# rTMS as a Cognitive Rehabilitation Approach in Veterans with Parkinson's Disease

> **NIH VA IK2** · EDWARD HINES JR VA HOSPITAL · 2022 · —

## Abstract

More than 100,000 US Veterans living with Parkinson's disease (PD) currently receive PD-related care and
services from the VA. In addition to motor complications, PD is characterized by progressive cognitive decline
leading to long-term functional impairment and diminished quality of life. Approximately 20-55% of PD
patients will develop mild cognitive impairment (PD-MCI) while up to 80% will develop dementia (PD-D).
Since PD-MCI is a risk factor for developing PD-D, there is a critical need to develop treatments to improve
cognition and slow or stop progression to PD-D. Limited treatment options for PD-MCI and PD-D and the
possible need to tailor treatments to Veterans makes this an important research topic. Repetitive transcranial
magnetic stimulation (rTMS) shows promise as an effective cognitive neurorehabilitation treatment. To date,
no rTMS studies have assessed the effect of rTMS on cognitive function in PD-MCI. Nor has there been PD
neurophysiological studies using rTMS to examine neural plasticity in cognitive neural networks. This CDA2
seeks to fill this gap by conducting a small scaled pilot randomized controlled trial (RCT) designed to assess the
safety and therapeutic effects of rTMS on cognitive outcomes as well as on brain connectivity in Veterans with
PD-MCI. PD-MCI participants will be randomized to either active rTMS or sham rTMS. Participants will
complete a standardized neurocognitive battery assessment at baseline, endpoint (immediately after the 24 day
intervention) and at a one month follow-up. The primary outcome is change in executive function. Secondary
outcomes include performance on other cognitive domain tasks and a proximal measure of real-life function
that captures relevant functional changes related to cognitive impairment in PD. Multi-modal neuroimaging, in
a subsample of participants, will be used to study neural connectivity changes induced by rTMS. Changes in
resting state functional connectivity, grey matter volume via voxel-based morphometry and white matter
integrity via diffusion tensor imaging will be assessed at baseline and endpoint. To inform how to optimize
rTMS treatment in PD-MCI, these changes will be correlated with changes in cognitive performance. Dr.
Kletzel is an excellent candidate for a CDA2. She has been building a strong foundation for establishing a career
as a VA clinical neuroscientist in the field of neurorehabilitation. Her preclinical neuroscience background
combined with her post-doctoral and CDA1 clinical research training makes her uniquely suited to successfully
address the research objectives. Dr. Kletzel's long-term career goal is to develop and optimize cognitive
rehabilitation treatments for Veterans with PD so as to improve their function and quality of life. Her
immediate career goals are to conduct her first small clinical RCT and use these data both to contribute to the
field of neurocognitive rehabilitation as well as to secure a VA Merit grant as an independent investig...

## Key facts

- **NIH application ID:** 10454831
- **Project number:** 5IK2RX002938-04
- **Recipient organization:** EDWARD HINES JR VA HOSPITAL
- **Principal Investigator:** Sandra Lynn Kletzel
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-06-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10454831

## Citation

> US National Institutes of Health, RePORTER application 10454831, rTMS as a Cognitive Rehabilitation Approach in Veterans with Parkinson's Disease (5IK2RX002938-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10454831. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*