Enhancing memory and thinking in Mild Cognitive Impairment: An 18-week feasibility pilot study using brain stimulation and cognitive training in older adults

Computerised Cognitive Training (CCT) + Intermittent Theta Burst Stimulation (iTBS): Week 1 – Combined Delivery (In-Person): Over 5 consecutive weekdays, participants attend in-person sessions at Western Sydney University (NICM or Campbelltown campus). Each daily session is approximately 3 hours in total, comprising: iTBS: 5 sessions per day (10 minutes apart), targeting the left dorsolateral prefrontal cortex (DLPFC), for a total of 25 sessions (15,000 pulses). • Delivered using MagPro X100 or MagStim Super Rapid2 Plus1 stimulators. • Coil positioned with neuronavigation (Brainsight, BeamF3). • Stimulation parameters: 3 pulses at 50 Hz, repeated at 5 Hz, delivered in 2-second trains with 8-second inter-train intervals, at 75% resting motor threshold (RMT), adjusted daily. • Delivered by the chief investigator (an occupational therapist/neuroscientist with 1 year of intensive TMS training), under the ongoing supervision of a neuroscientist and TMS expert. • Rest: 20-minute rest period following iTBS. CCT (In-Person): 1-hour one-to-one session, delivered on a computer by the same occupational therapist (chief investigator) with extensive experience in cognitive training. • Format: Computer-based interactive tasks; one-on-one delivery with real-time guidance. • Example exercises from the iCog.X Boost program: visual memory grids, auditory memory tasks, divided attention dual-tasks, logical reasoning exercises, and problem-solving strategy exercises. These sessions focus on teaching participants cognitive strategies that will later be applied in the online training. • Adherence monitoring: Daily attendance checklists for both iTBS and CCT are maintained by the research team. Weeks 2–10 – CCT Only (Online): Participants continue the CCT intervention independently online for an additional 9 weeks. • Delivery: ~1 hour per week (9 sessions), via a secure, university-hosted platform (developed in Flask Python and hosted through pythonanywhere). • Training Content: Same training modules as in-person, ensuring continuity. The online mode includes interactive activities, instructional videos, images, and practice questions. Unlike the in-person sessions, these modules are self-paced, with automated feedback and performance adaptation. • Psychoeducation: Two small-group sessions (each ~2 hours: 90 minutes content + 30 minutes group discussion) are delivered via Zoom by a registered psychologist. These occur during the online training phase, specifically, one session in Week 5 and the second in Week 8 of the 10-week intervention period. Content includes videos, slides, interactive exercises, and collaborative discussion of cognitive strategies. • Home-Based Tasks: Weekly assignments encourage transfer of skills into daily life. Examples include: • Memory challenges (recall a shopping list or recipe ingredients without notes). • Strategy-based activities (chunking information when learning new material). • Reflection questions or short quizzes on strategy use. • Adherence Monitoring: Online session completion is automatically logged by the platform. Attendance at psychoeducation sessions is recorded, and reminders/support are provided via phone and email. Sham iTBS Condition: Participants receive the same cognitive training protocol as the active intervention group. Sham stimulation is delivered using the same figure-of-eight coil rotated 180°, which substantially reduces magnetic field penetration while preserving the auditory and tactile sensations of active stimulation. Sham iTBS is administered over 5 consecutive days (3 pulses at 50 Hz, repeated at 5 Hz, delivered in 2-second trains with 8-second inter-train intervals, 5 sessions/day for 5 days, total 25 sessions). This method maintains blinding integrity and has been validated in previous TMS trials.