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However, the strategy for target determination and the mechanisms for cognitive improvement remain unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred and thirteen elderly subjects were recruited in this study, including both cross\u2010sectional (<jats:italic>n<\/jats:italic>\u00a0=\u00a079) and longitudinal experiments (the rTMS group: <jats:italic>n<\/jats:italic>\u00a0=\u00a024; the sham group: <jats:italic>n<\/jats:italic>\u00a0=\u00a010). The cross\u2010sectional experiment explored the precise intervention target based on the cortical\u2013hippocampal network. The longitudinal experiment investigated the clinical efficacy of neuro\u2010navigated rTMS treatment over a four\u2010week period and explored its underlying neural mechanism using seed\u2010based and network\u2010based analysis. Finally, we applied connectome\u2010based predictive modeling to predict the rTMS response using these functional features at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>RTMS at a targeted site of the left angular gyrus (MNI: \u221245, \u221267, 38) significantly induced cognitive improvement in memory and language function (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The improved cognition correlated with the default mode network (DMN) subsystems. Furthermore, the connectivity patterns of DMN subsystems (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.52, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.01) or large\u2010scale networks (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.85, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001) at baseline significantly predicted the \u0394 language cognition after the rTMS treatment. The connectivity patterns of DMN subsystems (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.47, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.019) or large\u2010scale networks (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.80, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001) at baseline could predict the \u0394 memory cognition after the rTMS treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings suggest that neuro\u2010navigated rTMS targeting the left angular gyrus could improve cognitive function in AD patients. Importantly, dynamic regulation of the intra\u2010 and inter\u2010DMN at baseline may represent a potential predictor for favorable rTMS treatment response in patients with cognitive impairment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cns.14177","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T08:08:49Z","timestamp":1679386129000},"page":"2267-2280","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Multi\u2010networks connectivity at baseline predicts the clinical efficacy of left angular gyrus\u2010navigated rTMS in the spectrum of Alzheimer's disease: A sham\u2010controlled study"],"prefix":"10.1111","volume":"29","author":[{"given":"Hai\u2010Feng","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science Nanjing University  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