Synergistic effects of repetitive transcranial magnetic stimulation and a dance movement intervention on mild cognitive impairment: study protocol for a four-arm factorial randomized controlled trial.

BACKGROUND: Mild Cognitive Impairment (MCI) represents a critical transitional stage between normal cognitive aging and dementia, characterized by a high conversion rate to Alzheimer's disease (AD). Current pharmacological interventions provide limited symptomatic relief and do not alter disease trajectory. Consequently, there is an urgent need for effective, multimodal, non-pharmacological interventions. While repetitive Transcranial Magnetic Stimulation (rTMS) and Dance Movement Intervention (DMI) individually show promise in mitigating cognitive decline, their combined synergistic effects in older adults remain uninvestigated. This protocol outlines a randomized controlled trial to evaluate the clinical efficacy of combining rTMS with a culturally tailored DMI (Chinese square dancing) for older adults with MCI.

METHODS: This study is designed as a four-arm, single-blinded, parallel-group randomized controlled trial. We aim to recruit 160 community-dwelling older adults (aged 50-85 years) diagnosed with MCI. Participants will be randomly allocated (1:1:1:1) to one of four groups: Combined Intervention (active rTMS + DMI), rTMS Only (active rTMS + social control), DMI Only (sham rTMS + DMI), or a Control Group (sham rTMS + social control). The 12-week intervention phase utilizes intermittent theta burst stimulation (iTBS) targeted at the left dorsolateral prefrontal cortex (DLPFC) and a structured Chinese square dancing program. Assessments occur at baseline, 12 weeks (post-intervention), and 24 weeks (follow-up). The primary outcome is global cognitive function, measured by the Montreal Cognitive Assessment (MoCA). Secondary outcomes assess memory, executive function, electroencephalography (EEG) biomarkers of neuroplasticity (P300), physical performance, and quality of life.

DISCUSSION: This factorial trial will comprehensively evaluate the individual and interactive effects of neuromodulation and physical-cognitive training. By hypothesizing that rTMS will effectively prime cortical excitability to maximize the benefits of the complex sensorimotor demands of DMI, this study aims to establish a scalable, evidence-based multimodal therapy to delay cognitive decline in aging populations.