REVIEW OF: Koch G et al, Alzheimers Res Ther 2025;17(1):69

STUDY TYPE: RCT
The precuneus, a region in the superior parietal lobe involved in memory and self-awareness, is among the first areas to show degeneration in Alzheimer’s disease (AD). This study tested whether repetitive transcranial magnetic stimulation targeting the precuneus (PC-rTMS) could help slow decline in mild to moderate AD.

Forty-eight patients received either neuronavigated PC-rTMS or sham treatment for 52 weeks (a 2-week intensive course followed by weekly maintenance). The primary outcome, Clinical Dementia Rating Scale–Sum of Boxes (CDR-SB), showed slower decline with PC-rTMS (1.36 vs 2.45). Functional decline showed the strongest effect: ADCS-ADL declined by only 1.5 points with PC-rTMS vs -11.6 with sham. Cognitive measures (ADAS-Cog, MMSE) and behavioral symptoms (NPI) also favored PC-rTMS, though MMSE did not reach statistical significance. The treatment was well tolerated, with only mild headaches and scalp discomfort.

Carlat Take
This is the first long-term study to show that targeting the precuneus with rTMS may preserve both cognition and daily function in early AD. The sample was small, but the results are promising and suggest a noninvasive option may be emerging. While this treatment is not ready for routine clinical use, the findings suggest TMS could eventually complement medications to preserve function and reduce caregiver burden in AD.