Interventions in inhibitory control among military cadets via repetitive transcranial magnetic stimulation combined with working memory training

QIN Yilong; WEN Zhihong; XI Yuanhang; YANG Lin; WANG Hang; DAI Jing; WANG Chunchen; LIU Yang; GAO Zhijun; CAO Xinsheng

doi:10.3969/j.issn.2097-1753.2025.04.020

Abstract：Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) combined with working memory training strategy on enhancing inhibitory control in military academy students. Methods Forty-eight male students from the Department of Aerospace Medicine at Air Force Medical University who met the criteria in a pre-trial cognitive ability training were enrolled between November and December 2024. They were randomly divided into four groups: combination group, single rTMS group, single training group, and control group, with 12 participants in each group. The rTMS group received a two-week intervention with three sessions per week; the combination group received working memory training after the rTMS intervention; the training group only performed working memory training during the trial period; and the control group received sham stimulation. The improvement in inhibitory control performance, including reaction time and accuracy, was analyzed before and after the intervention in all four groups. Results The stop-signal task (SST) results showed that after the intervention, the stop-signal reaction time (SSRT) of the single rTMS group, single training group, and combination group were all lower than that of the control group (P < 0.001, P = 0.033, P < 0.001, respectively). The SSRT of the single rTMS group and single training group were higher than that of the combination group (both P < 0.001). The differences in SSRT before and after the intervention were statistically significant in the single rTMS group, single training group, and combination group (all P < 0.05). The error rate of the combination group after the intervention was lower than that of the control group (P = 0.014), and both the single rTMS group and combination group had lower inhibition error rates after the intervention compared to before (both P < 0.001). The Stroop task results showed that the differences in Stroop reaction time before and after the intervention were statistically significant across all four groups (Wald χ² time = 5.505, P time = 0.019). After the intervention, the Stroop inhibition error rates of the single rTMS group and combination group were both lower than those of the control group (both P < 0.001). Compared to the single training group, the Stroop inhibition error rate of the combination group was significantly reduced (P < 0.001). The differences in Stroop inhibition error rates before and after the intervention were statistically significant in both the combination group and the single rTMS group (P < 0.001 and P = 0.002, respectively). Conclusion rTMS stimulation of the left DLPFC has a positive effect on inhibitory control function, and combining it with working memory training produces a synergistic effect.