{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:30:08Z","timestamp":1789047008462,"version":"build-2803163510"},"reference-count":55,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High\u2010frequency repetitive transcranial magnetic stimulation (HF\u2010rTMS) is a promising intervention for cognitive impairment across neuropsychiatric disorders. However, existing evidence remains fragmented within disease\u2010specific reviews, lacking cross\u2010disorder synthesis and rigorous evaluation of evidence certainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This umbrella review systematically evaluates the efficacy of HF\u2010rTMS on cognitive function across six neuropsychiatric disorders with sufficient meta\u2010analytic evidence on cognitive outcomes, including Alzheimer's disease, vascular cognitive impairment, Parkinson's disease, schizophrenia spectrum disorders, major depressive disorder, and attention\u2010deficit\/hyperactivity disorder\u2014and assesses the certainty of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched CNKI, Cochrane Library, Embase, PubMed, and Web of Science from inception to March 1, 2026, for systematic reviews or meta\u2010analyses reporting cognitive outcomes. Re\u2010meta\u2010analyses were performed using a random\u2010effects model to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was appraised via AMSTAR\u20102, and evidence certainty was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The corrected covered area (CCA) was calculated to quantify overlap of primary studies across reviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010nine meta\u2010analyses comprising 54 outcome indicators met the inclusion criteria. Pooled analysis indicated that HF\u2010rTMS significantly improved global cognitive function (SMD = 0.68, 95% CI: 0.53\u20130.83, p &lt; 0.001), though with substantial heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 88.5%). Subgroup analyses highlighted distinct disease\u2010specific effects: the most robust benefits were observed in Alzheimer's disease (SMD = 0.91) and vascular cognitive impairment (VCI) (SMD = 0.81). We found small\u2010to\u2010moderate effects in schizophrenia spectrum disorders (SSD) and Attention\u2010Deficit\/Hyperactivity Disorder (ADHD), but no significant improvements for Parkinson's disease or major depressive disorder. Domain\u2010specific analyses showed that VCI patients benefited across attention, memory, and executive function, whereas SSD patients primarily improved in memory and executive domains. While sensitivity analyses and publication bias adjustments slightly attenuated effect sizes, the overall conclusions remained stable. Notably, the GRADE assessment revealed a paucity of high\u2010quality evidence (1.9%), with 40.7% of outcomes rated as very low quality, largely due to inconsistency (substantial unexplained heterogeneity,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      &gt; 50%), risk of bias (methodological limitations including lack of protocol registration and inadequate assessment of primary study bias), and imprecision (wide confidence intervals crossing the null). Overlap across reviews was low (CCA = 4.08%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HF\u2010rTMS appears to provide consistent cognitive benefits in Alzheimer's disease and VCI, whereas its efficacy in other neuropsychiatric disorders remains uncertain. Given the low certainty of evidence and substantial heterogeneity, findings should be interpreted with caution. Future large\u2010scale, multicenter randomized controlled trials with standardized protocols are needed to confirm efficacy and support clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71695","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:49:59Z","timestamp":1787032199000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Evidence Certainty of High\u2010Frequency rTMS for Cognitive Impairment Across Neuropsychiatric Disorders: An Umbrella Review"],"prefix":"10.1002","volume":"16","author":[{"given":"Lin\u2010ling","family":"Wu","sequence":"first","affiliation":[{"name":"Unit 2\u2014Department of Female Acute Psychiatry Disorders The Fourth People's Hospital of Chengdu  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin\u2010cheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology The Fourth People's Hospital of Chengdu  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan\u2010juan","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology The Fourth People's Hospital of Chengdu  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei\u2010yuan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Health Management Center, Sichuan Provincial People's Hospital, School of Medicine University of Electronic Science and Technology of China  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2017.27"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000055"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10020\u2010021\u201000284\u20105"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072\u2010023\u201006779\u20109"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0000000000002377"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010023\u201005261\u20102"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.28888"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2021.01.022"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.01.014"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2023.1177594"},{"issue":"9","key":"e_1_2_12_12_1","first-page":"3","article-title":"Cognitive Impairment and Functional Outcome in Schizophrenia and Bipolar Disorder","volume":"67","author":"Green M. F.","year":"2006","journal-title":"Journal of Clinical Psychiatry"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/00207454.2020.1809394"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072\u2010024\u201007709\u2010z"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2015.04.016"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380\u2010022\u201001524\u20108"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.034"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102753.2008.00986.x"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13859"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2020.593000"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883\u2010020\u201001953\u20104"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00135"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968317712468"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.75194"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2019.11.002"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)01296\u20100"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(20)30367\u20106"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prdoa.2026.100422"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1021\/acschemneuro.2c00420"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11065\u2010016\u20109325\u20101"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5974"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2024.102278"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.11.007"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1159\/000535665"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4008"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2022.09.010"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2021.101499"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984\u2010025\u201001777\u20108"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1252900"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1377257"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0000000000000464"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010019\u201009644\u2010y"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1374395"},{"issue":"7","key":"e_1_2_12_46_1","first-page":"931","article-title":"Efficacy of Transcranial Magnetic Stimulation on Cognitive Function and Behavioral and Psychological Symptoms of Dementia in Patients With Alzheimer's Disease: A Meta\u2010Analysis","volume":"41","author":"Wang Y.","year":"2021","journal-title":"Journal of Shanghai Jiao Tong University (Medical Science)"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12984\u2010025\u201001566\u20103"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072\u2010023\u201007072\u20105"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2022.2155515"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci13121665"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nicl.2022.102977"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2022.984708"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883\u2010025\u201004292\u20104"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1424792"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108415"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883\u2010024\u201003726\u20109"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71695","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/brb3.71695","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:03:08Z","timestamp":1789045388000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.71695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":55,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/brb3.71695"],"URL":"https:\/\/doi.org\/10.1002\/brb3.71695","archive":["Portico"],"relation":{},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-04-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71695"}}