Inclusion Criteria:

• Age range 55-90 years.
• Must speak English fluently.
• Diagnosis of MCI as defined by:
  • Clinical diagnosis by a neurologist;
  • Neuropsychological testing support of MCI;
  • Meet criteria for MCI (53):
    • Subjective cognitive decline reported by participant and/or an informant;
    • Objective impairment in one or more cognitive domains for age;
    • Essentially preserved general cognitive function;
    • Largely intact functional activities;
    • Does not meet criteria for dementia as judged by a clinician.
• Eligible for transcranial magnetic stimulation (TMS) based on safety criteria.
• Clinical Dementia Rating = 0.5.
• Geriatric Depression Scale score less than 6.
• Medically stable and in good general health.
• Not pregnant, lactating, or of childbearing potential.
• Stable medication regimen for at least 4 weeks prior to baseline visit.
• Adequate visual and auditory abilities to complete neuropsychological testing.
• Ability to provide informed consent.
• Have a care partner who is available to accompany the participant to study visits for the duration of the protocol.

Exclusion Criteria:

• Inability to communicate in the English language.
• Meet criteria for dementia.
• Contraindications to TMS or MRI, including patients who have:
  • conductive, ferromagnetic or other magnetic-sensitive metals implanted in their head or within 30 cm of the treatment coil (e.g., cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils, stents, bullet fragments or jewelry);
  • active or inactive implants, including deep brain stimulators, cochlear implants, vagus nerve stimulators or implanted device leads.
• Any true positive findings on the TMS safety screening form.
• Prior exposure to TMS, electroconvulsive therapy (ECT), or any neurostimulation within the past 12 months.
• History of epilepsy or seizures.
• Medical conditions or use of medications that increase risk of seizures:
  • History of traumatic brain injury;
  • History of intracranial mass or lesion;
  • History of stroke, including hemorrhagic stroke and ischemic stroke.
• Psychiatric disorders:
  • Primary psychotic disorder (schizophrenia, schizoaffective, or schizophreniform disorder), any history;
  • Primary mood disorder (major depressive disorder, bipolar disorder) within the past 12 months
  • Substance use disorder (except caffeine and nicotine) within the past 12 months.
• Active symptoms of depression, anxiety, mania, psychosis, or substance use (except caffeine and nicotine) within the past year:
  • Active symptoms of depression will be identified based on geriatric depression scale ≥ 6;
  • Other active symptoms of psychiatric conditions to be determined by study investigators.
• Sleep disorders that are considered clinically significant and not sufficiently treated by the investigative team, including untreated obstructive sleep apnea, untreated/ suboptimally treated REM sleep behavior disorder, untreated/ suboptimally treated restless legs syndrome.
• Pregnancy or suspected pregnancy.
• Participation in another concurrent interventional clinical trial.
• Any unstable medical condition.
• Inability to provide informed consent.
• Inability to adhere to the protocol.

Note: Other protocol defined Inclusion/Exclusion Criteria may apply.

Eligibility last updated 12/27/23. Questions regarding updates should be directed to the study team contact.