STUDY PROTOCOL article
Front. Hum. Neurosci.
Sec. Brain Health and Clinical Neuroscience
This article is part of the Research TopicWomen In Brain Health and Clinical Neuroscience III: 2025View all 4 articles
Exploring cortical excitability modulation to promote cognitive resilience in aging: an rTMS study protocol
Provisionally accepted
Chiara Di Fazio1,2
Eugenio Scaliti3
Mario Stanziano4,5
Anna Nigri4
Greta Demichelis4
Marco Tamietto1,6,7
Sara Palermo1,4,7*- 1Department of Psychology, University of Turin, Turin, Italy
- 2International School of Advanced Studies, University of Camerino, Camerino, Italy, Camerino, Italy
- 3Human Science and Technologies, University of Turin, Italy, Torino, Italy
- 4Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- 5Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini, Turin, Italy
- 6Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, Tilburg, AB5037, Netherlands, Tilburg, Netherlands
- 7Neuroscience Institute of Turin (NIT), Turin, Italy, Torino, Italy
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Promoting cognitive resilience in aging is essential for preserving autonomy and quality of life. Non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), have shown promise in enhancing neuroplasticity and cognitive functioning in older adults. This study protocol outlines the methodological framework for an investigation designed to examine whether high-frequency rTMS applied over the left dorsolateral prefrontal cortex (DLPFC) can modulate cortical excitability (CE) and characterize changes in cognitive and emotional functioning in healthy older individuals. The protocol provides detailed descriptions of stimulation parameters, safety monitoring procedures, and assessment tools. Cortical excitability will be measured using transcranial magnetic stimulation–derived motor-evoked potentials (MEPs), while cognitive and emotional outcomes will be assessed with a comprehensive neuropsychological battery. A preliminary feasibility phase with four participants was conducted to refine procedures and assess tolerability, safety, and data acquisition reliability. The study aims to determine the feasibility and signal characterization of cortical excitability modulation within a crossover framework and to explore the potential relationship between CE modulation and behavioral outcomes. Observations from this pilot phase will inform procedural refinement and the design of a larger ongoing trial.
Keywords: Brain ageing, Cognitive resilience, cortical excitability, dorsolateral prefrontal cortex (DLPFC), high-frequency repetitive TMS, neuroplasticity, Quality of Life, repetitive transcranial magnetic stimulation (rTMS)
Received: 10 Nov 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 Di Fazio, Scaliti, Stanziano, Nigri, Demichelis, Tamietto and Palermo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sara Palermo
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