Personalized Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: Impact of Cognitive Flexibility on Treatment Outcomes
Personalized Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: Impact of Cognitive Flexibility on Treatment Outcomes

Summary/Abstract: This systematic review evaluates the current evidence on the relationship between cognitive flexibility and transcranial magnetic stimulation (TMS) efficacy in Obsessive-compulsive disorder (OCD). Specifically, the potential of cognitive flexibility to serve as a neuropsychological marker capable of predicting treatment response and the potential of personalized TMS protocols developed on this basis to enhance therapeutic efficacy were investigated. A comprehensive search of PubMed, Scopus, and Google Scholar was conducted to identify clinical trials and observational studies examining both cognitive flexibility and response to TMS. Studies utilizing standardized neuropsychological measures such as the Wisconsin Card Sorting Test, Trail Making Test, and Verbal Fluency tasks were included. Results suggest that cognitive flexibility may play a moderating role in treatment outcomes, with about half of the reviewed studies reporting a positive association between higher cognitive flexibility and improved TMS response. Nevertheless, discrepancies across studies—particularly in assessment tools and stimulation protocols—limit the ability to draw firm conclusions. In conclusion, cognitive flexibility appears to be a potentially important factor in enhancing the effectiveness of TMS for OCD.

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