500 Section - Effects of Combined Transcranial Magnetic Stimulation and Photobiomodulation in Mild Cognitive Impairment: A Randomized Controlled Trial

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Design: This study employed a randomized, single-blind, controlled de

sign. The sample size was determined a priori using GPower 3.1

based on the following parameters: Expected effect size (Cohen's

d=0.8), statistical power 80% (β=0.2), significance level:

α=0.05 (two-tailed). Four-group ANOVA with planned post hoc

comparisons. The calculation yielded a minimum required sam

ple size of 76 participants (19 per group). To account for a 10%

attrition rate, we enrolled 88 participants (22 per group); two

participants withdrew due to TMS-related discomfort, which

retained adequate power (post hoc power >85%). Randomly

assigned to four groups: Group A (TMS+sham tPBM), Group

B (tPBM+sham TMS), Group C (combined TMS+tPBM),

and Group D (sham stimulation control), with a 1:1:1:1 alloca

tion ratio.


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Results: This study demonstrates that the combination of TMS and tPBM

significantly improves WM in patients with MCI. The accom

panying neurophysiological findings, such as activation of the

cerebral cortex, alterations in WA, and FC, suggest that dual

stimulation optimizes neural efficiency and enhances task

specific neural activation. Notably, the observed reduction in FC

between the left and right premotor cortices points to a decrease

in compensatory neural mechanisms, potentially easing cogni

tive load in patients with MCI. In addition, increased activation

in the right posterior occipital cortex may indicate improved

sensory-cognitive integration.


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Conclusion:
These findings underscore the potential of TMS and tPBM as

noninvasive interventions for enhancing cognitive function and

delaying cognitive decline in older adults. Moreover, this study

represents the first to simultaneously apply both TMS and tPBM

in a combined neuromodulatory approach, providing important

evidence of their feasibility and safety when used together. 




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