of mild cognitive impairment to normal cognition. Front Psychiatry 2025; 16: 1544728.
Han C, Zhang Z, Lin Y, Huang S, Mao J, Xiang W, Wang F, Liang Y, Chen W, Zhao X. Monitoring Sleep Quality Through Low α-Band Activity in the Prefrontal Cortex Using a Portable Electroencephalogram Device: Longitudinal Study. J Med Internet Res 2025; 27: e67188.
Lee J, Kim HJ. Normal Aging Induces Changes in the Brain and Neurodegeneration Progress: Review of the Structural, Biochemical, Metabolic, Cellular, and Molecular Changes. Front Aging Neurosci 2022; 14: 931536.
Lejko N, Larabi DI, Herrmann CS, Aleman A, Ćurčić-Blake B. Alpha Power and Functional Connectivity in Cognitive Decline: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 78: 1047-1088.
Lustenberger C, Boyle MR, Foulser AA, Mellin JM, Fröhlich F. Functional role of frontal alpha oscillations in creativity. Cortex 2015; 67: 74-82.
Mahajan S, Bodahanapati A, Katta A, Aydemir E, Mendoza A, Vigilia C, Blum K, Baron D, Lewandrowski KU, Badgaiyan RD, Sunder K. Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS®) Coupled with Transcranial Photobiomodulation (tPBM) For Co-Occurring Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD). Acta Sci Neurol 2025; 8: 20-27.
Makale MT, Nybo C, Blum K, Dennen CA, Elman I, Murphy KT. Pilot Study of Personalized Transcranial Magnetic Stimulation with Spectral Electroencephalogram Analyses for Assessing and Treating Persons with Autism. J Pers Med 2024; 14: 857.
Mann SK, Malhi NK. Repetitive Transcranial Magnetic Stimulation. 2023 Mar 6. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. PMID: 33760474.
Meng R, Huang M, Miller CB, Fong DYT, Gregory AM, Pakpour AH, Dzierzewski JM, Henry AL, Voinescu BI, Yang N, Ma H, Luo Y, Lau EYY, Spruyt K, Espie CA. Global perspectives on the Sleep Condition Indicator for DSM-5 insomnia disorder: a COSMIN and STARD systematic review of psychometric and diagnostic performance. BMC Med 2025; 23: 542.
Miniussi C, Harris JA, Ruzzoli M. Modelling non-invasive brain stimulation in cognitive neuroscience. Neurosci Biobehav Rev 2013; 37: 1702-1712.
Mohankumar K, Karthikeya S, Mahajan S, Bodhanapati J, Vigilia C, Odron M, Blum K, Baron D, Lewandrowski KU, Badgaiyan RD, Modestino EJ, Sunder K. EEG-Spectra-Guided Personalized rTMS in PTSD with Co-occurring Psychiatric Disorders: A Case Series. Acta Sci Neurol 2025; 8: 3-9.
Moreira HS, Costa AS, Machado Á, Castro SL, Lima CF, Vicente SG. Distinguishing mild cognitive impairment from healthy aging and Alzheimer's Disease: The contribution of the INECO Frontal Screening (IFS). PLoS One 2019; 14: e0221873.
Murman DL. The Impact of Age on Cognition. Semin Hear 2015; 36: 111-121.
Pandi-Perumal SR, Zisapel N, Srinivasan V, Cardinali DP. Melatonin and sleep in aging population. Exp Gerontol 2005; 40: 911-925.
Pranckeviciene A, Saudargiene A, Gecaite-Stonciene J, Liaugaudaite V, Griskova-Bulanova I, Simkute D, Naginiene R, Dainauskas LL, Ceidaite G, Burkauskas J. Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample. PLoS One 2022; 17: e0263027.
Rush AJ, South CC, Jha MK, Grannemann BD, Trivedi MH. Toward a very brief quality of life enjoyment and Satisfaction Questionnaire. J Affect Disord 2019; 242: 87-95.
Saxena K, Nettles S (2022). Understanding Alzheimer’s risk factors associated with the prevalence of US populations and women. Journal of Student Research 2022; 11(1).
Sumiyoshi T, Uchida H, Watanabe K, Oosawa M, Ren H, Moriguchi Y, Fujikawa K, Fernandez J. Validation and Functional Relevance of the Short Form of the Perceived Deficits Questionnaire for Depression for Japanese Patients with Major Depressive Disorder. Neuropsychiatr Dis Treat 2022; 18: 2507-2517.
Yan Y, Tian M, Wang T, Wang X, Wang Y, Shi J. Transcranial magnetic stimulation effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease: a systematic review and meta-analysis. Front Neurol 2023; 14: 1209205.
Yiallouris A, Tsioutis C, Agapidaki E, Zafeiri M, Agouridis AP, Ntourakis D, Johnson EO. Adrenal Aging and Its Implications on Stress Responsiveness in Humans. Front Endocrinol (Lausanne) 2019; 10: 54.